Objective
To report a case of vocal cord actinomycosis and provide a systematic review of the literature to provide a reference for its diagnosis and management.
Review methods
Relevant cases from a PubMed search were reviewed for age/gender, risk factors, clinical manifestations, and treatment.
Results
Thirty-two cases of laryngeal actinomycosis have been reported in the literature. Most (80%) cases presented in patient with known risk factors. The majority presented with dysphonia (61.5%). Thirteen (58.3%) involved the true vocal cords. Penicillin based therapy was treatment of choice.
Conclusion
A structured assessment revealed 32 cases of laryngeal actinomycosis in the literature. Actinomycosis should be considered on the differential, even in healthy individuals with symptoms of laryngeal impairment.
Variable | n | % |
Age (n=30) | ||
Average age | 53.7 | |
Oldest | 77 | |
Youngest | 14 | |
Sex (n=30) | ||
Males | 26 | 86.70% |
Females | 4 | 13.30% |
Risk factors (n=30) | ||
Radiotherapy | 8 | 26.70% |
None | 6 | 20.00% |
Immunocompromised | 6 | 20.00% |
Chronic steroid use | 2 | 6.70% |
Chemotherapy | 2 | 6.70% |
Leukemia | 1 | 3.30% |
HIV | 1 | 3.30% |
Oropharyngeal trauma | 5 | 16.70% |
Airway dilation | 2 | 6.70% |
Tooth extraction | 1 | 3.30% |
Prolonged intubation | 1 | 3.30% |
Recent laryngeal surgery | 1 | 3.30% |
Concurrent laryngeal carcinoma | 3 | 10.00% |
Concurrent secondary actinomycosis infection | 2 | 6.70% |
Diabetes | 2 | 6.70% |
Environmental exposure | 1 | 3.30% |
Site of involvement (n=27) | ||
Cricoid region | 3 | 11.10% |
Anterior commissure | 4 | 16.70% |
Aryepiglottal fold | 4 | 16.70% |
Epiglottis | 3 | 12.50% |
Posterior commissure | 1 | 4.20% |
Pyriform sinus | 3 | 12.50% |
Subglottic region | 1 | 4.20% |
Thyroid cartilage | 1 | 4.20% |
Vestibular fold | 5 | 20.80% |
Vocal cord | 14 | 58.30% |
Clinical presentation (n=29) | ||
Dyspnea | 5 | 17.20% |
Cough | 3 | 11.50% |
Dysphagia | 9 | 34.60% |
Dysphonia | 16 | 61.50% |
Edema of ear | 1 | 3.80% |
Fever | 1 | 3.80% |
Odynophagia | 3 | 11.50% |
Pharyngitis | 5 | 19.20% |
Stridor | 3 | 11.50% |
Weight loss | 5 | 19.20% |
Author | Age | Gender | Risk Factors | Site of Involvement | Clinical Presentation | Treatment |
Lensing F, et al. [8] | 24 | M | Oropharyngeal trauma: airway dilation | Cricoid cartilage and adjacent fat pad | Acute dyspnea and laryngeal pain 2 days after recent airway dilation | IV penicillin 6 weeks |
Patel S, et al. [9] | 74 | M | Immunocompromised (neutropenia secondary to chemotherapy) | Vocal cord and Vestibular fold | Odynophagia and dysphagia | Ciprofloxacin and amoxicillin/clavulanic acid for 1° month |
Sari M, et al. [10] | 21 | M | None | Vocal cord | Dysphonia for 6 months | Amoxicillin-clavulanate 625 mg TID for 8 weeks |
Shaheen SO, et al. [11] | 45 | M | Hx of recent tooth extraction | Cricoid area and vocal cord | Recurrent pharyngitis | IV penicillin 1 mega unit 6 hours for 23 days, then PO 2 mega units daily for 10 days |
Yoshihama K, et al. [12] | 49 | M | None | Vocal cord | Dysphonia 2 years | Amoxicillin-clavulanate 625 mg orally three times a day for 8 weeks |
Syed MA, et al. [13] | 74 | M | Post radiotherapy for laryngeal carcinoma | Cricoid region | Dysphagia | Amoxicillin 500 mg three times daily |
Sims HS, et al. [14] | 47 | M | Immunocompromised (post-transplant recipient, chronic steroid use for SLE) | Vocal cord | Dysphonia and dysphagia | IV penicillin for 2 wks. then PO penicillin for 3 months |
Artesi L, et al. [15] | 75 | M | None (smoker) | Epiglottis and aryepiglottal fold | Dysphagia progressing to slight dyspnea over 2 months | IV penicillin for 15 days then PO clindamycin 600 mg TID for 4 months |
Khademi B, et al. [16] | 14 | M | Hx of recent tooth extraction | Vocal cord | Dysphonia worsening over 2 months | IV penicillin for 2 wks. then PO penicillin for 3 months |
Batur Çali? A, et al. [17] | 66 | M | Concurrent cancer diagnosis (smoker) | Vocal cord and Vestibular fold | Dysphonia 4 months and dyspnea for 2 months | Surgical excision of lesion (for cancer) |
Batur Çali? A, et al. [17] | 45 | M | Concurrent cancer diagnosis (smoker) | Vestibular fold and Vocal cord | Dysphonia, dyspnea, dysphagia for 1 month | Surgical excision of lesion (for cancer) |
Ferry T, et al. [18] | 67 | M | Hx of laryngeal carcinoma, chemotherapy and Radiotherapy (also smoker and previous MI) | Vocal cord and Vestibular fold | Dysphonia 2 yrs | Amoxicillin 6g/day for 4 months |
Meidani M, et al. [19] | 77 | M | Prolonged intubation (from heart surgery) and Pulmonary actinomycosis | Fever, Cough, Weight loss | Penicillin | |
Menezes MC, et al. [20] | 77 | M | None (smoker) | Aryepiglottic fold | Dysphonia and pain worsening over 2 months | Antibiotics for 6 months |
Moreno PJM, et al. [21] | 52 | F | Diabetes | Posterior commissure and Vocal cord | Cough 2 months | Cefuroxime-axetil 250 mg twice a day for 3 weeks |
Wierzbicka M, et al. [22] | 20 | M | None | Epiglottis | Dysphagia and weight loss over several months | IV penicillin and clindamycin |
Silvestri SB, et al. [23] | 69 | M | Concurrent cancer diagnosis (smoker) | Thyroid cartilage | Dysphonia, persistent cough, weight loss over 8 months | IV ampicillin 500 mg every 6 hours for 12 weeks, then PO for 6 to 12 months |
Schumann R, et al. [24] | 56 | M | Environmental exposure | Aryepiglottic fold and pyriform sinus | Mild dysphagia and increased edema of ear | Surgical resection of abscess then amoxicillin and clavulanic acid for 3 weeks |
Yasuda M [25] | 53 | M | Immunocompromised (adult T cell leukemia) | Anterior commissure | Dysphonia | Penicillin 20 million IU daily for 35 days |
Fernandez SH [26] | 30 | F | Concurrent pulmonary actinomycosis infection | Vocal cord | Dysphonia 1 month | IV penicillin 6 wks. |
Abed T, et al. [27] | 35 | F | Immunocompromised (chronic steroid use for SLE) | Anterior commissure | Dysphonia | Oral penicillin |
Tsuji DH, et al. [28] | 68 | M | Post radiotherapy for laryngeal carcinoma | Vocal cord | Dysphonia, odynophagia, and pharyngitis for 3 weeks | Penicillin 10 million IU daily for 40 days |
García Lozano MC, et al. [29] | 53 | M | None (smoker) | Vocal cord | Dysphonia | Penicillin 600,000 units orally q6 hours for 3 weeks |
Brandenburg JH, et al. [32] | 67 | M | Post radiotherapy for laryngeal carcinoma | Subglottic | Dyspnea, stridor, dysphonia, weight loss over 7 months | Penicillin |
Hughes RA Jr, et al. [33] | 66 | M | Diabetes | Pyriform sinus, aryepiglottic fold, hypopharyngeal wall | Pharyngitis and dysphagia over 5 days and weight loss, stridor | Cephalexin 4 months |
Citation: Benjamin G, David K, Kim G, John S (2016) Laryngeal Actinomycosis: A Case Report and Systematic Review of 32 Cases in the Literature. J Otolaryng Head Neck Surg 2: 006.
Copyright: © 2016 Benjamin Googe, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.