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  1. It is caused anaerobic or microacrophilic gram positive bacilli bacteria primarily Act-inomyces israelii. Three presentations that should prompt consideration of this unique infection are
    1. The combination of chronicity, progression across tissue boundaries, and mass like features (mimicking malignancy with which it is often confused).
    2. The development of sinus tract which may spontaneously resolve & recur.
    3. A refractory or relapsing infection after a short course of therapy, since cure of established actinomycosis requires prolonged treatment.
  2. It most frequently occurs at an oral, cervical or facial site, usually as a soft tissue swelling, abscess or mass that is often mistaken for neoplasm. Angle of jaw is most commonly involved.
  3. Involvement of bone is usually due to adjacent soft tissue, but may be associated with trauma (fracture mandible) or hematogenous spread. Mandible is most commonly involved. Vertebrae (spreading from lung or gut) or pelvis (spreading from cecum or colon) may also be involved. Infection of an extremity is uncommon Cutaneous sinus tract frequently developed.
  4. X-ray show cystic areas of bone destruction with concomitant bone formation and bone destruction.
  5. Treatment is penicillin G, tetracycline, or erythromycin for several months.

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