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Primary actinomycosis of the bladder is an infrequent presentation of this condition. The main concern is obtaining a differential diagnosis from tumours of the bladder and the subsequent impact this has on the therapeutic choices. Contribution of one case report of a male patient with actinomycosis of the bladder, with remarks on relevant diagnostic (including differential diagnosis) and therapeutic data.
Actinomycosis is a rare chronic infectious disease that usually develops abscesses and fistulas. It can also mimic other diseases such as cancer, inflammatory bowel diseases or diverticulitis. We present the case of a 67-year-old woman with an unusual form of actinomycosis. Clinically, the disease simulated an inflammatory bowel disease. Computerized axial tomography, intestinal transit and colonoscopy were performed and the suspected 1 diagnosis continued to be inflammatory bowel disease. The definitive diagnosis was made after histopathological study of the surgical specimen. We highlight the diagnostic difficulty of this rare disease and the importance of prolonged antibiotic treatment.
Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes. We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma. After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe. Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy. Prolonged antibiotic treatment produced a complete response. The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.
INTRODUCTION: Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual. EXEGESIS: We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up. CONCLUSION: Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.
The authors report a case of abdominopelvic actinomycosis, a rare bacterial infection. This case is exceptional for its clinical tumoral expression with fistulization through the skin, and for its rapid diagnosis by ultrasonically-guided needle biopsy. The clinical, bacteriological, histological and therapeutic aspects of actinomycosis are detailed.
The diagnosis of severe actinomycosis parallel to that of neoplasia leads to speculation of a possible fortuitous association. Because underlying conditions such as immuno-suppression are suspected in such disease, and to strengthen this hypothesis, we report one more case of disseminated actinomycosis associated with a malignant disease, namely an epidermoid pulmonary carcinoma. The diagnosis was made by thoracotomy a few months after the infectious episode. Two years later the patient recovered. The analysis of the literature data is in favor of a fortuitous association between both diagnoses.
A case of disseminated actinomycosis caused by Actinomyces meyeri in a 43-year-old man is described. The patient presented with signs of pericarditis, weight loss, dry cough, and subsequently an inferior vena cava syndrome. Diagnosis of thoracic as well as abdominal actinomycosis was made 4 months after admission. This article stresses the importance of considering the diagnosis of the disease. Cure was achieved by administering penicillin for several months.
A retrospective investigation of 25 cases of verified cervico-facial actinomycosis recorded in the period 1971--76 is presented. The results have been compared with the findings from a previous examination carried out by one of the authors during 1955--64. A marked increase of cervico-facial actinomycosis was noted. The clinical picture seems to be changing to a more alarming appearance, in agreement with the classical description of this entity. According to this agreement with the classical description of this entity. According to this a prolongation of the period of treatment was found. Other aspects of the disease are discussed based on the present results. The recommended treatment is still a combination of antibiotic medication and surgical removal of infectious foci.
Actinomycosis of the female genital tract has greatly increased over the last two decades. A pelvic form of the disease, associated with the use of Intra-uterine Devices (IUD), can severely damage pelvic organs and even can lead to death. We report a case of pelvic actinomycosis presenting as cutaneous fistula.
A patient presented with a pelvic tumor which mimicked an advanced ovarian carcinoma with invasion into urinary bladder, rectum and uterus, as detected by MR imaging. After surgery, however, actinomycosis of the left ovary was diagnosed by pathological examination. Ovarian actinomycosis in this patient was complicated by diabetes mellitus.
Actinomycosis and nocardiosis are bacterial infectious diseases with distinct morphologic features, that can be diagnosed in tissue sections. The clinico-pathologic features of 17 cases are reported with emphasis on their histopathologic diagnosis by using a simple combination of common tissue stains. Actinomycosis was frequently observed as a secondary and localized infection often with lung involvement, especially in residual cavities or bronchiectasis; in these cases numerous actinomycotic granules and only occasionally individual bacterial filaments within the suppurative foci and/or granulomas with suppurative centers were identified. Nocardiosis was observed as an opportunistic infection in the three cases studied; in these, isolated filaments of acid-fast and Gram-positive bacteria were observed. The morphologic features and the differential diagnosis in tissue sections of both infections are discussed with emphasis on their identification by the general pathologist in the routine material.
INTRODUCTION: Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using specific treatments. METHOD: Data were reviewed from 6 patients with actinomycotic anal abscesses of obvious cryptoglandular origin observed in a single proctology unit between 1983 and 2000. Therapeutic management included conventional surgical treatment of anal sepsis followed by a specific oral antibiotic therapy maintained until the surgical wound had completely healed. RESULTS: All but one of the patients were men (median age, 53 years). All abscesses, except one, were indolent. No patient presented macroscopic "sulphur granules" in the pus, but one presented "watery pus". The diagnosis was established by histological study of the surgically excised tissue or by anaerobic culture of the pus. In the one HIV-positive patient, an uncommon organism was isolated: Actinomyces meyeri. Two cases of recurrence were observed without evidence of Actinomyces infection. CONCLUSION: Actinomycosis should be suspected particularly in indolent anal suppuration. The absence of macroscopic "sulphur granules" does not mean this diagnosis can be ruled out. Careful histological examination of the excised tissue and appropriate anaerobic cultures of pus should be carried out to achieve complete eradication of this rare, but easily curable disease.
Traditional ways of identification of anaerobic Gram-positive non-sporulating bacilli by isolation of the organism and studying it phenotypically by elucidation of its morphologic and biochemical characteristics and metabolic end products are associated with a need for special equipment and expertise, and strains that are "unidentified" because of ambiguous biochemical profiles. In this study, an anaerobic Gram-positive non-sporulating bacterium was isolated from the intrauterine contraceptive device of a 36-year old woman with pyosalpinx. The Vitek system (ANI) showed that it was 99% Propionibacterium granulosum; whereas the API system (20A) showed that it was 78% Actinomyces meyeri/odontolyticus. The 16S ribosomal RNA gene of the strain was amplified and sequenced. There was 0 base difference between the isolate and A. odontolyticus (GenBank Accession no. AJ234047), indicating the isolate most closely resembled a strain of A. odontolyticus. Identification of the organism in this study was important because the duration of antibiotic therapy would be entirely different. In the present case, identification of the bacterium as A. odontolyticus inferred that the patient suffered from an intermediate form of pelvic actinomycosis. A prolonged course of antibiotics would be more desirable, as the relapse rate of actinomycosis after a short course of antibiotics is high.
Actinomycosis is a chronic-suppurative disease characterized by abscesses and draining sinus tracts, with fibrosis and granulation involving the face and neck and thoracic or pelvic-abdominal regions. Dermatological findings in patients at high risk are the key to the correct diagnosis. Actinomycosis is frequently undiagnosed or misdiagnosed until the correct diagnosis is made after surgical resection. Alcoholic, homeless, and disadvantaged individuals and patients with other factors predisposing to infection including poor dentition, alcoholism, seizures, and trauma are common in the emergency department; thus, emergency physicians should be aware of the different presentations and complications of this disease. The treatment of choice is a high dose of penicillin in conjunction with surgical debridement. The prognosis is excellent with correct diagnosis and therapy.
We report two cases of pulmonary actinomycosis in two young men. These observations are an opportunity to review the usual difficulties of diagnosis and the clinical, radiological and therapeutic characteristics in patients with this rare disease. Pulmonary actinomycosis often appears in a debilitated patient with significant disease of the teeth and gingival margins. High-dose penicillin G which is the standard treatment generally provides cure.
Actinomycosis was first described as a clinical entity over 100 years ago. However, the fundamental characteristics of this entity have not been fully discussed, and major questions remain unanswered, such as the highly diversified pathogenicity of the phenomenon according to numerous published case reports and clarification of solid diagnostic criteria. Even the frequency of cervicofacial actinomycosis occurrence is unclear; some authors consider it to be rare and others to be common. We present 11 cases examined and treated in our department within the last 14 years along with a review of the literature. Diagnostic problems are emphasized, and a comprehensive overview of the entity is suggested.
Two cases of cervicofacial actinomycosis, resulting in submandibular swelling, are presented. How actinomycosis may present under the guise of malignancy is well demonstrated. Factors predisposing to the condition, difficulties with diagnosis, isolation methods of the causative organism and treatment of the disease, are discussed.
An unusual case of cervicofacial actinomycosis presenting as acute upper airway obstruction and demanding urgent tracheostomy is reported. Diagnosis was established by microscopic examination of the pus and culture of Actinomyces israelii. Repeated surgical drainage of the purulent foci and prolonged treatment with penicillin obtained resolution of the disease. Clinicians dealing with acute head and neck swellings should always consider actinomycosis as a possible diagnosis.