Snapshot A 45-year-old man comes into urgent care for several months of lumps on his neck. Since he has not had any fevers or pain, he had ignored the lumps and had not sought treatment. He states that he has had multiple dental procedures but no other surgeries. On physical exam, he has multiple dental caries and 2 large, nontender masses under his chin. Yellow pus drains from these masses. He is counseled on oral hygiene and given antibiotics. Introduction Classification Actinomyces israelii an anaerobic, branching, filamentous gram + rod produces yellow, sulfur-colored granules transmission direct contact with bacteria Epidemiology demographics male > female location most commonly affects the face and neck may also cause pelvic inflammatory disease risk factors poor oral hygiene dental caries dental extraction or procedure dental trauma intrauterine device (IUD) Pathogenesis anaerobic environment in abscess cavities allow the bacteria to flourish Associated conditions cervicofacial actinomycosis Prognosis slowly progresses over weeks to months may relapse even after treatment Presentation Symptoms mass on the face or neck Physical exam may have a fever facial actinomycosis nontender and indurated mass sinut tracts may drain thick yellow pus pus may contain sulfur granules cervicoactinomycosis may have draining yellow pus from cervical orifice Studies Labs tissue biopsy, culture, or pap smear gram + branching rods not acid-fast microscopy of draining pus yellow granules filled with bacteria Making the diagnosis most cases are clinically diagnosed Differential Nocardiosis distinguishing factors weakly acid fast and aerobic branching filamentous gram + rod primarily causes pulmonary infections that can spread to central nervous system SNAP = Sulfa for Nocardia; Actinomyces use Penicillin Treatment Conservative improved oral hygiene indication all patients Medical penicillin all patients tetracyclines indications penicillin allergy Operative surgical drainage or excision indication all patients along with antibiotics Complications Fistula formation Scarring