Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore.
Infectious Disease Service, Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore.
J Paediatr Child Health. 2023 Jun;59(6):833-839. doi: 10.1111/jpc.16400. Epub 2023 Apr 5.
Actinomycosis is a rare subacute to chronic granulomatous infection which can mimic other infectious or malignant diseases. This study examined the epidemiology and treatment outcome of actinomycosis in children.
A retrospective study on children admitted for actinomycosis in a tertiary paediatric hospital in Singapore, from January 2004 to December 2020. Clinical profile, therapeutic interventions and outcomes were examined.
A total of 10 patients were identified; 7 were female. The median age at first presentation was 9.8 years (range 4.7-15.7). The most common presenting symptom was fever (n = 6, 60%), followed by facial or neck swelling (n = 3, 30%) and ear pain (n = 3, 30%). Actinomycosis occurred predominantly in the orocervicofacial region (n = 6, 60%). Four patients (40%) had preceding dental infections in the form of dental caries or gingivitis. One patient had poorly controlled insulin-dependent diabetes mellitus. Actinomycosis was confirmed via culture in four patients, histopathology in four patients and both methods in two patients. All except one patient (n = 9, 90%) underwent surgical procedures. All patients received ampicillin or amoxicillin/clavulanate or other beta-lactams, for a median duration of 6.5 months (range 1.5-14). Complications included osteomyelitis (n = 4, 40%), mastoiditis (n = 2, 20%), brain abscess (n = 1, 10%) and recurrent neck abscess (n = 1, 10%). There was no mortality and all patients achieved complete resolution.
Paediatric actinomycosis was rare in our 16-year review, but had a high complication rate. It can occur in immunocompetent patients, and dental infection was the predominant risk factor identified. Prognosis was excellent after surgical intervention and appropriate antimicrobial therapy.
放线菌病是一种罕见的亚急性至慢性肉芽肿性感染，可模仿其他传染性或恶性疾病。本研究探讨了儿童放线菌病的流行病学和治疗结果。
对 2004 年 1 月至 2020 年 12 月在新加坡一家三级儿科医院就诊的放线菌病患儿进行回顾性研究。检查了临床特征、治疗干预措施和结果。
共确定了 10 名患者；7 名女性。首次就诊时的中位年龄为 9.8 岁（范围为 4.7-15.7）。最常见的首发症状是发热（n=6，60%），其次是面部或颈部肿胀（n=3，30%）和耳痛（n=3，30%）。放线菌病主要发生在口咽面颈部（n=6，60%）。4 名患者（40%）有龋齿或牙龈炎等先前的牙科感染。1 名患者患有未控制的胰岛素依赖型糖尿病。4 名患者（40%）通过培养、4 名患者通过组织病理学和 2 名患者通过两种方法确认放线菌病。除 1 名患者（n=9，90%）外，所有患者均接受手术治疗。所有患者均接受氨苄西林或阿莫西林/克拉维酸或其他β-内酰胺类药物治疗，中位疗程为 6.5 个月（范围 1.5-14）。并发症包括骨髓炎（n=4，40%）、乳突炎（n=2，20%）、脑脓肿（n=1，10%）和颈部脓肿复发（n=1，10%）。无死亡病例，所有患者均完全缓解。
在我们 16 年的回顾中，儿科放线菌病很少见，但并发症发生率很高。它可发生于免疫功能正常的患者，且牙科感染是确定的主要危险因素。经手术干预和适当的抗菌治疗后，预后良好。
