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Journal of Infection in Developing... Jun 2021To review unusual actinomycosis cases that appeared as a diagnostic and therapeutic challenge at our institution and to present a literature review on the usual clinical... (Review)
Review
INTRODUCTION
To review unusual actinomycosis cases that appeared as a diagnostic and therapeutic challenge at our institution and to present a literature review on the usual clinical presentations.
METHODOLOGY
This retrospective review included all patients hospitalized for actinomycosis in a 10-year period at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia.
RESULTS
A total of 15 patients were hospitalized during the observed period, 9 (60%) females and 6 (40%) males. The localizations of actinomycosis were: pelvis (5), lungs (3), blood stream (2), colon (1), penis (1), stomach (1), skin (1), cervicofacial region (1). We present four unusual cases: subcutaneous actinomycotic abscess, actinomycosis of the stomach with underlying non-Hodgkin lymphoma, sepsis due to Actinomyces neslundii originated from chronic asymptomatic periapical tooth abscesses and actinomycosis of the distal part of the penile shaft.
CONCLUSIONS
Actinomycosis was a very rare clinical problem in our clinical practice (0.032% of all hospitalizations and 0.0034% of all outpatients) but among those cases classical clinical presentations were also very rare.
Topics: Actinomycosis; Aged; Croatia; Diagnosis, Differential; Female; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 34242202
DOI: 10.3855/jidc.13414 -
The New England Journal of Medicine Sep 2018
Topics: Actinomycosis; Humans; Lung Diseases; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 30207906
DOI: 10.1056/NEJMicm1802090 -
Pediatric Pulmonology Oct 2021Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Pulmonary actinomycosis is very rarely seen in the paediatric population. The...
Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Pulmonary actinomycosis is very rarely seen in the paediatric population. The classic radiological presentation of thoracic involvement of actinomycosis includes lower lobe consolidation, empyema and periostitis of the ribs. We report a case of endobronchial actinomycosis in a child diagnosed on endobronchial biopsy and bronchoalveolar lavage (BAL). Bronchoscopy can be dangerous when performed on these cases, as there is a risk of severe bleeding and large airway obstruction, as was the case with this patient.
Topics: Actinomycosis; Biopsy; Bronchoscopy; Child; Humans; Lung; Lung Diseases
PubMed: 34265174
DOI: 10.1002/ppul.25550 -
Nigerian Journal of Clinical Practice Oct 2022An extremely rare disease with a slow course, actinomycosis has a high mortality risk when not properly treated. Pulmonary actinomycosis is clinically and radiologically...
An extremely rare disease with a slow course, actinomycosis has a high mortality risk when not properly treated. Pulmonary actinomycosis is clinically and radiologically analogous with tuberculosis, foreign body aspiration, lung abscess, or lung cancer. Therefore, it often causes misdiagnosis or delay in diagnosis. A 65-year-old male patient, being followed up with the diagnosis of chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma, was admitted to our outpatient clinic with complaints of chronic cough. On chest CT, a cavitary lesion in the upper lobe of the right lung was observed. Sputum Acid Fast Bacilli (AFB) was negative for 3 consecutive times, fungal direct examination was negative, and there was no growth in mycobacterium culture and fungal culture. Flexible bronchoscopy revealed a raised, hard, white-colored lesion on the mucosa obliterating the apical and anterior segment bronchial entrance of the right lung upper lobe. A diagnosis of actinomycosis was made with sulfur granules seen in the pathology as a result of biopsy and lavage. Detection of sulfur granules in biopsy is essential for the diagnosis of actinomycosis, and a nearly complete response is usually obtained with long-term antibiotic treatment. Alternative methods such as surgical debridement should be considered in cases that do not respond to antibiotic treatment.
Topics: Male; Humans; Aged; Actinomycosis; Lung Diseases; Lung; Anti-Bacterial Agents; Sulfur
PubMed: 36308251
DOI: 10.4103/njcp.njcp_1357_21 -
Orphanet Journal of Rare Diseases Jun 2023CNS actinomycosis is a rare chronic suppurative infection with non-specific clinical features. Diagnosis is difficult due to its similarity to malignancy, nocardiosis... (Review)
Review
BACKGROUND
CNS actinomycosis is a rare chronic suppurative infection with non-specific clinical features. Diagnosis is difficult due to its similarity to malignancy, nocardiosis and other granulomatous diseases. This systematic review aimed to evaluate the epidemiology, clinical characteristics, diagnostic modalities and treatment outcomes in CNS actinomycosis.
METHODS
The major electronic databases (PubMed, Google Scholar, and Scopus) were searched for the literature review by using distinct keywords: "CNS" or "intracranial" or "brain abscess" or "meningitis" OR "spinal" OR "epidural abscess" and "actinomycosis." All cases with CNS actinomycosis reported between January 1988 to March 2022 were included.
RESULTS
A total of 118 cases of CNS disease were included in the final analysis. The mean age of patients was 44 years, and a significant proportion was male (57%). Actinomycosis israelii was the most prevalent species (41.5%), followed by Actinomyces meyeri (22.6%). Disseminated disease was found in 19.5% of cases. Most commonly involved extra-CNS organs are lung (10.2%) and abdomen (5.1%). Brain abscess (55%) followed by leptomeningeal enhancement (22%) were the most common neuroimaging findings. Culture positivity was found in nearly half of the cases (53.4%). The overall case-fatality rate was 11%. Neurological sequelae were present in 22% of the patients. On multivariate analysis, patients who underwent surgery with antimicrobials had better survival (adjusted OR 0.14, 95% CI 0.04-0.28, p value 0.039) compared to those treated with antimicrobials alone.
CONCLUSION
CNS actinomycosis carries significant morbidity and mortality despite its indolent nature. Early aggressive surgery, along with prolonged antimicrobial treatment is vital to improve outcomes.
Topics: Humans; Male; Adult; Abscess; Actinomycosis; Central Nervous System Diseases; Treatment Outcome
PubMed: 37269006
DOI: 10.1186/s13023-023-02744-z -
BMJ Case Reports Nov 2023
Topics: Humans; Empyema; Lung Diseases; Actinomycosis
PubMed: 37940195
DOI: 10.1136/bcr-2023-256320 -
European Journal of Gastroenterology &... Dec 2021
Topics: Actinomycosis; Heterocyclic Compounds, 3-Ring; Humans
PubMed: 35048664
DOI: 10.1097/MEG.0000000000001899 -
World Neurosurgery Feb 2019Intracranial actinomycosis is a rare bacterial infection with no characteristic clinical or radiologic diagnostic features. The usual presentation is similar to pyogenic... (Review)
Review
BACKGROUND
Intracranial actinomycosis is a rare bacterial infection with no characteristic clinical or radiologic diagnostic features. The usual presentation is similar to pyogenic brain abscess or osteomyelitis with or without pachymeningitis. Intracranial actinomycosis rarely manifests as a parenchymal mass lesion. A high index of suspicion is warranted in a patient with immunosuppression or predisposing factors, such as dental procedure, sinusitis, cardiac septal defect, craniofacial trauma, cranial surgery, lung infection, or abdominopelvic infection.
CASE DESCRIPTION
A young woman presented with a right parietal parenchymal lesion with involvement of the calvaria and pericranium. She had no predisposing factors for intracranial actinomycosis. She underwent complete microsurgical excision of the lesion followed by prolonged antibiotic therapy. She experienced a good functional recovery.
CONCLUSIONS
Intracranial actinomycosis manifesting as a parenchymal mass lesion is extremely rare compared with abscess and pachymeningitis. Histopathologic examination remains the mainstay of definitive diagnosis, as culture may be negative in significant number of cases. Aggressive surgical excision with prolonged antibiotic therapy enhances the chances of a good functional outcome.
Topics: Actinomycosis; Brain; Brain Diseases; Diagnosis, Differential; Female; Humans; Young Adult
PubMed: 30391617
DOI: 10.1016/j.wneu.2018.10.134 -
Orphanet Journal of Rare Diseases Apr 2021Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately. (Review)
Review
BACKGROUND
Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately.
METHODS
Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline.
RESULTS
Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection.
CONCLUSION
HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented.
Topics: Actinomyces; Actinomycosis; Asia; Europe; Humans; Male
PubMed: 33931097
DOI: 10.1186/s13023-021-01821-5 -
Ear, Nose, & Throat Journal Nov 2022Actinomycosis is an infrequent infectious disease caused by species. Actinomycoses in the nasopharynx are extremely rare, especially in the Rosenmüller's fossa. This...
Actinomycosis is an infrequent infectious disease caused by species. Actinomycoses in the nasopharynx are extremely rare, especially in the Rosenmüller's fossa. This report presents a case of actinomycosis in the Rosenmüller's fossa. A 75-year-old woman presented with a 6-month history of bloody sputum. A grayish-white caseous tissue was found in the right Rosenmüller's fossa after retracting the torus tubarius. Magnetic resonance imaging showed a well-defined lesion with low-signal intensity on T1- and T2-weighted images; small low-signal areas were interspersed inside. The lesion was removed under an endoscope. Histopathological examination revealed eosinophilic, club-shaped structures surrounding a hematoxylophilic center, leading to the diagnosis of actinomycosis. The symptoms improved after 3 months of amoxicillin administration but recurred quickly. After 6 months of amoxicillin administration, the bloody sputum disappeared, and local and imaging findings were normal.
Topics: Actinomyces; Actinomycosis; Aged; Amoxicillin; Female; Hemoptysis; Humans; Magnetic Resonance Imaging
PubMed: 33236645
DOI: 10.1177/0145561320974850