Cervicofacial Manifestation and Clinical Significance of Actinomyces Israelii

Actinomyces israelii is a common organism of the oropharynx and may cause infection when it is introduced to the deeper tissue sites following soft tissue trauma. Around 50% of actinomycosis cases occur in the oral and maxillofacial areas and may cause failure of dental implants. Other parts of the body, such as the respiratory system and the abdomen, may also be affected. Actinomycosis has mostly been misdiagnosed as malignant rather than an infectious disease due to its variable clinical presentation. Actinomyces lesions contain clusters of neutrophils, plasma, and multinucleated giant cells with macrophages and foamy cytoplasm. These clusters (1-2 mm diameter) discharge a yellowish exudate of aggregates of organisms and calcium phosphate throughout sinus tracts known as “sulfur granules”. Because of its similarity to other infectious and inflammatory diseases, diagnosis of actinomycosis is challenging, and tissue biopsy and histopathology remain the gold standard for its diagnosis. Management is achieved with long-term pharmacological and surgical intervention, with a promising success rate if commenced at an early stage. In this review, we aimed to provide a deep insight into the different aspects of Actinomyces israelii infection of oral and non-oral involvement.