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Periapical actinomycosis
LETTER TO THE EDITOR
Periapical actinomycosis To the Editor: We read “Periapical actinomycosis: A clinicopathologic study” by Hirshberg et al (2003;95:614-620), and we believe that the article perpetuates the erroneous view that the finding of colonies with the morphology of Actinomyces species in periapical pathologic specimens equates with a diagnosis of actinomycosis. There is no evidence of which we are aware that such lesions are the counterpart of actinomycosis at other sites. We regard the presence of the colonies as indicating proliferation of a commensal organism in a periapical lesion, rather than being pathogenic. We believe that a diagnosis of true periapical actinomycosis would need to be made on both clinical and histopathologic grounds. The comment in the article that periapical actinomycosis is rare probably reflects the fact that, although the finding of the organism in such a site is not uncommon, few published articles would make the claim of infection by the bacterium. We do not consider the finding of a colony of Actinomyces species in a periapical lesion sufficient justification in itself for antibiotic treatment. The article might have been better entitled “Periapical Actinomyces: A clinicopathologic study.” Michael J. Aldred, BDS, PhD, GradCertEd, FDSRCS, FRCPath, FFOP(RCPA) Anna A. Talacko, BDSc, MDSc, FRCPath, FFOP(RCPA) Dorevitch Pathology Melbourne, Australia doi:10.1016/S1079-2104(03)00364-0
In reply: We thank Drs Aldred and Talako for their comments regarding our article. The purpose of the study was to
386
evaluate the incidence of accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination. We agree with Drs. Aldred and Talako that the clinical course of periapical actinomycosis differs considerably from that of actinomycosis in other sites. However, the term periapical actinomycosis has been applied by most authors to a periapical lesion associated with actinomycotic infection and has been suggested as a contributing factor in the perpetuation of periapical infection. Therefore, in any case in which a nonhealing and endodontically nonresolving periapical lesion is associated with histologic identification of actinomycotic colonies in the periapical specimen, the diagnosis of periapical actinomycosis should be applied. The results of the present study showed that the prevalence of actinomycotic infection is low and has a favorable outcome. Periapical actinomycosis has been regarded in the literature as a mild form of cervicofacial actinomycosis, and as such, has required prolonged antibiotic treatment. The results of the present study, along with the review of the literature, do not support this approach. Most cases of periapical actinomycosis do not differ clinically from other periapical lesions, and the outcome following surgical treatment is good. Nevertheless, it should be remembered that it is possible for the microorganisms to invade the surrounding structures and propagate to cervicofacial actinomycosis. In these cases, a more vigorous treatment should be taken. Dr Abraham Hirshberg, MD, DMD Dr Igor Tsesis, DMD Professor Zvi Metzger, DMD Dr Ilana Kaplan, DMD The Maurice and Gabriela Goldschleger School of Dental Medicine Tel Aviv University Tel Aviv, Israel doi:10.1016/S1079-2104(03)00365-2
Periapical actinomycosis To the Editor: We read “Periapical actinomycosis: A clinicopathologic study” by Hirshberg et al (2003;95:614-620), and we believe that the article perpetuates the erroneous view that the finding of colonies with the morphology of Actinomyces species in periapical pathologic specimens equates with a diagnosis of actinomycosis. There is no evidence of which we are aware that such lesions are the counterpart of actinomycosis at other sites. We regard the presence of the colonies as indicating proliferation of a commensal organism in a periapical lesion, rather than being pathogenic. We believe that a diagnosis of true periapical actinomycosis would need to be made on both clinical and histopathologic grounds. The comment in the article that periapical actinomycosis is rare probably reflects the fact that, although the finding of the organism in such a site is not uncommon, few published articles would make the claim of infection by the bacterium. We do not consider the finding of a colony of Actinomyces species in a periapical lesion sufficient justification in itself for antibiotic treatment. The article might have been better entitled “Periapical Actinomyces: A clinicopathologic study.” Michael J. Aldred, BDS, PhD, GradCertEd, FDSRCS, FRCPath, FFOP(RCPA) Anna A. Talacko, BDSc, MDSc, FRCPath, FFOP(RCPA) Dorevitch Pathology Melbourne, Australia doi:10.1016/S1079-2104(03)00364-0
In reply: We thank Drs Aldred and Talako for their comments regarding our article. The purpose of the study was to
386
evaluate the incidence of accidental finding of actinomycotic colonies in periapical lesions submitted for histologic examination. We agree with Drs. Aldred and Talako that the clinical course of periapical actinomycosis differs considerably from that of actinomycosis in other sites. However, the term periapical actinomycosis has been applied by most authors to a periapical lesion associated with actinomycotic infection and has been suggested as a contributing factor in the perpetuation of periapical infection. Therefore, in any case in which a nonhealing and endodontically nonresolving periapical lesion is associated with histologic identification of actinomycotic colonies in the periapical specimen, the diagnosis of periapical actinomycosis should be applied. The results of the present study showed that the prevalence of actinomycotic infection is low and has a favorable outcome. Periapical actinomycosis has been regarded in the literature as a mild form of cervicofacial actinomycosis, and as such, has required prolonged antibiotic treatment. The results of the present study, along with the review of the literature, do not support this approach. Most cases of periapical actinomycosis do not differ clinically from other periapical lesions, and the outcome following surgical treatment is good. Nevertheless, it should be remembered that it is possible for the microorganisms to invade the surrounding structures and propagate to cervicofacial actinomycosis. In these cases, a more vigorous treatment should be taken. Dr Abraham Hirshberg, MD, DMD Dr Igor Tsesis, DMD Professor Zvi Metzger, DMD Dr Ilana Kaplan, DMD The Maurice and Gabriela Goldschleger School of Dental Medicine Tel Aviv University Tel Aviv, Israel doi:10.1016/S1079-2104(03)00365-2