Cervicofacial actinomycosis in children.

Actinomycotic infections, once common in humans and cattle, are now rare causes of disease in man. This general group of organisms belongs taxonomically between the true bacteria and the fungi; however, the organisms behave clinically like true anaerobes. The organism, although phagocytized by the host cells, is not killed. Therefore, it is defined as a facultative intracellular parasite of the host. The protean manifestations of actinomycotic infections often mimic infectious processes, such as osteomyelitis or granulomatous disease, as well as neoplasia. It is therefore important for the surgeon to include actinomycosis in the differential diagnosis of cervicofacial masses in children as well as in adults. Being an anaerobe, the organism is difficult to culture and the diagnosis must be considered at the time of biopsy of a cervicofacial mass or when culturing a sinus tract. A case of a 12-year-old girl seen at Children's Hospital of Los Angeles prompted the review of our experience with this disease. In this child, actinomycosis presented as an expansile mass in the mandible. From 1956 to 1986, five children were treated for cervicofacial actinomycosis. Detailed case analysis, pathophysiology, clinical characteristics, and current treatment recommendations are presented.