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Three cases of thoracic actinomycosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empyema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are thoroughly analyzed.
A case of actinomycosis of lower abdominal wall and bladder apex related to and involving urachal remnants is reported. The elderly patient presented with the not uncommon problem of a lower abdominal mass and vague sympatomatology but, in this case, of rare aetiology.
A case of hepatic actinomycosis contracted one year after removal of an intrauterine device during ongoing Actinomyces cervicitis is reported. During active disease, lymphocytes from the apparently fully immunocompetent patient were able to proliferate but not to produce the proinflammatory lymphokine gamma-interferon in response to Actinomyces antigen. This ability was only partly restored during antibiotic therapy.
UNLABELLED: AN UNUSUAL INFECTION: Actinomycosis, uncommon in a pelvic localization, is a severe condition not well known to gynecologists. It is caused by Actinomyces israeli and is closely associated with long-term use of an intrauterine device. In the pelvic localization, the disease generally presents as a pseudoneoplastic formation. DIFFICULT DIAGNOSIS: Diagnosis is generally not established clinically. Pathology provides positive diagnosis. The germ cannot be isolated easily as it does not survive standard bacteriology sampling. Monoclonal antibodies may be helpful. MEDICAL TREATMENT: Intravenous penicillin G followed by at least 6 months oral penicillin is generally successful in eradicating the infection. Indications for surgery should be limited to diagnostic procedures (pathology specimen), drainage in case of abscess formation, and removal of an obstacle compressing the digestive or urinary tract.
Actinomycosis located in the central nervous system is an extremely uncommon event, but if correctly diagnosed and properly treated may have a good prognosis. This case report of a cerebral abscess caused by actinomyces suggests that such a rare event should be included in the differential diagnosis of infectious diseases that affect the central nervous system.
The authors according to literature data, discuss some difficulties in diagnosis of three cases of facial and perimaxillary tissue actinomycosis. The histopathological examination of changed tissue is the most important point in diagnostic procedure in relation to clinical symptoms.
The authors report the history of a patient suffering from abdominal actinomycosis. The correct diagnosis could be established by an ultrasound-guided aspiration sampling from the small-intestinal abscess, following the sonographic localisation of the lesion. The patient recovered by a long-term antibiotic treatment. Related to the case the authors review the relevant literary data of the past few years and point to the value of ultrasonography in the successful management of the disease.
INTRODUCTION: Actinomycosis is a rare spreading suppurative and granulomatous disease. In 50 to 60 p. 100 of cases, cervico-facial area is involved. Involvement of other cutaneous areas is very uncommon. CASE-REPORTS: Two men (51 and 58 year-old, respectively) were admitted to the hospital because of erythematous and violaceous nodules with fistulization to the skin, localized on the perianal area and buttocks for several months. Bacterial cultures of the pus and of skin biopsy specimens yielded Actinomyces meyeri in case 1 and Actinomyces israelii in case 2. Patients did not have other infectious lesions. Treatment included systemic antibiotics and surgical iterative excisions in case 1. DISCUSSION: The main interest of those two cases is their similar clinical presentation and in one case the rarity of the micro-organism involved (Actinomyces meyeri). Since the lesions involved only the skin, we postulate that the organism may have extended from the oral mucosa through the gastrointestinal tract.
The authors report a case of a Dalkon Shield, forgot in a 55 years old patient, responsible for actinomycosis infection. Basing on a review of the literature, diagnostic methods and management of this kind of complication are discussed.
Actinomyces are Gram positive, anaerobic, filamentous bacteria, saprophytes of the oral cavity and intestinal tract of humans. They rarely cause chronic suppurative infections. Abdominal abscess can masquerade as a malignant process and lead to a surgical intervention with resection. We report three patients with abdominal actinomycosis; the first affected the liver with a favorable outcome on medical treatment, the second of abdomino-pelvic localisation was related to an intra-uterine device and the last affecting the transverse colon simulated a malignant process and required an hemicolectomy. These observations illustrates the difficulties of the diagnosis of this rare and unrecognized disease.
A skin condition in cattle, associated with crusted lesions on the back, flanks, neck, head and skin of the udder was found to be cutaneous actinomycosis (streptothricosis) caused by D. congolensis, which is common in tropical regions during the rainy season. This actinomycete was isolated for the first time from cattle in the Netherlands in the case reported. Data culled from the literature as well as the diagnosis and treatment of the patient are discussed.
The authors report a case of renal actinomycosis in an adolescent presenting with two fistulized lumbar abscesses. This rare disease, which generally has a good prognosis, is difficult to diagnose, both clinically and radiologically. The positive diagnosis is based on histological examination, more frequently of the nephrectomy operative specimen, than ultrasound-guided fine needle aspiration biopsy of an atypical renal tumour. Conservative treatment with high-dose penicillin gives excellent results.
A series of 10 instances of genital actinomycosis infection complicating the use of intrauterine contraceptive devices is recorded and its pathogenesis described. The likelihood is suggested that this complication is more frequent than is generally appreciated. A pathway of infection extending upward from the patient's anus, across the perineum, and up the vagina and cervix is suggested as the route of infection. The traumatizing effect of the device and a previously existing or intercurrent infection as additional contributing factors to the development of actinomycotic infection in the female genitalia is also postulated.
The difficulties in diagnosis of abdominal actinomycosis are presented. Clinical manifestations and colonoscopy suggested malignancy. Final diagnosis was made on the basis of pathological assessment of resected sigmoid. Authors underline that in case of "negative" pathomorphological results of material obtained during endoscopy from lesions suspected, benign disease should be consider including anctinomycosis and intraoperative pathomorphological examination should be performed.
Actinomycosis is a suppurative infection usually due to a facultative anaerobic bacteria, actinomyces israelii. This rare infection has been reported in immunocompetent individuals, with buccal or pharyngeal mucosal erosions. Paradoxically, few cases have been observed after solid organ transplantation: 2 cases after lung, 1 case after heart-lung transplantation and 1 case after renal transplantation. We report on a renal transplant recipient who developed a tongue and oropharynx suppurative abscess, looking like an epithelioma. Histological examination showed granulomatous inflammation with an angiofibroblastic reaction; few colonies of actinomyces were also observed by the pathologist. This lesion disappeared easily and totally after tetracycline treatment.
The case of a 49 year-old female patient, with frequency of urination for 2 years, having a mass at the anterior bladder wall and at the anterior abdominal wall is reported. Cystoscopy found an impression of the anterior bladder wall and hyperremic edematous bladder mucosa. Pre-operative computerized tomography suspected bladder tumor. Laparotomy revealed an inflammatory firm mass at the anterior bladder wall and another mass at the anterior abdominal wall. Partial cystectomy and excision of the mass at the anterior abdominal wall were performed. After the pathological examination confirmed actinomycosis, the patient was treated post operatively with penicillin. She recovered well.
The authors present a case of actinomyces of the tongue indicating initial actinomyces with signs of ulceration possibly neoplastic. A swab from a discharge confirmed actinomycosis. A diagnosis by antibiogram led to a cure of the specific location and the general infection.
The patient was a 58-year-old man who had been admitted in 1995 because of hemoptysis. Chest CT scans showed air-space consolidation with dilated bronchi and calcification in the right S3. He received a diagnosis of bronchiectasis with old tuberculosis. Bronchial arteriography showed arterialization in the right S3, and bronchial artery embolization was performed. But in 1996 hemoptysis reappeared. He was readmitted in May 1999 because of recurrent hemoptysis. Bronchial arteriography showed recurrence of arterialization in the same area, and chest CT scans showed growth of the mass shadow. Right upper lobectomy was performed, and the microscopic findings of the resected specimen showed sulfur granules in the dilated bronchus. We concluded that pulmonary actinomycosis should be considered in the differential diagnosis of abnormal chest shadows.