{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T20:05:37Z","timestamp":1777320337068,"version":"3.51.4"},"reference-count":64,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T00:00:00Z","timestamp":1633392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Actinomyces species are part of the normal flora of humans and rarely cause disease. It is an uncommon cause of disease in humans. The clinical features of actinomycosis have been described, and various anatomical sites (such as face, bones and joints, respiratory tract, genitourinary tract, digestive tract, central nervous system, skin, and soft tissue structures) can be affected. It is not easy to identify actinomycosis because it sometimes mimics cancer due to under-recognition. As new diagnostic methods have been applied, Actinomyces can now more easily be identified at the species level. Recent studies have also highlighted differences among Actinomyces species. We report a case of Actinomyces viscosus bacteremia with cutaneous actinomycosis. Materials and Methods: A 66 years old male developed fever for a day with progressive right lower-leg erythematous swelling. Blood culture isolates yielded Actinomyces species, which was identified as Actinomyces viscosus by sequencing of the 16S rRNA gene. In addition, we searched for the term Actinomyces or actinomycosis cross-referenced with bacteremia or \u201cblood culture\u201d or \u201cblood stream\u201d from January 2010 to July 2020. The infectious diseases caused by species of A. viscosus from January 1977 to July 2020 were also reviewed. Results: The patient recovered well after intravenous ampicillin treatment. Poor oral hygiene was confirmed by dental examination. There were no disease relapses during the following period. Most cases of actinomycosis can be treated with penicillin. However, clinical alertness, risk factor evaluation, and identification of Actinomyces species can prevent inappropriate antibiotic or intervention. We also compiled a total of 18 cases of Actinomyces bacteremia after conducting an online database search. Conclusions: In summary, we describe a case of fever and progressive cellulitis. Actinomyces species was isolated from blood culture, which was further identified as Actinomyces viscosus by 16S rRNA sequencing. The cellulitis improved after pathogen-directed antibiotics. Evaluation of risk factors in patients with Actinomyces bacteremia and further identification of the Actinomyces species are recommended for successful treatment.<\/jats:p>","DOI":"10.3390\/medicina57101064","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T01:57:54Z","timestamp":1633917474000},"page":"1064","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Clinical Characteristics of Actinomyces viscosus Bacteremia"],"prefix":"10.3390","volume":"57","author":[{"given":"Yi-Chun","family":"Hsiao","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, Taichung Veterans General Hospital, Taichung 40705, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4478-9790","authenticated-orcid":false,"given":"Yi-Hsuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung 41354, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Mei","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, Taichung Veterans General Hospital, Taichung 40705, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2098-8872","authenticated-orcid":false,"given":"Chien-Hao","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, Taichung Veterans General Hospital, Taichung 40705, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jui-Hsing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Disease, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 40705, Taiwan"},{"name":"Department of Internal Medicine, School of Medicine, Buddhist Tzu Chi Medical Foundation Taichung Tzu Chi Hospital, Taichung 427213, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1288\/00005537-198409000-00013","article-title":"Actinomycosis: Diagnostic and therapeutic considerations and a review of 32 cases","volume":"94","author":"Bennhoff","year":"1984","journal-title":"Laryngoscope"},{"key":"ref_2","unstructured":"(2021, June 07). Actinomyces species (Actinomycoses)\u2014Infectious Disease and Antimicrobial Agents n.d. Available online: http:\/\/www.antimicrobe.org\/b73.asp."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/9619724","article-title":"Actinomyces and Alimentary Tract Diseases: A Review of Its Biological Functions and Pathology","volume":"2018","author":"Li","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1128\/CMR.00100-14","article-title":"Actinomyces and Related Organisms in Human Infections","volume":"28","author":"Wade","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1177\/00220345690480053601","article-title":"Plaque Formation and Implantation of Odontomyces viscosus in Hamsters Fed Different Carbohydrates","volume":"48","author":"Jordan","year":"1969","journal-title":"J. Dent. Res."},{"key":"ref_6","first-page":"5","article-title":"Influence of diet and spiramycin on Actinomyces viscosus-associated experimental perio-dontitis","volume":"2","author":"Keyes","year":"1992","journal-title":"Newsl. Int. Acad. Periodontol."},{"key":"ref_7","unstructured":"(2021, June 07). Emended Description of Actinomyces Naeslundii and Descriptions of Actinomyces Oris sp. nov. and Actinomyces johnsonii sp. nov., Previously Identified as Actinomyces Naeslundii Genospecies 1, 2 and WVA 963|Microbiology Society n.d. Available online: https:\/\/www.microbiologyresearch.org\/content\/journal\/ijsem\/10.1099\/ijs.0.000950-0?crawler=true."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3955","DOI":"10.1128\/JCM.39.11.3955-3961.2001","article-title":"Phenotypic Identification of Actinomyces and Related Species Isolated from Human Sources","volume":"39","author":"Sarkonen","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","first-page":"2324709620910645","article-title":"Bacterial Endocarditis Caused by Actinomyces oris: First Reported Case and Literature Review","volume":"8","author":"Phichaphop","year":"2020","journal-title":"J. Investig. Med. High Impact Case Rep."},{"key":"ref_10","first-page":"158","article-title":"Actinomyces viscosus causing disseminated disease in a patient on methotrexate","volume":"25","author":"Habib","year":"2018","journal-title":"Respir. Med. Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1128\/am.18.1.80-87.1969","article-title":"Identification of Human Strains of Actinomyces viscosus","volume":"18","author":"Gerencser","year":"1969","journal-title":"Appl. Microbiol."},{"key":"ref_12","first-page":"183","article-title":"Actinomycosis: Etiology, clinical features, diagnosis, treatment, and management","volume":"7","author":"Valour","year":"2014","journal-title":"Infect. Drug Resist."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1111\/j.1469-0691.2008.02070.x","article-title":"Then and now: Use of 16S rDNA gene sequencing for bacterial identification and discovery of novel bacteria in clinical microbiology laboratories","volume":"14","author":"Woo","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3442","DOI":"10.1128\/JCM.40.9.3442-3448.2002","article-title":"Genotypic Diversity of Clinical Actinomyces Species: Phenotype, Source, and Disease Correlation among Genospecies","volume":"40","author":"Clarridge","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.anaerobe.2018.09.007","article-title":"Identification and diversity of Actinomyces species in a clinical microbiology laboratory in the MALDI-TOF MS era","volume":"54","author":"Fong","year":"2018","journal-title":"Anaerobe"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijporl.2018.11.001","article-title":"A case of pediatric cervicofacial actinomyces masquerading as malignancy: Case report and review of the literature","volume":"116","author":"Savoca","year":"2018","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/1752-1947-1-141","article-title":"Pelvic actinomycosis presenting with a large abscess and bowel stenosis with marked response to conservative treatment: A case report","volume":"1","author":"Nozawa","year":"2007","journal-title":"J. Med Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e627","DOI":"10.4317\/medoral.19124","article-title":"Treatment of cervicofacial Actinomycosis: A report of 19 cases and review of literature","volume":"18","author":"Moghimi","year":"2013","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1128\/JCM.03074-15","article-title":"Is the Presence of Actinomyces spp. in Blood Culture Always Significant?","volume":"54","author":"Millar","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4103\/2229-5178.110645","article-title":"A rare case of cutaneous actinomycosis","volume":"4","author":"Nair","year":"2013","journal-title":"Indian Dermatol. Online J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4081\/cp.2018.1102","article-title":"Cutaneous Actinomycosis and Long-Term Management Through Using Oral and Topical Antibiotics: A Case Report","volume":"8","author":"Najmi","year":"2018","journal-title":"Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.anaerobe.2011.03.002","article-title":"Actinomyces graevenitzii bacteremia in a patient with alcoholic liver cirrhosis","volume":"17","author":"Hwang","year":"2011","journal-title":"Anaerobe"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.diagmicrobio.2012.02.012","article-title":"Actinomyces cardiffensis septicemia: A case report","volume":"73","author":"Seo","year":"2012","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4252","DOI":"10.1128\/JCM.02142-13","article-title":"Actinomyces urogenitalis Bacteremia and Tubo-Ovarian Abscess after an In Vitro Fertilization (IVF) Procedure","volume":"51","author":"Beuckelaers","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.idcr.2014.05.002","article-title":"Postoperative testicular abscess with bacteremia due to Actinomyces neuii","volume":"1","author":"Crescencio","year":"2014","journal-title":"IDCases"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2169\/internalmedicine.53.0403","article-title":"Actinomyces meyeri Meningitis: The Need for Anaerobic Cerebrospinal Fluid Cultures","volume":"53","author":"Hagiya","year":"2014","journal-title":"Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s00508-013-0471-7","article-title":"The polymicrobial Actinomyces naeslundii and Pseudomonas aeruginosa sepsis in a patient with ulcerative colitis 2 months after colonoscopy","volume":"126","author":"Desnica","year":"2014","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.2169\/internalmedicine.54.4637","article-title":"Actinomyces turicensis Bacteremia Secondary to Pyometra","volume":"54","author":"Hagiya","year":"2015","journal-title":"Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.nmni.2015.05.001","article-title":"First report of Actinomyces europaeus bacteraemia result from a breast abscess in a 53-year-old man","volume":"7","author":"Nielsen","year":"2015","journal-title":"New Microbes New Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1128\/JCM.00164-14","article-title":"Isolation of an unusual gram-positive coccus from a positive blood culture in a patient with pneumonia","volume":"54","author":"Suwantarat","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"bcr2015213236","DOI":"10.1136\/bcr-2015-213236","article-title":"Intrauterine device infection causing concomitant streptococcal toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus bacteraemia","volume":"2016","author":"Wu","year":"2016","journal-title":"BMJ Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.12659\/AJCR.911374","article-title":"Preterm Labor Caused by Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) Syndrome and Postpartum Infection Complicated with Actinomyces Species: A Case Report","volume":"19","author":"Alghamdi","year":"2018","journal-title":"Am. J. Case Rep."},{"key":"ref_33","first-page":"e2887","article-title":"Pylephlebitis Caused by Actinomyces Bacteremia","volume":"10","author":"Abughanimeh","year":"2018","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Yang, W.-T., and Grant, M. (2019). Actinomyces neuii: A case report of a rare cause of acute infective endocarditis and literature review. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4149-2"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"rjz286","DOI":"10.1093\/jscr\/rjz286","article-title":"A case report of necrotizing fasciitis with growth of Actinomyces europaeus and Actinotignum schaalii","volume":"2019","author":"Kus","year":"2019","journal-title":"J. Surg. Case Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/apm.13000","article-title":"Bacteremia and urogenital infection with Actinomyces urogenitalis following prolonged urinary retention","volume":"128","author":"Holmgaard","year":"2020","journal-title":"APMIS"},{"key":"ref_37","first-page":"e6761","article-title":"A Case of Life-threatening Actinomyces turicensis Bacteremia","volume":"12","author":"Kansara","year":"2020","journal-title":"Cureus"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"115052","DOI":"10.1016\/j.diagmicrobio.2020.115052","article-title":"Catheter-related bloodstream infection due to Tsukamurella pulmonis identified by MALDI-TOF spectrometry, 16S rRNA gene sequencing, and secA1 gene sequencing in an immunocompromised child: A case report and literature review","volume":"97","author":"Leroy","year":"2020","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1136\/jcp.30.6.518","article-title":"Isolation of Actinomyces viscosus from two patients with clinical infections","volume":"30","author":"Radford","year":"1977","journal-title":"J. Clin. Pathol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/S0022-3476(78)81082-8","article-title":"Cervicofacial Actinomyces viscosus infection","volume":"93","author":"Larsen","year":"1978","journal-title":"J. Pediatr."},{"key":"ref_41","first-page":"203","article-title":"Actinomyces viscosus infections of the chest in humans","volume":"120","author":"Thadepalli","year":"1979","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1093\/ajcp\/75.1.113","article-title":"Infections Caused by Actinomyces viscosus","volume":"75","author":"Eng","year":"1981","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1128\/jcm.20.6.1187-1189.1984","article-title":"Isolation of Wolinella recta and Actinomyces viscosus from an actinomycotic chest wall mass","volume":"20","author":"Telford","year":"1984","journal-title":"J. Clin. Microbiol."},{"key":"ref_44","first-page":"44","article-title":"Esophageal Actinomycosis: A Case Report and Review of Radiographic Findings","volume":"3","author":"Thompson","year":"2009","journal-title":"J. Radiol. Case Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1086\/517024","article-title":"Successful Treatment of Primary Actinomyces viscosus Endocarditis with Third-Generation Cephalosporins","volume":"26","author":"Hamed","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0732-8893(99)00009-7","article-title":"Actinomyces viscosus postoperative endophthalmitis","volume":"34","author":"Scarano","year":"1999","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1075-122X.2005.21613.x","article-title":"A Rare Case of Primary Actinomycosis of the Breast Caused by Actinomyces viscosus: Diagnosis by Fine-needle Aspiration Cytology under Ultrasound Guidance","volume":"11","author":"Capobianco","year":"2005","journal-title":"Breast J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jinf.2004.04.006","article-title":"Actinomyces viscosus endocarditis requiring aortic valve replacement","volume":"50","author":"Julian","year":"2005","journal-title":"J. Infect."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"413","DOI":"10.4103\/0255-0857.37353","article-title":"Cutaneous actinomycosis: A rare case","volume":"25","author":"Sheetal","year":"2007","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1080\/08880010802106580","article-title":"Actinomycetes species infection in a patient of t-cell acute lymphoblastic leukemia (all) presenting with loculated pleural effusion","volume":"25","author":"Dolai","year":"2008","journal-title":"Pediatr. Hematol. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jmii.2010.03.002","article-title":"Fatal subdural empyema caused by Streptococcus constellatus and Actinomyces viscosus in a child\u2014Case report","volume":"44","author":"Bouziri","year":"2011","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1038\/nature06244","article-title":"The Human Microbiome Project: Exploring the microbial part of ourselves in a changing world","volume":"449","author":"Turnbaugh","year":"2007","journal-title":"Nature"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Gajd\u00e1cs, M., Urb\u00e1n, E., and Terhes, G. (2019). Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview. Dent. J., 7.","DOI":"10.3390\/dj7030085"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/jac\/dki206","article-title":"Antimicrobial susceptibility testing of Actinomyces species with 12 antimicrobial agents","volume":"56","author":"Smith","year":"2005","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/jac\/dkv347","article-title":"Resistance patterns in clinical isolates of pathogenic Actinomyces species","volume":"71","author":"Steininger","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.jmii.2016.04.007","article-title":"Subgingival microbiota in individuals with severe chronic periodontitis","volume":"51","author":"Tsai","year":"2018","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1099\/00207713-40-3-273","article-title":"Actinomyces georgiae sp. nov., Actinomyces gerencseriae sp. nov., Designation of Two Genospecies of Actinomyces naeslundii, and Inclusion of A. naeslundii serotypes II and III and Actinomyces viscosus serotype II in A. naeslundii Genospecies","volume":"40","author":"Johnson","year":"1990","journal-title":"Int. J. Syst. Bacteriol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1099\/00207713-47-3-899","article-title":"Characterization of Some Actinomyces-Like Isolates from Human Clinical Specimens: Reclassification of Actinomyces suis (Soltys and Spratling) as Actinobaculum suis comb. nov. and Description of Actinobaculum schaalii sp. nov","volume":"47","author":"Lawson","year":"1997","journal-title":"Int. J. Syst. Bacteriol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1099\/00207713-47-1-46","article-title":"Phylogenetic Analysis of the Genus Actinomyces Based on 16S rRNA Gene Sequences: Description of Arcanobacterium phocae sp. nov., Arcanobacterium bernardiae comb. nov. and Arcanobacterium pyogenes comb. nov","volume":"47","author":"Ramos","year":"1997","journal-title":"Int. J. Syst. Bacteriol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"282","DOI":"10.5125\/jkaoms.2017.43.4.282","article-title":"Actinomyces: A deceptive infection of oral cavity","volume":"43","author":"Thukral","year":"2017","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"256","DOI":"10.5051\/jpis.2012.42.6.256","article-title":"Differential diagnosis and treatment of periodontitis-mimicking actinomycosis","volume":"42","author":"Kim","year":"2012","journal-title":"J. Periodontal Implant Sci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1086\/381099","article-title":"Short-Term Treatment of Actinomycosis: Two Cases and a Review","volume":"38","author":"Sudhakar","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.ijmm.2015.08.018","article-title":"Prevalence of Actinomyces spp. in patients with chronic periodontitis","volume":"305","author":"Vielkind","year":"2015","journal-title":"Int. J. Med. Microbiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1590\/0103-6440201701449","article-title":"Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion","volume":"28","author":"Esteves","year":"2017","journal-title":"Braz. Dent. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/10\/1064\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:09:38Z","timestamp":1760166578000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/10\/1064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,5]]},"references-count":64,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["medicina57101064"],"URL":"https:\/\/doi.org\/10.3390\/medicina57101064","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,5]]}}}