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We describe an unusual case of actinomycosis that appeared as a nasal mass. The diagnosis was established when Actinomyces viscosus was isolated from pus obtained from the right maxillary antrum by intranasal antrostomy. The patient was treated with intravenous crystalline penicillin and made an uneventful recovery within 10 days.
We report one case of renal pseudotumor caused by actinomycosis with cutaneous fistula in a young French Guyana's boy. Diagnosis before surgery and histology is difficult. CT is the best examination to evaluate the extent of the disease. A short review of the literature is presented.
This first polish paper presents respiratory actinomycosis as a complication caused by aspiration of a foreign body. Aspiration of a citrus fruit stone occurred as a result of esophagus stenosis and dysphagia caused by a mistake made by a blind person of drinking a caustic substance. Clinical and bronchoscopic features suggested bronchogenic carcinoma but it's not confirmed by two histopathologic examinations of section from pathological bronchial changes. Diagnosis was based on the morphological picture of sections taken during third fibreoptic bronchoscopy and on cytological sputum examination. Removing the aspired foreign body from bronchus and prolonged penicillin treatment resulted in clinical and radiological amelioration.
The authors present the case of primary actinomycosis of the middle ear. The frequency of this disease, treatment and pathological diagnosis are discussed. A check-up examination 20 months after the last surgery of the ear revealed a good local at general condition of the patient.
A case of primary endogenous genitalactinomycosis with an IUD in situ is reported. 200 cases of actinomycosis of the female genital organs have so far been reported in literature. The mode of infection are discussed. In this case the ascension from the vagina and uterus are most probable. The treatement completely cured the patient.
Pelvic actinomycosis is uncommon, presenting most frequently as an abdominal mass and simulating advanced malignancy in female patients with a past history of intrauterine contraceptive use. It responds favourably to prolonged antibiotic therapy with occasional need for abscess drainage and débridement or ureteric stenting. Incorrect diagnosis may result in overly invasive investigations and unnecessarily radical extirpative surgery.
A 54-year-old man was admitted to our hospital with hemoptysis. Chest radiography and chest CT scanning demonstrated atelectasis in the right middle lobe. Bronchoscopy showed nothing of abnormal appearance. We performed a middle lobe lobectomy suspecting that the continuing hemoptysis was caused by the lesion in the middle lobe. Histologically, a vegetable foreign body (cryptomeria) was recognized in a bronchiole of the middle lobe, surrounded by inflamed tissues and sulfur granules. It was suggested that all of these were the cause of the hematoptysis. The patient was discharged on the fourteenth postoperative day, and has been asymptomatic since. This was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis.
Two cases of pediatric thoracic actinomycosis are presented. A review of the English literature revealed forty-six additional cases in the last 25 years. The mean age of diagnosis was 10 years. The most common presentation was a mass associated with weight loss, fever, and cough. Actinomyces israelii was the most common causative organism. Prognosis was generally excellent after long-term therapy with penicillin.
Actinomyces is an aerobic, Gram positive bacteria saprophyte of the genital tract. The endometrial involvement is extremely rare. The authors report two cases of pelvic actinomycosis in a 58 and 55 year old women, the second using intrauterine device for 11 years.
A case of liver actinomycosis successfully treated with high doses of penicillin for a long period after surgery is reported. The unusual location of the disease and early detection difficulties delayed the diagnosis and establishment of proper treatment, causing additional liver damage. Serum globulin levels, alkaline phosphatase and turbidity tests were of diagnostic significance. Adequate drainage of the lesion and long-term antibiotic treatment with penicillin proved therapeutically satisfactory.
We report 4 cases of osteitis with extensive necrosis of the maxillofacial bone due to actinomycosis. Histological study showed soft tissue necrosis with bone involvement, suppuration and granulomatous inflammation. At contact with bone destruction, numerous Gram and PAS positive bacteria with branched filaments, inconsistently associated with granules, were noted. Cultures were negative. Ultrastructural study showed in two cases, some elongated bacteria, variable in size, less to one micron in diameter, associated with ossein destruction. Actinomycetes usually represented in the normal oral flora, may become pathogenic in debilited host. Histologic study is necessary for the diagnosis allowing to confirm the tissue invasion by the bacteria.
Case report of tubo-ovarian abscess due to Actinomyces israeli is presented with revision of the literature with regard to pathogenesis, diagnostic difficulties and treatment. Diagnosis was established by culturing the organism from exudate obtained during surgery. The pathogenesis of pelvic actinomycosis is still controversial. Penetration of the GI tract with subsequent infection of the pelvic viscera seems to be the most likely mode of infection. Penicillin has an important role in the treatment of this disease. It does not cure, but retards the course of the infection. Surgical extirpation of infected tissue in combination with penicillin offers the best therapeutic results. When chronic pelvic inflammatory disease does not respond to therapy, when the sedimentation rate remains high, and the patient's general debility is progressive, an actinomycotic infection should be suspected.
Medical records of 48 dogs with cutaneous actinomycosis or nocardiosis were reviewed. Male, large-breed dogs kept outdoors were overrepresented. The mean age at admission was 3.6 years. Cutaneous swelling (68%), abscesses (65%), draining tracts (48%), fever (36%), and signs of pain (13%) were the most common clinical findings. The cervicofacial area was affected in 48% of the dogs. Abdominal and thoracic wall involvement was less common. Leukocytosis, neutrophilia with left shift, monocytosis, and hyperglobulinemia were common. The diagnosis was confirmed by cytologic examination, bacteriologic culture, or histologic examination. Gram-positive filamentous bacteria were seen in 69% of the fine needle aspirates and in 50% of the biopsy specimens. Actinomyces spp were isolated from cutaneous lesions in 27 (60%) dogs. Nocardia asteroides was isolated from 1 dog. Treatment consisted of surgical debridement, drainage, and administration of antibiotics in 29 dogs (group A) and antibiotics alone in 13 dogs (group B). The infection redeveloped in 10 (42%) group-A dogs and 6 (60%) group-B dogs. Of the 10 group-A dogs with recurrent infection, 6 had resolution after a second surgery and 4 were euthanatized. Of the 6 group-B dogs, 1 had resolution after surgery, 4 were euthanatized or died because of persistent disease, and 1 had an unresolved infection. The combination of surgery and antibiotic treatment appeared to be superior to antibiotic treatment alone in resolving cutaneous Actinomyces and Nocardia infections.
Intramural masses were resected from jejunum and ileocecal portion of a 49-year-old, female patient with partial gut obstruction. Histopathological examination indicated the masses to be tumorous eosinophilic enterocolitis. Recent and late development phases of Sarcocystis in relation to bradyzoite infection have been observed and considered to be responsible for eosinophilic inflammation. Concomitant intestinal actinomycosis, known to produce tumorous lesion without eosinophilia, appears as an attractive natural model in producing tumorous eosinophilic enterocolitis. Pertaining to parasitic development, it is suggested that persisting sporulated oocyst may undergo spontaneous excystation in the host's intestinal wall, along with complex sporogony.
Most cases of thoracic actinomycosis (TA) have been surgically diagnosed and treated, since it is difficult to distinguish this condition from lung cancer. To clarify the features that are useful for the radiological diagnosis of TA, we analyzed the correlation between the radiological and pathological findings. TA was histologically diagnosed in the 11 patients of the present study, who were admitted to our hospital between 1976 and 2001. In the chest CT, consolidation was observed in 5 cases, a mass-like shadow in 4, a central low attenuation area (LAA) in 7, and bronchial and bronchiolar dilatation in 6. In the pathological findings, all cases showed bronchial dilatation and abscess formation in the bronchi, as well as peribronchial granulation. The evaluation of radiological and pathological correlation revealed that the central LAA in the chest CT corresponded to the abscess formation composing of actinomyces, and the cavity corresponded to the bronchial dilatation. These results suggest that radiological findings, such as LAA and bronchial and bronchiolar dilatation, are characteristic for TA, and can be useful in making a diagnosis of TA.
One case of breast actinomycosis in a 29-year-old woman is reported. Material of a sectoral resection was morphologically considered as a lobular infiltrative carcinoma. In surgically removed breast and regional lymph nodes granulomatous process with foci of suppuration and druses of actynomycetes were found.
A case of actinomycosis mimicking abdominal neoplasm in a 56-year old woman is presented. Actinomyces israelii is a common saprophyte found in the mouth and gastrointestinal tract. It is an anaerobic, Gram-positive, branching filamentous fungus related in many respects to the bacteria. Damage to the mucosa by trauma, disease or surgery is an essential prerequisite to infection with this organism. In 20% of the cases the abdomen is involved, but an abdominal mass is a rare presentation. In such cases diagnosis prior to exploratory laparotomy is difficult.
Pulmonary actinomycosis, a rare bacterial disease, is characterized by focal suppuration and an expansile fibrogranulomatous process that has a pseudotumoral evolution. On radioclinical examinations, it often mimicks an advanced or even inextractable primary bronchial tumor, thus leading to extensive surgery or even to give up the treatment. The effectiveness of antibiotic therapy leads the authors to discuss the role and limitations of surgery.