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Five patients with central nervous system actinomycosis are presented. There were risk factors in 2 patients like penetrating head injury and tetralogy of Fallot. All the cases were diagnosed by histopathology. Four patients recovered after surgery and antibiotic therapy, and 1 patient died.
A middle aged woman presented with right submandibular swelling, fever off and on and anemia. Excisional biopsy of the gland showed Actinomycosis. It is a rare disease in the neck. Patient was treated with high doses of parenteral pencillins followed by three months course of oral Doxycyclines. The patient was followed up to six months and she was symptom free. In this case report the disease is elaborated and literature is reviewed.
A case report of pulmonary actinomycosis is presented. The 33-years old man complained of long term pain in the thorax, coughing and subfebrile body temperature. Pleural empyema and pulmonary neoplasm were suspected. The final diagnosis was established by open thoracotomy and definitive histological examination. Partial lung resection and post operative penicillin G therapy were performed.
Actinomycosis is a chronic, suppurative, fibrotic infection produced by a gram-positive anaerobic bacteria of the normal mouth flora, the infection having tendency to fistulate and to extend without respecting tissue layers. Initial diagnosis is usually delayed due to its painless evolution. Three clinical forms are known: cervicofacial, abdominal and thoracic. Occasionally, there is vascular involvement which is mainly associated with venous thrombotic phenomena with low clinical expresion and hematogenous dissemination that can result in a formation of abscess or meningitis in the central nervous system. We report the case of a 28 year old female patient with type I diabetes and microangiopathyc complication with a internal carotid artery stenosis adjacent to mandibular angle actinomicosis. A few months later and after a miscarriage she suffered from ischemic stroke. The anticardiolipin antibody were positive at the time of stroke with post-operative period and over the next two years. To our knowledge (Medline, 1984-2004), it is the first report of internal carotid vasculitis originated by cervicofacial actinomicosis. We discuss the neuroradiological aspects of our case.
A 51-year-old man complaining of cough and bloody sputum, was admitted to our hospital because of antibiotic-resistant chronic pneumonia in the right upper lobe. Initially, bronchoscopic examination and sputum culture revealed no evidence of malignancy or any specific infection, either pathologically or microbiologically. However, pathological examination of a solid body expectorated with sputum revealed typical sulfur granules, indicating pulmonary actinomycosis. Two actinomyceses named Actinomyces odontolyticus and Actinomyces meyeri were detected later. Pulmonary infection caused by these types of actinomyceses is rare, and the diagnostic procedure seemed to be unusual.
Cervicofacial actinomycosis, a rare chronic infectious disease, is, however, an important clinical entity, due to the difficulties involved, still today, in its diagnosis. Following personal experience in a case referred to our Department, and in agreement with reports in the literature, attention is drawn to the presenting clinical manifestations, stressing that these are often confusing since they mimic those of other diseases, Moreover, many pre-operative investigations (radiological scans, incisional biopsy, fine-needle aspiration) are generally nonspecific. Finally, surgical excision of the mass is now the last essential step to make a definitive diagnosis and define the appropriate antibiotic therapy.
The authors present a case-review of a patient with a thoracic form of actinomycosis, simulating a "pancoastoid" lung tumor clinical picture- furthermore, confirmed by a false-positive cytological examination. The disorder was managed by enlarged lobectomy from the right lung, followed by postoperative antibiotic therapy, lege artis. The long-term outcome is very good.
Actinomycosis is an infection due to an anaerobic Gram-positive bacilus bacteria: Actinomyces. Tubo-ovarian locallisation is rare. It more often appears clinically as a pseudo-tumoral and feverish syndrom, evoking wrongly a malignant tumoral pathology, and often leads to a mutilating surgical treatment. Intra-uterine device appears as the principal favorable factor of this pathology. Basing on two cases reported by the authors, and after literature review, physiopathology, clinical and paraclinical expression, and treatment of this affection are discussed. A set up is made.
Actinomycosis is a rare disease and may be discovered at operation. It may produce numberous thoracic or abdominal signs; the diagnosis is very difficult and requires histological examination.
Actinomyces species are rare but treatable causes of central nervous system infection. A case of actinomycotic cerebral abscess is reported. The primary source of infection was probably the lung based on radiological findings although culture of the bronchial brushings was negative. The patient had surgical excision and repeated drainage with two prolonged causes of antibiotic therapy. At follow-up examination 36 months later, the patient was well except for a residual left hemiplegia. Diagnosis of cerebral actinomycosis can be made by anaerobic culture of the appropriate specimens or on histologic grounds. Optimal management combines adequate surgical drainage and prolonged antibiotic therapy.
Arachnia propionica was isolated from an abscess resembling actinomycosis in a four-year-old crossbred cow. The properties of the organism were described in comparison with closely related organisms.
The authors report a case of pseudo-tumoral thoracic actinomycosis with lysis of a rib in a young man who was a heavy smoker and drinker. This observation is an opportunity to review the usual difficulties of diagnosis in patients with this rare disease occurring most often in a patient who is debilitated with important disease in the teeth and gingival margins. The standard treatment is penicillin G, which leads to a cure within one month.
Abdominopelvic actinomycosis associated with the use of an intrauterine contraceptive device (IUD) is described. The diagnosis is usually made after exploratory laparotomy for severe abdominal pain and signs of an acute abdomen, or for prolonged lower abdominal pain and findings consistent with pelvic malignancy. 3 women aged 33, 44 and 52 years, respectively, are presented.
Actinomycosis is a bacterial infection that affects chiefly the cervico-oro-facial area, the abdomen and lungs. From these sites it may sometimes spread to the central nervous system. Extremely rare, and controversial, is the possibility of a primary infection of the central nervous system. We report an odd case of apparently primary brain abscess caused by Actinomyces israeli and review the literature.
The Authors describe a clinical case of a 60 year old man with cervico-facial actinomycosis. The histology, the differential diagnosis and the successful penicillin therapy are also discussed.
We present a case of cervical actinomycosis which due to its localization, unusually low and posterior, made its debut as a monoparesis and which due to its unexpected size, marked aggressiveness, and radiologic image mimicked a tumor. We have not found in the literature this kind of presentation up to date. Although sulphur grains were not observed, empiric treatment could be started based on the Gram stain information. Culture was delayed 15 days, but we could promptly obtain reliable diagnosis thanks to pathologic study. Associated Pseudomonas aeruginosa was isolated.
We report 8 cases of thoracic actinomycosis, a disease which is now uncommon owing to the widespread use of antibiotics and which is caused by anaerobic filamentous bacteria living as saprophytes in natural cavities. Recent pathogenetic data, such as propagation by continuity or blood stream, as well as bacteriological and clinical data (mediastino-pulmonary, pleural, parietal, cardiac and disseminated lesions) are reviewed. Diagnostic problems are due to the difficulties encountered in trying to isolate the saprophytic organism, and pathological examination is often required for the diagnosis. Treatment is basically medical and consists of penicillin G or A administered for prolonged periods. Nitroimidazoles are ineffective against these anaerobic bacteria.
Pelvic actinomycosis is uncommon and usually represents a complication of an intrauterine device (IUD). This organism is very difficult to culture, and most actinomyces is actually identified by histologic features in pathologic specimens or by cytologic features on Papanicolaou smears. A specific fluorescent antibody stain is also available. Tubo ovarian abscess is usually polymicrobial with a preponderance of anaerobic organisms and the exact role of actinomyces in abscess formation remains unclear.