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Thoracic actinomycosis is a rare infection but sensitive to penicillin G which is the antibiotic of choice. We report a case of thoracic actinomycosis which was characterised by a relapse, probably linked to antibiotic resistance following treatment with Tetracycline. This relapse presented as diffuse nodular dissemination, of miliary type, of which there are only a few examples in the literature.
Pelvic actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. This rare disease can be severe and life-threatening. A intra pelvic bridge becomes chronic and produces a pseudo-tumoural syndrome of the pelvis with retroperitoneal infiltration or extension to neighbouring organs. Initially, neoplasia is usually diagnosed, leading to mutilating surgical exeresis before the pathology results reveal the presence of pelvic actinomycosis. The most difficult task is to entertain the diagnosis in a patient with an intrauterine device and poor general health, signs of infection and a pelvic syndrome. We observed such a case where the diagnosis was suspected before surgery. Adapted first intention antibiotic therapy led to spectacular recovery and allowed limited surgery without unnecessary ablation of neighbouring organs.
Pulmonary actinomycosis is rare at present. A 11-year-old girl complained of left anterior chest pain and chest wall swelling. A radiograph of the chest revealed a consolidation in the left upper lobe. Sputum cultures showed normal flora and sputum cytology was negative for malignant disease. On 16 days after admission, the infection involved the bronchocutaneous fistula. Surgery was necessary to curettage. Histopathological specimen of resected necrotic tissue showed typical "sulfur granule" of actinomycosis. We administered penicillin for 3 months and the consolidation disappeared.
This article presents two cases of actinomycosis. Case 1 was a 39-year-old man who was first seen with the chief complaint of swelling around the left submandibular region. Case 2 was a 40-year-old woman who was first seen with the chief complaint of mass formation around the left buccal area. Both cases were initially diagnosed as malignant tumors and were later histopathologically interpreted as actinomycosis because of the presence of sulfur granules.
BACKGROUND: Thoracic actinomycosis is an rare disease in our medium. This fact, together with the variability of its forms of presentation and the difficulty in isolating its etiologic agent, make its diagnosis, particularly difficult. METHODS: A series of 8 cases diagnosed in the years 1988, 1989 and 1990 in two centers (Hospital de Bellvitge-Prínceps d'Espanya and Hospital de l'Esperança) is described with evaluation of the clinical and analytical data and the therapy applied. RESULTS: Species were only identified in 3 cases with Actinomyces israelii in two and Actinomyces odontolyticus in the third. The proven association with Mycobacterium tuberculosis, the presence of distant septic metastasis and eosinophilic pleuritis as forms of presentation are of note. Medical treatment was penicillin or derivatives in all the cases except one which was treated with diagnostic/therapeutic segmentectomy. CONCLUSIONS: It is concluded that when any subacute involvement of the thoracic and/or pleuropulmonary wall specific cultures should be carried out to discard eventual thoracic actinomycosis.
Actinomycosis of the gallbladder is rare, and the pathogenesis of the infection is poorly understood. The authors report the case of a 77-year-old man admitted to hospital because of abdominal pain. Clinical and laboratory findings suggested the diagnosis of cholecystitis and cholelithiasis. At cholecystectomy the gallbladder was inflamed and contained many calculi. Gram staining of material from the mucosa of the gallbladder demonstrated gram-positive pleomorphic filaments, and Actinomyces israelii grew in pure culture, thus confirming the diagnosis of actinomycosis of the gallbladder. The pathogenesis of the condition is also discussed.
A previously healthy 42 years old male was admitted to hospital with chest pain. Chest radiograms revealed a solid mass in the left thoracic cavity. A lung biopsy showed findings consistent with probable actinomycosis. It was feared that the specimen was not representative and a left upper lobe lobectomy was performed. This confirmed the diagnosis of actinomycosis. The patient was postoperatively treated with penicillin and tetracycline and has remained well during a follow-up period of two years.
Human actinomycosis may pose a diagnostic problem at times and is often mistaken for a neoplasm. A thirty-five year old male was clinically diagnosed as a case of carcinoma of the right maxillary sinus on the basis of history, clinical presentation and radiologic findings. Tissue biopsy was negative for malignancy on three consecutive occasions. Microscopic examination showed bits of granulation tissue and fragments of filamentous structures. On microbiological examination, Actinomyces israelii was isolated and fungus culture was negative. Long term Penicillin treatment caused disappearance of all signs and symptoms. The report highlights the importance of bearing in mind the fact that certain rare, chronic, suppurative granulomatous infections, like actinomycosis, may mimic malignancy.
We have had the chance to follow three patients with thoracic actinomycosis in a relatively short period of time (18 months). They were three male patients, with chronic dental infections. The illness appeared as toxic syndrome and fever. In all three cases diagnosis was made through samples obtained through fibropticbronchoscopy. At the same time all of them evolved favorably to the antibiotic treatment (penicillin and/or tetracyclines) prescribed. We conclude that the diagnosis of thoracic actinomycosis should be suspected in those patients with a compatible clinical and radiological condition, and who has suffered previous weakening diseases and periodontal lesions.
The case of a female patient aged 34 suffering from abdominal actinomycosis is reported. She underwent emergency surgery for an abscess-forming tumour infiltrating the lateral abdominal wall and giving rise to the clinical picture of acute abdomen. The casuistry is complemented by two further case histories of actinomyces infections in patients with fistulas of the anal region and pilonidal sinus respectively. Abdominal actinomycosis presents itself as a rare chronic bacterial inflammation, usually located in the right lower abdomen, with local abscess or fistula formation as well as tumour-like infiltration of the surrounding tissues. Exceptionally, the diagnosis is ascertained prior to surgery. Postoperative antibiotic therapy with penicillin for several months ist essential.
The authors describe in their case study the history of a 51 year old man, at whom they verified without thoracotomy thoracal actinomycosis. They achieved recovery giving permanently high doses of Penicillin. In connection with this rare case the authors review pathogenesis, the symptomatology, the diagnosis and the therapy of actinomycosis. The authors have found only one case in the Hungarian literature, which was recognized without thoracotomy and was cured by antibiotic therapy within a short period of time.
Actinomycosis is a chronic infection due to an anaerobic Gram positive commensal bacteria harbored in the healthy cavities. From the main localizations in facial, respiratory and gynecology cavities, the infection can progress forming abdominothoracic or pelvis tumors simulating pseudo-neoplastic formations. Macroscopic diagnosis of this uncommon disease is difficult even intraoperatively. The extemporaneous pathology examination confirms the presence of actinomyces grains. We report two cases of abdominopelvic actinomycosis which developed on a "forgotten" intrauterine device leading to torpid severe disease. Actinomyces are sensitive to penicillin if treatment is continued for several months but infiltrations into the urinary and digestive tract may lead to fistulae and hydronephrosis.
Pancoast's syndrome is almost exclusively caused by a malignant apical lung tumor invading the structures of the thoracic outlet. We report a case of thoracic actinomycosis as a cause of Pancoast's syndrome. A 65 y/o bm presented with a 6 month history of nonproductive cough, weight loss, a left upper lobe infiltrate, and a positive PPD of 20 mm. He failed to improve with triple antituberculous therapy for 3 months with worsening of left upper lobe disease. CT scan of the chest showed a mass lesion of the left upper lobe. Bronchoscopy with BAL and biopsy as well as percutaneous fine needle aspiration failed to reveal a diagnosis. Patient developed Pancoast's syndrome characterized by reflex sympathetic dystrophy with pain, swelling, and numbness of left shoulder, arm, and hand. A thoracoscopic left upper lung biopsy was performed and histologic examination revealed sulfur granules containing filamentous organisms characteristic of Actinomyces species. All sections were negative for malignancy. AFB stain and culture were negative. Patient was clinically cured following a 6-month course of penicillin with resolution of the left upper lobe mass. Although rare, thoracic actinomycosis must be considered in the differential diagnosis of Pancoast's syndrome. This case emphasizes the importance of obtaining a precise etiologic diagnosis before a treatment decision is made.
Affection of the CNS by actinomycosis is a rare but treatable manifestation of an infection with actinomyces israeli. Neurological involvement includes a meningeal, granulomatous and also pseudotumoral form. We report the case of a patient suffering from an intracerebral actinomycosis abscess. The source of infection was the upper jaw. After a right frontal craniotomy the intracerebral abscess was removed. Postoperatively the patient received initially a combined antiedemateous and antibiotic therapy with 12 mg dexamethasone and 6 g cefotaxime and 3 g amoxicilline. After 4 weeks of treatment with improving neurological deficits dexamthasone therapy was reduced followed by an exclusive antibiotic therapy for another 4 weeks. During this time the patient recovered completely.
Abdominal actinomycosis is a chronic suppurating granulomatosis caused by a Gram positive germ, Actinomyces. Manifestations of this rare disease are usually pseudotumoral syndrome leading to surgical exeresis. The diagnosis is obtained from the pathology report. We report a pseudotumor of the transverse colon which invaded the greater omentum and the anterior abdominal wall. From a review of the recent literature, we observed that most papers deal essentially with a relatively new entity, pelvic actinomycosis related to prolonged use of an intra-uterine device without medical surveillance.
Primary laryngeal actinomycosis is rare. The case of a woman with diabetes that presented with a 2-month history of hoarseness and cough is reported. The literature is reviewed and the clinical features and histology of laryngeal actinomycosis are discussed.
A case report of intrauterine device (IUD)-associated tubo-ovarian actinomycosis is presented. The patient was a 37-year-old nulliparous woman with IUD usage for the last four years. She presented anemia and weight lost of 8 kg. Ultrasound and computed tomography showed an unilateral large mass in the right adnexum adherent to the uterus and compressing the urinary bladder. Preoperative diagnosis of ovarian cancer with liver metastases was made. Bilateral salpingoophorectomy and total abdominal hysterectomy were performed. After pathological and biological analyses, actinomycosis was diagnosed and the patient was treated postoperatively with penicillin. The purpose of this article is to add to the literature a new case of this rare disease which clinically mimics ovarian cancer.
Four cases of actinomycosis involving the uterus and adnexal structures are reported. In 2 cases the infection was transmitted from a ruptured appendix. Ascending actinomycosis involving the endometrium and resulting in adnexal abscesses was associated with the use of an IUD in 2 patients. This infection should be suspected in any patient who develops a pelvic abscess with an IUD in place. Culture and histologic examination of tissue removed with the IUD may be a means of early diagnosis. The nature of these infections became apparent only after serious complications developed. Each patient required several surgical procedures. The diagnosis remained unsuspected until repeated laboratory examinations detected the fungus. The difficulty encountered identifying Actinomyces israeli indicates the infection is often undetected. Gallium scans were helpful in localizing occult abscesses in 2 patients.