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Ileo-caecal actinomycosis: report of a case simulating complicated inflammatory bowel disease.

Abdominal actinomycosis is a rare infectious disease caused by Actinomyces israelii, a gram-positive anaerobic saprophyte germ that is a normal inhabitant of the upper intestinal tract in humans. Actinomyces israelii rarely cause abdominal infections or actinomycosis. Abdominal actinomysosis is characterised by fistulae and abscesses and may mimic cancer or inflammatory bowel disease. Abdominal actinomycosis is difficult to diagnose preoperatively, and often require surgical removal of the diseased tissue, allowing pathologists for giving the definitive diagnosis, revealed by characteristic "sulfur granules". The authors report herein the case of a 47-year-old man who presented with diarrhoea and abdominal pain. Abdominal computed tomography evoked complicated inflammatory bowel disease and surgical procedure was decided. Laparoscopic exploration did not provide further significant information, and laparotomy with diseased bowel resection was performed. Pathology demonstrated "sulfur granules" and allowed the diagnosis of abdominal actinomycosis. This case demonstrated that abdominal actinomycosis should be included in the differential diagnosis when computed tomography shows an infiltrative and inflammatory mass.

Actinomycosis↗

Atypical presentations of pediatric actinomycosis: report of a case.

It is well recognized that cervicofacial actinomycosis is rare in children, especially at maxilla. Actinomycosis involving the maxilla usually is seen as a localized intraoral infection in contrast to classical cervicofacial actinomycosis. In this article, we describe an 8-year-old patient who had actinomycosis involving the bone at the left maxillary lateral incisor region. The diagnosis was based on histologic report because of location and development of the lesion with unusual history. The treatment of choice was removal of the soft and hard tissues with concomitant prolonged penicillin administration. In cases of persistent oral infection the diagnosis of actinomycosis should be actively attempted through microbiologic and histologic examination.

Actinomycosis, Cervicofacial↗

[Pulmonary actinomycosis diagnosed through transbronchial lung biopsy (TBLB)].

Pulmonary actinomycosis is a rather rare chronic pulmonary infection. Its diagnosis may be difficult without biopsy, because its culture from sputum or bronchial secretion is rarely successful. We report a case of pulmonary actinomycosis diagnosed by means of TBLB. A 57-year-old man was admitted to our hospital because of hemosputum. The chest radiograph at the first visit revealed a nodular lesion in the right middle lobe. The biopsy examination showed sulfur granules of which PAS-positive mycelium was arranged in a radiating pattern. On the basis of these findings, we diagnosed pulmonary actinomycosis. So far, there have been only 4 reported cases of pulmonary actinomycosis diagnosed by TBLB in Japan. TBLB is worth trying in the diagnosis of pulmonary actinomycosis, because it can avoid surgical procedures, if successful.

Actinomycosis↗

Actinomycosis of the temporal bone: a report of a case.

Actinomycosis is a chronic suppurative infection of the cervicofacial region caused by Actinomyces species, which are anaerobic, gram-positive filamentous bacteria. Although actinomycosis has a propensity for involving the oral cavity, rare cases of actinomycosis involving the temporal bone have been published. We report the case of a 14-year-old girl who presented with clinical, audiometric, and radiologic findings consistent with right chronic suppurative otitis media that persisted despite tympanomastoidectomy. Findings on histologic evaluation of a specimen obtained during revision surgery were consistent with a diagnosis of actinomycosis. Although actinomycosis of the temporal bone is rare, it should be considered in the differential diagnosis of chronic suppurative temporal bone infections that are resistant to standard therapy.

Actinomycosis↗

Actinomycosis of the ano-rectum: a rare infectious disease mimicking carcinomatosis.

Abdominal actinomycosis is an infectious disease caused by Actinomyces israeli, a usual germ of the gastro intestinal tract. It gives unusual tumoral lesions with abcesses and fistulas. More rarely is abdominal actinomycosis at the end of the abdominal tube. Cope in 1949 said: "Actinomycosis occurs so seldom in the colon and the rectum that no surgeon, even if he be a proctologist is likely in a life time to see more than a few cases" (4). An anorectal actinomycosis case that looked like rectal cancer is reported. It was treated successfully by surgery and antibiotherapy. Some anatomopathologic and mainly histologic characteristics lead to the diagnosis. General and pathological aspects, symptoms, diagnosis, differential diagnosis and therapy of anorectal actinomycosis are discussed.

Actinomycosis↗

[Inflammation of the small pelvis caused by Actinomycosis infection].

Authors report their observations obtained in the course of treatment of 36 patients suffered from pelvic Actinomycosis. The course of disease of patients treated with pelvic inflammatory disease during a period of five years was compared with the occurrence at IUD users and non-users. The interdependence of occurrence of Actinomycosis, as well as previous deliveries, abortions and the period of use of IUD was investigated retrospectively. Difference was made between primary and secondary Actinomycosis. Authors investigated the methods of diagnostics of Actinomycosis and those of prevention and treatment. It was stated that because of pelvic Actinomycosis at IUD users the surgical intervention was not higher than the PID caused by other pathogenic. microorganisms.

Actinomycosis↗

[Actinomycosis of the bladder in a girl].

Abdominal actinomycosis is a rare finding in pediatric patients and its location in the urinary bladder is exceptional. On the other hand, immunodepression can be found in several disorders including that of actinomycosis. The purpose of this study was to report a case of urinary bladder actinomycosis seen in a seven year old girl. No risk factors were found. It was diagnosed as an abdominal tumor which was successfully surgically removed and treated with penicillin. During her recovery, she suffered from a transitory cell-mediated depression of her immune system which later returned to normal once treatment as installed. The pathogenesis of actinomycosis is presented and a review of the literature is cited. Actinomycosis; immunodepression; bladder.

Actinomycosis↗

[X-ray computed tomographic and radiographic aspects of thoracic actinomycosis].

UNLABELLED: The aim of this study was to evaluate chest radiographs and computed tomography (CT) in patients with thoracic actinomycosis. MATERIAL AND METHOD: Chest radiographs and CT scans of 9 patients with proved thoracic actinomycosis were reviewed. CT scans were performed after intravenous contrast administration. RESULTS: Airspace consolidation was present in the upper lobes in 6 patients and in the lower lobes in 3. Cavitations not apparent on the radiographs were seen on CT s in 2 cases. Mediastinal lymphadenopathies were seen on CT s in 2 cases, in one the infection extended through the mediastinal pleura into the mediastinum. Pleural thickening adjacent to the airspace consolidation was identified in 6 cases. Chest wall invasion occurred in 4 cases with a wavy periostal reaction involving ribs adjacent to the site of parenchymal involvement in 3 cases. Extension into the abdomen through the diaphragm was seen in one case. DISCUSSION: In humans, actinomycosis involves the thorax in 15% of the cases. Thoracic and pulmonary parenchymal involvement is usually secondary to aspiration of colonized material from the oropharynx in patients with poor oral hygiene. There is a basilar predominance of the disease, but some studies have reported apical predominance. The pulmonary infection leads to an airspace consolidation mainly in the lung periphery. The infection may extend across fissures and through the pleura. Chest wall and bone invasion are not uncommon. A wavy periosteal reaction involving ribs is said to be highly suggestive of pulmonary actinomycosis. CONCLUSION: Thoracic actinomycosis is characterized by airspace consolidation with adjacent pleural thickening. Chest wall invasion with a wavy periosteal reaction is highly suggestive.

Actinomycosis↗

[Pulmonary actinomycosis resembling an anterior mediastinal tumor].

A 25-year-old, previously healthy man was referred to us because of fever, left-sided chest pain, and an abnormal mass shadow at the left pulmonary hilum on chest X-ray films. Laboratory tests and fiberoptic bronchoscopy revealed no abnormality. Thoracotomy was done because a mediastinal tumor was suspected. Surgery revealed that the left lingula was atelectatic and that the mass was in the left S4, not in the mediastinum. Pathological examination of tissue from the partially resected lung showed sulfur granules, and a diagnosis of pulmonary actinomycosis was made. At least 80 cases of pulmonary actinomycosis were reported in Japan between 1963 and 1995. Pulmonary actinomycosis is most common among men in the fifth and sixth decades of life, and almost all patients have oral disease. Pulmonary actinomycosis is often difficult to distinguish from lung cancer, because both appear as mass shadows on X-ray films, and almost all cases of pulmonary actinomycosis are diagnosed by thoracotomy.

Actinomycosis↗

Some etiologic concepts of actinomycosis of the greater omentum.

Since 1955, 33 patients with actinomycosis were treated at the University Hospital, Saskatoon, Sixty-seven per cent of the lesions involved the cervicofacial region; 24 per cent, the abdomen, and 9 per cent, the thorax. Trauma, inflammation or immunosuppression may have been partly responsible for the infection in 14 of the patients. Follow-up data were available for 21 patients. One of these patients died of thoracic actinomycosis, having received immunosuppressive therapy for leukemia. The others progressed well after treatment. In one patient with intra-abdominal actinomycosis, the disease was confined to the greater omentum and was apparently unrelated to the gastrointestinal or genitourinary tracts. He recovered after excision of the greater omentum and large dosages of penicillin. A search of the literature reveals that other reports on seemingly isolated intra-abdominal actinomycosis describe disease adjacent to hollow organs which required their removal. Immunologic studies demonstrated that a saline suspension of Actinomyces israelii was capable of inhibiting phytohemagglutinin stimulation of both the lymphocytes of the patient and of those of three normal donors. This may play a part in the progression of the disease.

Abdomen↗

[Mediastinal actinomycosis with formation of an esophagotracheal fistula. A case report].

Before antibiotics were available, actinomycosis was the most commonly diagnosed "fungal disease" of the lung because of its morphological similarity to true fungi. At that time actinomycosis presented a fairly typical clinical picture of empyema thoracis and sinus tracts in the chest wall. Nowadays it has become a rare infectious disease that is usually caused by the bacterium Actinomyces israelii and is amenable to treatment by most antibiotics available today. The following report describes the case of a 59-year-old man with an uncommon mediastinal actinomycosis that caused an oesophagotracheal fistula. This complication may develop due to the necrotizing inflammatory process that is typical for actinomycosis. With regard to the literature, the clinical manifestations of the disease and diagnostic and therapeutic considerations are discussed.

Actinomycosis↗

Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis.

BACKGROUND: Pelvic actinomycosis is a chronic suppurative inflammatory disease caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rarely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis. CASE: A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the presence of actinomyces presented with chronic vague lower abdominal pain, weight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guided core needle biopsy established the diagnosis of pelvic actinomycosis obviating immediate surgical intervention. Intravenous and subsequent long-term oral penicillin therapy was constituted and resulted in a significant decrease in the size of the pelvic mass. CONCLUSION: In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attempted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonged antibiotic therapy might eliminate the need for extensive extirpative surgery and assist in maintaining future fertility.

Actinomycosis↗

[Actinomycosis of the sigmoid as obstructive space-occupying lesion of the pelvis. A case report].

Abdominal actinomycosis is a rare chronic infectious disease, which may mimic abdominal cancer, inflammatory bowel disease or diverticulitis. We report the case of a 46-year-old women with a large bowel obstruction caused by extensive abdominal actinomycosis. Colon contrast examination revealed a stenosis in the sigmoid colon, while abdominal ultrasound showed a stenosis of the left ureter with left hydronephrosis. Preoperative presumptive diagnosis was a carcinoma of the sigmoid colon. She required emergency surgery, which involved both resection and colostomy. As in most cases reported in the literature, diagnosis was made postoperatively. Pathological examination following the sigmoid colon resection surprisingly revealed an actinomycosis. This case illustrates that consideration of actinomycosis in women with bowel obstruction and prolonged use of an intrauterine device could help to improve the preoperative diagnosis of this rare disease.

Actinomycosis↗

[Thyroid actinomycosis: a case report].

Actinomycosis is nowadays a not very common festered chronic infection. Cervicofacial actinomycosis is the most frequent clinical form, and it is due in most cases to Actinomyces israelii. Thyroid actinomycosis has been scarcely described in the literature. The lesions, that are characterized to be notably indurated and to contain multiple abscesses that drain to the surface through sinus tracts, frequently simulate other infective clinical entities and often neoplasms, therefore the diagnosis is delayed in the time. From a case of thyroid actinomycosis diagnosed and treated in our service which was initial diagnosed as a thyroid neoplasm, we revise the cases described in the literature and we make a point in the difficulty to arrive to the diagnosis of this entity.

Actinomycosis↗

Surgical considerations for pulmonary actinomycosis.

BACKGROUND: Diagnosis and treatment of pulmonary actinomycosis is difficult without surgical intervention. METHODS: Thirteen patients (10 men, 3 women; mean age, 62 years) underwent pulmonary resection and were given a pathologic diagnosis of pulmonary actinomycosis at our institution between 1976 and 2001. To clarify when pulmonary actinomycosis should be suspected in patients and the role of surgical intervention, we reviewed preoperative clinical characteristics, computed tomography findings, surgical indication, operative procedure, postoperative clinical course, and outcome. RESULTS: Ten patients (77%) had poor oral hygiene. Twelve patients (92%) were symptomatic, and 10 patients (77%) had hemoptysis. The mean interval between radiographic identification of the abnormality and surgical intervention was 8 months (interquartile range, 3.25 to 8 months). Computed tomography findings in all cases included radiologic opacity with air bronchogram or a low attenuation area. Lung cancer was diagnosed initially because of computed tomography findings of spiculation or pleural indentation, and operation was required in 8 patients (62%). The others were diagnosed with chronic pneumonia, and surgical intervention became necessary because of recurrent hemoptysis or prolonged illness. Six patients underwent lobectomy; the others underwent partial resection or segmentectomy. Neither complication nor recurrence has occurred. CONCLUSIONS: When patients, particularly those with poor oral hygiene, show radiologic opacity with an air bronchogram or low attenuation area on the computed tomography scan, pulmonary actinomycosis should be considered and penicillin should be administered as diagnostic therapy. Surgical intervention may be necessary when frequent hemoptysis has no resolution or lung neoplasm cannot be ruled out.

Actinomycosis↗

Urogenital aspects of actinomycosis.

Urogenital actinomycosis has always been a rare entity, limited to a few cases in any series. Treatment is highly successful but diagnosis remains elusive owing to low incidence, variable clinical picture, and biopsy and culture uncertainties. The general incidence of actinomycosis is believed to be decreasing in recent years but many infections may go undiagnosed while being suppressed or cured by conventional antibiotic therapy given for other resons. Our incidence of 4 cases of genitourinary and abdominal actinomycosis occurring in a 1-year period is highly unusual but the reasons remain speculative. Prior operation, abortion and induced infection via an intrauterine device were probably contributory. Whatever the case, if our experience is shared by others, genitourinary actinomycosis deserves more prominent diagnostic consideration in the future.

Actinomycosis↗

[Oral and cervicofacial actinomycosis. Presentation of five cases].

BACKGROUND: Actinomycosis is a suppurative and granulomatous chronic infectious disease caused by Actinomyces sp. and most commonly affecting the cervicofacial area. AIM: To study the clinical characteristics of patients with actinomycosis, with regard to clinical history, presentation, method of diagnosis, treatment and follow up. PATIENTS AND METHODS: A retrospective review was performed on all cases of microbiologically or histologically proven oral or cervicofacial actinomycosis. RESULTS: Five patients were studied, 2 men and 3 women, 25-69 years old. Four patients had a history of surgical procedures and/or dental manipulations. Three patients showed the classic presentation of a lump and fistulization, and two patients presented intra-oral lesions. Four patients were diagnosed by cultures positive to A. israelii on microbiologic study and the remaining patient by cytologic detection of a sulfur granule. The first patient received the classic initial regimen of iv penicillin and 3 were treated with third-generation cephalosporins, continuing with oral amoxicillin during 12 months. Patient no.2 required a second surgical procedure. Patient no. 5, who had an exclusively oral process, received a short course of amoxicillin. There were no relapses during follow-up. CONCLUSION: Actinomycosis is an uncommon disease. Establishment of the definite diagnosis requires a high index of suspicion and good clinical-microbiological collaboration. The classic course of iv penicillin and oral amoxicillin during 6-12 months is effective. For the acute phase treatment, iv penicillin can be replaced by third-generation cephalosporins.

Actinomycosis, Cervicofacial↗

Pelvic actinomycosis in menopause: a case report.

OBJECTIVE: To examine the association between the use of intra uterine device (IUD) and the risk of actinomycosis in postmenopausal women. METHODS: We report a case of pelvic actinomycosis in a postmenopausal woman who was wearing an IUD for 14 years until 20 months after the beginning of menopause. In the last 5 years the patient had been suffering occasionally from pain, abdominal tension and rectal tenesmus. The disease was revealed clearly 18 months after removing the intrauterine device. RESULTS: The diagnosis of pelvic actinomycosis was only possible after hysterectomy, bilateral oophorectomy and multiple biopsies. At histological features a focus with actynomycetes colonies was evident. CONCLUSIONS: This study supports the previously reported association between the pelvic location of actinomycosis and the use of the IUD. The removal of IUD should be mandatory in postmenopausal women.

Actinomyces↗