Paediatric actinomycosis: a 16-year, single-institution retrospective review of cases

• Main Authors: Chew, Siu-Jun, Low, Kelly B. B., Chong, Chia Yin, Maiwald, Matthias, Thoon, Koh Cheng, Ong, Rina Y. L., Yung, Chee Fu, Li, Jiahui, Nadua, Karen Donceras, Kam, Kai-Qian, Tan, Henry K. K., Lian, Derrick W. Q., Tan, Leon Y. R., Tan, Natalie Woon Hui
• Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
• Format: Article
• Language: English
• Published: 2024
• Subjects: Medicine, Health and Life Sciences; Abscess; Actinomycosis
• Online Access: https://hdl.handle.net/10356/174555
• Institution: Nanyang Technological University

Aim: 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. Methods: 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. Results: 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. Conclusions: 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.