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PubMed1999

[Genital actinomycosis. Diagnostic and therapeutic difficulties. Report of three cases].

Genital actinomycosis is a rare bacterial infection affecting women of child-bearing age, which is sometimes related to the use of an IUD or an intra-vaginal pessary. Nevertheless, this relationship is at best tenous and actinomycosis is not the only bacterial infection caused by IUD use. Genital actinomycosis often occurs as a pelvic tumour which is sometimes difficult to correctly diagnose and consequently treat accordingly. Rapid diagnosis is essential in order to avoid any irreparable tissue damage. Treatment of this condition consists of a combination of antibiotics and surgery to achieve complete recovery. Three cases are described.

Actinomycosis↗
PubMed1999

Pulmonary actinomycosis: a study of 16 cases from Central Chest Hospital.

Actinomycosis is a relatively rare infection. This is a report of 16 patients with pulmonary actinomycosis diagnosed from 1990 to 1997 at the Central Chest Hospital, Thailand. Twelve patients were male and 4 were female, with a mean age of 59 years and a mean duration of symptoms of 9 months. Common symptoms were cough and hemoptysis. Mass-like shadowing was the most common radiographic finding (37%). The diagnosis, based on findings of typical sulfur granules, was reached by bronchoscopy (10 cases), surgery (5 cases) and fine needle aspiration (1 case). Endobronchial mass with luminal occlusion was the most frequent bronchoscopic finding (56%). Coexistent bronchial carcinoma was present in one specimen. Penicillin was given in 10 patients, 2 of whom (20%) were cured, 5 (50%) are currently on treatment and have achieved clinical response, whereas, the other 2 patients (20%) did not respond. Surgical resection was performed in 8 patients, all of whom recovered. An awareness of the full spectrum of actinomycosis manifestations will expedite diagnosis and optimize treatment.

Actinomycosis↗
PubMed2000

[A case of pulmonary actinomycosis radiologically mimicking a lung cancer].

A 59-year-old male clerk consulted in general practitioner due to cough and hemoptysis. A mass shadow was pointed out in the left upper lung field on a chest radiograph. Patient was referred to our hospital for further treatment. Any definitive daiagnosis could not be made after examinations including sputum culture, cytology and TBLB. Because a lung cancer was strongly suspected, an exploratory thoracotomy was performed. Actinomyces was detected by pathological study of excised specimen, with no evidence of cancer. ABPC was administered for two months postoperatively. The patient is doing well without recurrence of actinomycosis 2.5 years after the surgery. Pulmonary actinomycosis presenting a mass shadow on a radiograph may mimick a pulmonary tumor, especially a lung cancer. Pulmonary actinomycosis should be considered in a differential diagnosis of pulmonary lesion thought to be malignant.

Actinomycosis↗
PubMed2000

Actinomycosis mimicking a pelvic malignancy. A case report.

BACKGROUND: Pelvic actinomycosis is difficult to diagnose preoperatively. The chronic infection is locally infiltrative and causes a profound induration of infected tissue planes. This induration, combined with absence of fever and leukocytosis, can mimic a pelvic malignancy. CASE: A 55-year-old woman was diagnosed with a pelvic mass after a two-month history of intermittent lower abdominal pain. The patient had had an intrauterine device for 12 years; it was removed two months prior to an exploratory laparotomy for the symptomatic mass. The mass was highly suggestive of colorectal cancer, with the rectosigmoid colon indurated and adherent to the uterus and sacrum. The induration of the colon extended caudally to within 3 cm of the anal verge. An abdominoperineal resection was performed along with a total abdominal hysterectomy, bilateral salpingo-oophorectomy and colostomy. Pathology revealed acute and chronic endometritis, left tuboovarian abscess and extensive, acute inflammation of the rectosigmoid colon without evidence of diverticuli. Actinomycosis was diagnosed based on the characteristic sulphur granules seen on hemotoxylin and eosin staining. CONCLUSION: Actinomycosis can mimic pelvic and abdominal malignancies. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.

Abdominal Pain↗
PubMed1999

Actinomycosis of the vocal cord: a case report.

A 30-year-old Chinese lady was admitted for hoarseness of voice of one month's duration. Clinical examination revealed a granuloma of the left vocal cord while chest X-ray showed an opacity in the lower lobe of the right lung. The provisional clinical diagnosis was tuberculous laryngitis. A biopsy of the vocal cord lesion revealed inflamed tissue with actinomycotic colonies. Cultures and sputum smears did not reveal any tuberculous bacilli. The patient responded to a 6-week course of intravenous C-penicillin, regaining her voice on day 5 of commencement of antibiotics. A subsequent CT scan of the neck and thorax revealed multiple non-cavitating nodular lesions in both lung fields, felt to be indicative of resolving actinomycosis. She was discharged well after completion of treatment. It was felt that this is a case of primary actinomycosis of the vocal cord with probably secondary pulmonary actinomycosis.

Actinomyces↗
PubMed1975

Untraditional glucose fermenting actinomycetes as human pathogens. Part I: Actinomyces naselundii as a cause of abdominal actinomycosis.

Actinomyces naeslundii was proved as a primary pathogen in the case of a fulminant abdominal infection of a 74 aged woman. The preliminary diagnosis of actinomycosis based on direct microscopical findings of microgranules in the pus was confirmed by the results of cultivation and casuistry in addition. The case was of a typical course for actinomycosis and penicillin following surgery was of life saving effect for the patient who was dismissed asymptomatic after 55 days of hospitalization. Actinomycotic microgranules were demonstrated in the pus from the natural infection and from experimentally infected mice and the causative agent Actinomyces naeslundii TR 91/67 was defined. Nevertheless it was concluded that the judgment of the pathogenicity of Actinomyces naeslundii and of the other members of the heterogenous group of etiological agents of human actinomycosis still remains a matter of delicacy in any actual case of their isolation. In practice however, the presumption of actinomycotic etiology of an actual infection may be supported in retrospect by the dramatical effect of penicillin without regard to the presence of concomitant microflora not necessarily sensitive to penicillin.

Abdomen, Acute↗
PubMed2002

[A case of pulmonary squamous cell carcinoma coexisting with pulmonary actinomycosis].

A 71-year-old man was referred to our hospital complaining of cough. Chest radiography revealed a mass opacity in the right upper lung field. A transbronchial biopsy specimen revealed non-specific inflammatory changes. Percutaneous lung aspiration biopsy under ultrasound guidance demonstrated gram-positive rods, suggesting actinomyces. On the diagnosis of pulmonary actinomycosis, the patient was treated with penicillin-G and his symptoms were relieved. In a three-month follow-up, the mass shadow in the right upper lung field was found to have increased in size. Squamous cell lung cancer was diagnosed on the basis of repeated transbronchial tumor biopsies, and right upper lobectomy was performed. Most cases of pulmonary actinomycosis have been diagnosed from post-surgical tumor specimens taken on suspicion of the presence of lung cancer. However, the lung cancer in this case was difficult to diagnose because the lung cancer was co-existent with pulmonary actinomycosis.

Actinomycosis↗
PubMed2002

[Long-lasting disease after serious genital actinomycosis in a former IUD user].

A previous IUD user underwent surgery on suspicion of ovarian cancer. No malignancy was found and genital actinomycosis was diagnosed on the histology and a history of previously verified, but inadequately treated, actinomycosis of the internal genitals. Actinomycosis is a rare disease with a potentially high morbidity. Diagnosis is difficult, as symptoms are non-specific and culture is often negative.

Actinomycosis↗
PubMed2002

[Pelvic actinomycosis and sub-acute abdomen].

An interesting case of pelvic actinomycosis with paculiar clinical manifestation is presented. A 42 years-old patient came to our emergency service for an abdominal pelvic pain and fever. Past history showed IUD in situ for over 15 years. The patient was submitted to a ultrasonographic scan and a complete hematological screening was performed. The diagnosis was of subacute abdomen, and an exploratory laparotomy was carried out. During laparotomy an atypical reactive tissue and a suppurative cavity were found. The histological finding of tissue biopsy showed pelvic actinomycosis. On the basis of these findings the conclusion is drawn that a better prevention of pelvic actinomycosis is necessary of its diffusion in the last years due to sexual habit changes.

Abdomen, Acute↗
PubMed2002

[Hydronephrosis in course of actinomycosis of female reproductive organs].

OBJECTIVES: Pelvic actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. The most difficult task was to obtain the diagnosis in a patient with an intrauterine device and poor general health, signs of infection and a pelvic syndrome. RESULTS: This is a report of a case of hydronephrosis in course of actinomycosis of female reproductive organs in a patient aged 46 years with the intrauterine contraceptive device admitted to The Department of Gynecology & Obstetric in Hospital of Słupsk. Symptoms were presented as an acute abdomen associated with painful epigastric and mass in right adnexa. A pre-operative diagnosis of the right hydronephrosis, on ovarian tumor and uterus myoma were detected which lead to an extensive and difficult surgery. The pathologic process infiltrated the retroperitoneal space simulated sarcoma or lymphoma. The disease was serious and required hysterectomy with salpingo-oophorectomy and intra-abdominal drainage. Actinomycosis was confirmed by the postoperative histopathologic examination, and the patient was successfully treated with penicillin. The patient was completely free of symptoms two months within the operation. CONCLUSIONS: In patients who have intrauterine contraceptive devices or who have had them removed recently, abdominal pain, recurrent vaginal bleeding or adnexal masses should prompt a thorough search for potentially pathogenic actinomyces in the genital tract.

Actinomycosis↗
PubMed2003

[Abdominal actinomycosis. Three cases].

BACKGROUND: Abdominal actinomycosis is a suppurating affection caused by a positive Gram germ, Actinomyces israelii. Manifestations of this rare disease are usually pseudotumoral syndromes leading to surgical exeresis. The diagnosis is obtained from the histologic report. CASES REPORT: We report three cases in all of which this disease presents with tumoral symptoms. The first affected the sigmoïd, the second affected the mesentery and the last affected the greater omentum and abdominal wall. In no case, the diagnosis was done before surgery. In 2 of the cases reported here, the patients had an old, incontrolled intra-uterine device. DISCUSSION: From a review of the literature, we observed that the diagnosis of abdominal actinomycosis remains difficult. The radiologic findings are nonspecific. Actinomycosis is treated with prolonged antibiotics, and surgery is only needed in abdominal abscess and fistula. CONCLUSION: Theses observations illustrates the difficulties of the diagnosis of this rare unrecognized disease.

Abdominal Abscess↗
PubMed2003

[Actinomycosis infection presenting as malignant pelvic frostbite].

Actinomycosis is a chronic inflammatory disease rarely observed in the pelvic form but rather frequently in the cervicofacial tract. The pelviabdominal form is difficult to diagnose because of its various clinical presentations that can lead to misdiagnosis by imitating a neoblastic disease, a bowel inflammatory disease, an acute diverticulitis or gynecological disorders. The case is reported of a 43 year old woman with prolonged use of an intrauterine contraceptive device and with severe phlogosis secondary to extensive pelvic actinomycosis involving both ovaries, the urinary duct and the rectosigmoid, misdiagnosed as pelvic frostbite presentation of a malignant neoplasm. A bilateral hysterosalpingo-oophorectomy surgery was performed and a urethral stent was placed before the operation. Rarely, has the pelvis been so heavily involved by a chronic actinomycosis infection.

Actinomycosis↗
PubMed1992

Pelvic actinomycosis with colo-ileo-vesical fistula formation: report of a case.

Pelvic actinomycosis with multiple fistular formation is rarely reported in the literature. We herein present a case of pelvic actinomycosis with sigmoid colo-ileovesical fistulae in a 36-year-old intrauterine device (IUD) user. She was admitted to the hospital because of general malaise, weight loss and bilateral palpable adnexal masses. Sonography showed bilateral adnexal masses which contained many echolucent spots. A barium enema examination revealed sigmoid colo-ileo-vesical fistulae. A computed tomographic scan showed bilateral cystic adnexal masses, bilateral hydronephrosis and hydroureter. Preoperatively, pelvic malignancy was suspected. An exploratory laparotomy was performed. Bilateral tubo-ovarian abscesses with extensive adhesions were found. Pathologic examination of the operative specimen revealed pelvic actinomycosis. The patient was treated with penicillin for 14 weeks and had a stable clinical course.

Actinomycosis↗
PubMed1992

Actinomycosis of the larynx.

Actinomycosis of the larynx is rare. Only seven cases have been reported in the literature. We report a case of actinomycosis of the larynx in a 63-year-old male following radiation therapy for laryngeal carcinoma. The diagnosis of actinomycosis can be made with a biopsy. It is important to distinguish infection from radionecrosis and recurrent carcinoma. Treatment consists of airway control and a prolonged course of antibiotics.

Actinomycosis↗
PubMed1992

[Three cases of pulmonary actinomycosis].

Three cases of pulmonary actinomycosis are reported. Case 1 was a 33-year-old man complaining of hemosputum. A large mass lesion was noted in the right upper lobe and surgically resected. Actinomycosis was diagnosed pathologically. The second case was a 41-year-old man with lung abscess. An actinomyces species was cultured by percutaneous aspiration biopsy. He was effectively treated with clindamycin. The third case was a 46-year-old man with a chronic cough and cavitary lesion. Gram staining of sputum revealed sulfur granules. Piperacillin was administered with prompt response. All three cases had dental disease and two had diabetes mellitus. In patients with a mass lesion or those with lung abscess not effectively treated by cephem antibiotics, actinomycosis should be suspected especially when diabetes mellitus and/or dental disease coexists. Adequate treatment may not always require long-term antibiotics.

Actinomycosis↗
PubMed2003

[Intracranial actinomycosis in a child with dental caries].

A diagnosis of intracranial actinomycosis was made in a 9-year-old boy with headache, cranial nerve dysfunction and ataxia. Poor dental hygiene leading to caries and an inflammation in his right upper jaw probably was the cause of cervicofacial actinomycosis with intracranial extension. A full recovery was achieved by treatment with benzylpenicillin. Actinomyces is a gram-positive bacterium belonging to the endogenous flora of the mucous membranes of the oropharynx, gastrointestinal tract, and female genital tract. Disruption of the mucous membrane is the portal of entry for an extremely destructive infective process that is effectively treated with penicillin. Good orodental hygiene is important for the prevention of actinomycosis.

Actinomyces↗
PubMed2004

Thoracic actinomycosis.

Thoracic actinomycosis represents about one-fourth of all cases of the disease. Isolated pleural effusion due to Actinomycosis is rare. We report a case of right sided pleural effusion with discharging sinus in the right anterior chest wall. Actinomycosis was suspected and confirmed by microscopic identification of "sulfur granules" in the discharge of the sinus tract and also identification of gram-positive filamentous bacteria in the specimen of discharging sinus. The patient improved clinically and radiologically after treatment with intravenous penicillin G followed by oral penicillin and aspiration of pleural fluid.

Actinomycosis↗
PubMed2004

Primary actinomycosis of the abdominal wall.

Primary actinomycosis of the abdominal wall is a rare clinical entity. Only 7 adequately described cases have been reported in the English literature. We report a case of isolated abdominal wall actinomycosis involving the left lower quadrant of the abdominal wall in a 32-year-old diabetic male. The diagnosis was confirmed by histopathological examination. Surgical drainage of the abscess followed by long-term administration of penicillin resulted in cure. The clinicopathological spectrum of actinomycosis is reviewed and isolated involvement of the abdominal wall is characterized in light of the knowledge acquired from the available literature on this rare clinical presentation. The significance of obtaining tissues for culture and histopathology in all inflammatory lesions is emphasized.

Abdominal Wall↗