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Cervicofacial Actinomycosis

Last updated March 8, 2021

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Actinomycosis is a rare and chronic infection, caused predominantly by the bacterium. Cervicofacial Actinomycosis is the most common type of actinomycosis, occurring in over half of the reported cases. It involves the jaw, mouth, and neck, and is also known as Oral Cervicofacial Actinomycosis.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Lumpy (Big) Jaw Syndrome
  • Oral Cervicofacial Actinomycosis

What is Cervicofacial Actinomycosis? (Definition/Background Information)

  • Actinomycosis is a rare and chronic infection, caused predominantly by the bacterium Actinomyces israelii and to a lesser extent by other Actinomyces species
  • They exist naturally in the mucous lining of the nose, throat, mouth, digestive tract, and female reproductive tract, and are not normally harmful. These anaerobic bacteria have the ability to grow in the absence of oxygen, or in reduced concentrations of oxygen
  • However, any injury, trauma, or surgical procedure can cause the bacterial cells to enter deeper tissues, where they are not normally found. Since these bacteria can grow without oxygen, they can thrive in such environments, resulting in infection
  • Cervicofacial Actinomycosis is the most common type of actinomycosis, occurring in over half of the reported cases. It involves the jaw, mouth, and neck, and is also known as Oral Cervicofacial Actinomycosis
  • The condition is reported worldwide in all age groups. However, adult men are reportedly more susceptible to this infection when compared to women and children
  • Poor dental hygiene, injury to the jaw, or dental procedures may allow entry of the bacteria into deep tissue, where they proliferate in low oxygen conditions to cause the infection
  • The bacteria are slow-growing and the infection leads to the formation of hard, red or purple pus-filled abscess in the affected tissue. The abscess may drain and this can be accompanied by pain and fever
  • Analysis of pus under the microscope to check for “sulfur granules”, culture of organisms from pus or tissue sample, and imaging of abscesses may all be employed towards establishing the diagnosis of Cervicofacial Actinomycosis
  • With prompt diagnosis and sustained treatment with antibiotics, actinomycosis is curable. However, if the infection becomes generalized via spread of bacteria through the bloodstream, it can spread to other organs and tissues. In such cases, the recovery can be prolonged

Who gets Cervicofacial Actinomycosis? (Age and Sex Distribution)

  • Cervicofacial Actinomycosis is a rare bacterial infection reported worldwide. However, this form of actinomycosis is the most common one, constituting approximately 50-70% of all cases
  • Adults are more susceptible to Cervicofacial Actinomycosis when compared to children
  • Both male and female genders are affected, although the infection is more common in males

What are the Risk Factors for Cervicofacial Actinomycosis? (Predisposing Factors)

The following are some known risk factors for Cervicofacial Actinomycosis:

  • Poor dental hygiene; having undergone dental work recently
  • Male gender
  • Mandibular (jaw) injuries
  • Malnutrition
  • Diabetes mellitus
  • Alcoholism
  • Compromised immunity owing to HIV/AIDS, organ transplantation, chemotherapy or radiation therapy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cervicofacial Actinomycosis? (Etiology)

Cervicofacial Actinomycosis is caused by anaerobic bacteria, belonging to the family Actinomycetaceae. These bacteria are gram-positive and can survive in very low concentrations of oxygen. The following are some bacterial species known to cause actinomycosis:

  • Actinomyces israelii, which is responsible for majority of infections
  • Actinomyces gerencseriae
  • Actinomyces viscosus
  • Actinomyces meyeri
  • Actinomyces naeslundii

Under normal circumstances, the bacteria are present in the mucous lining of the mouth, throat, digestive system, and the female reproductive tract, without causing harm.

However, when the lining gets damaged owing to poor dental hygiene, injury to the jaw, or dental procedure/surgery, 

  • However, when the mucous lining gets damaged owing to numerous factors, such as poor dental hygiene, injury to the jaw, dental procedures or surgery, the bacteria enter the inner/deeper tissues
  • Being anaerobic, they can survive and multiply in the low oxygen conditions of deep tissue, causing the development of scar tissue and fistula (or abnormal tracts)
  • Abscess formation can take place with the accumulation of pus, which may drain when the tracts reach the surface of skin. This process may take months to years

When the bacteria get into the bloodstream from an infected tissue, they can travel to other organs and cause generalized infection. The following are some organs that may be affected:

  • Spine and brain
  • Liver
  • Heart and heart valves
  • Kidneys
  • Liver
  • Female reproductive organs

Note: Cervicofacial Actinomycosis is not a contagious infection, since the anaerobic bacteria are unable to survive outside the human body.

What are the Signs and Symptoms of Cervicofacial Actinomycosis?

The signs and symptoms of Cervicofacial Actinomycosis may vary depending on the severity of infection. The following are some known symptoms:

  • Swelling of the mouth, face, jaw, and neck region: These swellings may be small and hard. The synonym “Lumpy Jaw Syndrome” arises from swellings in the jaw, giving the jaw an uneven or lumpy appearance
  • Pain in the swollen areas
  • Abscesses in the mouth
  • Pus leaking out of lesions in the skin, near the infected sites
  • Sulfur granules released in the pus (round, yellow granules): These granules do not actually contain sulfur, but are named so, because of their characteristic appearance

How is Cervicofacial Actinomycosis Diagnosed?

Cervicofacial Actinomycosis is diagnosed on the basis of the following test and exams:

  • A thorough physical examination and assessment of symptoms
  • Evaluation of the affected individual’s medical history
  • Microscopic observation of pus or tissue samples, to check for the presence of sulfur granules. The tissue samples may have to be obtained surgically
  • Culture of fluid or tissue from infected area: These bacteria are slow to grow in culture, and it may take over 3 weeks to obtain a (positive) culture result
  • X-ray or computed tomography (CT) imaging to ascertain location and number of abscesses, as well as differentiate inflammatory masses due to infection from the tumors

Note: Cervicofacial Actinomycosis may mimic some malignant conditions, and therefore, ruling-out other health conditions may often be necessary to arrive at a final diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cervicofacial Actinomycosis?

The following potential complications can arise in individuals with Cervicofacial Actinomycosis:

  • Formation of large lesions
  • Disfigurement of the facial region
  • The infection spreading to other organs away from the primary site of infection
  • Meningitis or inflammation of the meninges (outer membrane covering of brain)
  • Pneumonia
  • Jaundice

How is Cervicofacial Actinomycosis Treated?

The treatment for Cervicofacial Actinomycosis may include:

  • Prolonged use of antibiotics (anywhere from 2 months to over 12 months); typically, β-lactam (such as penicillin, amoxicillin) or tetracycline family of antibiotics are used
  • Surgical drainage of abscess; draining the abscess by inserting a needle
  • Surgical removal of infected tissue:
    • Surgery is sometimes necessary for cases in which large abscesses have developed, the infection has spread to organs and bones, and antibiotics alone are unsatisfactory
    • Surgery creates an aerobic environment, which is detrimental to bacterial growth. It also allows for the excision of lesions, drainage of sinuses, as well as containment and elimination of the disease
  • Hyperbaric oxygen therapy to eliminate the bacteria
    • This therapy helps increase the concentration of oxygen in the infected tissues
    • The presence of oxygen results in higher amounts of oxygen-derived radicals that harm, and are specifically drawn to anaerobic organisms, such as Actinomyces
    • This method has only been approved as an adjunct to other forms of treatment

How can Cervicofacial Actinomycosis be Prevented?

The following tips may be helpful in the prevention of Cervicofacial Actinomycosis:

  • Practicing proper dental hygiene: Maintaining proper dental hygiene always, and particularly, following a dental procedure, surgery, or tooth extraction
  • Educating oneself or monitoring self for any signs of discomfort following a surgery, and promptly reporting to the attending healthcare provider, so that infections may be detected early and treated appropriately

Completing the full course of prescribed antibiotics regimen, to eliminate the infection causing bacteria from deep tissue, as well as to prevent relapse of infection and development of drug-resistant bacterial species.

What is the Prognosis of Cervicofacial Actinomycosis? (Outcomes/Resolutions)

The prognosis of Cervicofacial Actinomycosis is determined by the overall health of the affected individual.

  • The outcome is excellent if the infection is diagnosed early and treated promptly
  • The prognosis may be influenced by any pre-existing medical conditions and/or compromised immunity
  • Additionally, a lack of treatment may allow the infection to spread to other organs and tissues, which may prolong the treatment and recovery process

Additional and Relevant Useful Information for Cervicofacial Actinomycosis:

Actinomycosis commonly occurs in animals (mostly cattle) and rarely in humans. In cattle, the bacteria target areas around the head, especially the jaw, which gives rise to the name “big/lumpy jaw”.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 6, 2017
Last updated: March 8, 2021