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PubMed2006

[Digestive actinomycosis: three cases and review].

Actinomycosis is a chronic suppurative disease. It is caused by an anaerobic bacterium, generally Actinomyces israelii. Cervical and thoracic localizations are most frequent. Digestive actinomycosis is rare and can simulate cancer leading to resection. We report 3 cases of surgical abdominal actinomycosis. Localization was colic in 2 cases and hepatic in 1 case. The diagnosis of actinomycosis was made after resection in the 3 cases. The evolution was favourable under medical treatment. These observations illustrate the difficulty of diagnosing this rare and unrecognised disease which can be cured by long term penicillin therapy.

Actinomycosis↗
PubMed1990

A survey of thoracic actinomycosis.

We have reviewed the case notes of 19 patients with thoracic actinomycosis. The median age at presentation was 42 (range 9-66) years, 15 were male and 12 were urban residents. Cough, sputum production, chest pain and weight loss were the commonest symptoms. Six patients reported haemoptysis. In contrast with the classical appearances of thoracic actinomycosis, only four patients had cutaneous abnormalities, and only one patient had radiological evidence of bone involvement. The provisional diagnosis was bronchial carcinoma in nine patients, and in seven patients the diagnosis of actinomycosis was only made after resection of the lesion, in two cases by pneumonectomy. The median delay between presentation and diagnosis was 3.5 (range 1-24) weeks. Two patients developed extrathoracic complications, but all patients made a full recovery after receiving antibiotic therapy for a median of 6 (range 1-24) weeks. Thoracic actinomycosis is rare, but should still be considered in the differential diagnosis of a pulmonary lesion thought to be malignant.

Actinomycosis↗
PubMed2003

The role of surgery in hemoptysis caused by thoracic actinomycosis; a forgotten disease.

OBJECTIVE: Thoracic actinomycosis is a relatively uncommon anaerobic infection caused by Actinomyces israelii. Rarely, it may be complicated by an unusual but significant hemoptysis manifestation. We describe our experiences of surgical treatment for hemoptysis in patients with pulmonary actinomycosis. METHODS: From 1984 to 2002, 14 patients with thoracic actinomycosis and hemoptysis were diagnosed after thoracotomy. There were 11 male and three female patients with a mean age of 53.6 years. They all had non-specific symptoms and radiographic findings, and no case was an accurate diagnosis made at the time of hospital admission, including echo-guide aspiration, serial bronchoscopic biopsy and computed tomography biopsy. The indications of surgical intervention in our patients were for treating complications such as hemoptysis, chronic sinus discharge, or empyema, also limited to diagnostic purposes. Preoperative embolization was performed in seven cases; however, none was successful. RESULTS: Among the 14 patients, all the lesions were unilateral. The disease was confined to the lung in all patients; and chest wall involvement in one patient. The surgical procedures included were as follows: pneumonectomy (n=1), bilobectomy (n=1), lobectomy (n=10), wedge resection (n=2), and lung lesion with concomitant chest wall resection and chest wall reconstruction (n=1). Mean intraoperative and postoperative blood loss within the first 24 h was 192.3 ml, and five patients required blood transfusion. All of the specimens from the lesion site showed histological evidence of Actinomyces infection. All patients regularly took 12 million units per day of intravenous crystalline penicillin G during their hospitalization, and oral procaine penicillin for up to 2 months. During the follow-up, all patients had an uneventful postoperative course. CONCLUSIONS: A high index of suspicion for this disease is advised for the surgeon engaged in the treatment of hemoptysis. Surgical resection of pulmonary actinomycosis is effective in preventing recurrence of hemoptysis. After diagnosis, it is treated using penicillin chemotherapy for at least 2 months.

Actinomycosis↗
PubMed1998

Thoracic actinomycosis.

OBJECTIVE: Thoracic actinomycosis is a disease that is difficult to diagnose because its appearance varies from similarities with bronchogenic carcinoma to pneumonitis-like tuberculosis infections. Therefore the majority of patients undergo operations for diagnosis. We had seven patients with thoracic actinomycosis which were not diagnosed before operation. METHODS: Between July 1990 and November 1997, seven patients with thoracic actinomycosis were diagnosed after thoracotomy in our centre. They all had non-specific symptoms and radiographic findings, so we failed to diagnose the disease during preoperative examinations. Therefore they all underwent thoracotomy for diagnosis. Four patients were operated because of suspicion of malignancy, two patients were operated because of pulmonary infiltration and abscess formation and one patient because of undiagnosed pulmonary infiltration. Lobectomy was performed in five of them because of destroyed lobes, and wedge resection was performed in two patients. In two patients the disease was diagnosed by fresh smears obtained from specimens in the course of operation and confirmed histopathologically and in the others histopathologically in the postoperative period. RESULTS: Three major complications, acute renal failure, empyema and persistent air leakage developed in three cases after the operations. Bronchopleural fistula was found in only one of them and the patient died because of uncontrolled infection and sepsis on the 26th postoperative day. All of the other six cases are still alive. We did not observe any other problem in their long-term follow-up. All patients regularly took 20 million units/day of intravenous crystalline penicillin G when they were in the hospital. After that, antibiotic treatment was completed up to 2 months with procaine penicillin. CONCLUSIONS: Sometimes diagnosis of the actinomycosis of the lung is very difficult although it is an infection. In that case thoracotomy is needed for the diagnosis and sometimes for the treatment. In some cases because of the irreversible parenchymal change resective surgery may be needed. Actinomyces israelii infections should be suspected of in chronic infiltrative, nodular, cavitary process and tumour-like mass lesions besides other most probable causes. After diagnosed, it is treated using penicillin chemotherapy at least for 2 months.

Actinomycosis↗
PubMed2002

Actinomycosis imitating an adrenal tumor.

Abdominal actinomycosis is a rare condition that may mimic malignant disease. The authors report a case of adrenal actinomycosis discovered incidentally by computed tomography scan of the abdomen. Frozen sections and culture of the mass were consistent with actinomycosis. The diagnosis and management of actinomycosis is discussed in detail.

Abdominal Injuries↗
PubMed2000

[Actinomycosis of the sigmoid colon as the etiology of lower abdominal pain].

We report a case of abdominal actinomycosis in a young woman wearing an intrauterine contraceptive device. The patient presented with right lower abdominal pain. A diagnostic laparoscopy was performed. Intraoperatively two perforations of the sigma were detected, a sigmoidectomy was performed. Postoperatively no problems occurred. Histology revealed an abdominal actinomycosis. In the literature only some case reports are published dealing with abdominal actinomycosis. Women wearing intrauterine contraceptive devices seem to have a higher risk of actinomycosis. In unproblematic cases antibiotic therapy is the treatment of choice. In cases of doubt as in our case surgery is recommended to confirm the diagnosis.

Abdominal Pain↗
PubMed1982

[Actinomycosis of the female genital tract in wearers of intra-uterine contraceptive devices (author's transl)].

Two cases of actinomycosis of the upper female genital tract in wearers of intrauterine contraceptive devices are reported. The cases were both observed within a short time interval. In the first case the disease had spread to large portions of the minor pelvis and shown the expected symptoms and signs. In the second case the actinomycosis was confined to the endometrium. The rarity of pelvic actinomycosis and the differential diagnosis with malignant tumours of the female genital tract prompted us to examine this infection in detail. Apparently pelvic actinomycosis is more common than suspected.

Actinomycosis↗
PubMed1986

Abdominal actinomycosis.

Abdominal actinomycosis seldom occurs before puberty. The symptomatology of abdominal actinomycosis is non-specific and the diagnosis is difficult to make. Previously, this condition was associated with a high mortality rate. The following patient had a flank abscess due to actinomycosis as a late complication of perforated appendix which was diagnosed by biopsy and culture. The patient responded to a prolonged course of chemotherapy with intravenous penicillin and metronidazole. This case illustrates the problems encountered in the diagnosis and management of childhood actinomycosis.

Abscess↗
PubMed2003

A case of ovarian actinomycosis.

BACKGROUND: Pelvic actinomycosis is uncommon and often presents as a complication of an intrauterine device (IUD). A diagnosis of actinomycosis can be made from the finding of sulfur granules within inflammatory exudate on histologic examination after surgery. However, it may be possible to diagnose actinomycosis before surgery by finding Actinomyces-like organisms on Papanicolaou smears. CASE: A 41-year-old woman had been diagnosed as having a pelvic abscess, and bilateral salpingo-oophorectomy was performed. She had been an IUD user for 6 years. Actinomyces-like organisms were detected in her previous Papanicolaou cervical smears. If the patient had been treated when the Actinomyces-like organisms were detected by Papanicolaou smears, the serious ovarian actinomycosis might have been avoided. CONCLUSION: We suggest that routine cervical examinations are important for women who are IUD users.

Abdominal Pain↗
PubMed1986

Radionuclide angiography in two cases of hepatic actinomycosis.

Primary hepatic actinomycosis is rare, and there have been few reports concerning its nuclear imaging findings. Two cases of actinomycosis, in which hypervascular hepatic masses were observed in the arterial phase of radionuclide angiography are reported. To the authors' knowledge, this finding has not been reported in the literature. In one of the two cases, intense Ga-67 uptake also was noted. Although the preoperative diagnosis based on the findings of nuclear imaging (liver scan, liver flow study, Ga-67 scan), ultrasound, CT, and angiography was hepatoma, hepatic masses in our cases proved to be hepatic actinomycosis. Because hepatic actinomycosis is rare, this disease is neglected often in the differential diagnosis of hepatic mass lesions. It should be included in the gamut of hypervascular hepatic mass lesions.

Actinomycosis↗
PubMed2000

Aggressive thoracic actinomycosis complicated by vertebral osteomyelitis and epidural abscess leading to spinal cord compression.

STUDY DESIGN: Report of a successfully diagnosed and treated case of spinal cord compression due to epidural actinomycosis. OBJECTIVE: To illustrate that proper use of imaging strategy can greatly facilitate diagnosis and management of this rare condition. SUMMARY OF BACKGROUND DATA: Spinal actinomycosis causing epidural abscess and significant spinal cord compression is an uncommon condition. Although diagnosis is difficult, favorable results are widely reported when specific therapy is instituted. METHODS: A 32-year-old Chinese man had extensive dorsal thoracic soft tissue swelling and lower limb weakness. Collapse of the T5 vertebral body was found on plain radiographs with mediastinal infiltrates on chest radiograph. It took magnetic resonance imaging (MRI) to fully delineate the epidural abscess and dorsal muscular abscesses, which were not depicted by computed tomographic (CT) scan. Diagnosis was made by examination of CT-guided aspirate and tissue recovered during surgery by a microbiologist. The patient received high-dose intravenous penicillin and prompt spinal decompression once diagnosis of actinomycosis was confirmed. RESULTS: The dorsal muscular abscesses and upper thoracic epidural abscess resolved rapidly after intravenous antibiotics and surgical drainage. This was well documented by follow-up MRI and the full recovery of motor power and lower limb sensation in the patient. CONCLUSIONS: High clinical suspicion and proper use of imaging data led to timely diagnosis of this rare case of mediastinal, epidural, and intramuscular thoracic actinomycosis. Specific antibiotic therapy and timely, well-targeted surgical intervention greatly improve the outcome of this condition.

Actinomycosis↗
PubMed1998

Cutaneous disseminated actinomycosis in a patient with acute lymphocytic leukemia.

Actinomycosis is an uncommon infectious disease caused predominantly by Actinomyces israelii. The cutaneous disseminated form is usually caused by hematogenous dissemination from a primary extra-cutaneous lesion. We report here cutaneous disseminated actinomycosis without any detectable extra-cutaneous lesions in a 42-year-old Japanese woman with acute lymphocytic leukemia. Multiple soft nodules developed on her upper and lower extremities. Histopathological examination revealed "sulfur granules", which are a specific finding for actinomycosis. Cultures from biopsy specimens were not successful. There were no cervicofacial, thoracic, nor abdominal lesions. These findings suggest that cutaneous disseminated actinomycosis in our patient developed primarily in the skin. Although the patient was immunocompromised, antibiotic treatment with minocycline was effective.

Actinobacillus↗
PubMed2005

Primary testicular actinomycosis mimicking metastatic tumor.

We report a rare case of right primary testicular actinomycosis presenting as multiple testicular lesions mimicking a metastatic tumor in a 71-year-old patient with gastric adenocarcinoma. Preoperative diagnosis is difficult. The enlarged and inflamed testis was removed by orchiectomy and testicular actinomycosis was diagnosed after pathological examination. The patient had not received any further antibiotic prescription and there was no recurrent or other site involvement after orchiectomy. We illustrate this case, though it is rare, to alert pathologists and clinicians to the possible occurrence of primary testicular actinomycosis mimicking metastatic lesions in a cancer patient. To diagnose, extensive sampling of the tissue specimens may be needed. We also reviewed the published literature and found that the treatment of choice for testicular actinomycosis was orchiectomy. The usage of penicillin after orchiectomy does not seem to affect the outcomes of the disease.

Actinomyces↗
PubMed2005

Hepatic actinomycosis with infiltration of the diaphragm and right lung: a case report.

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria of the genus Actinomyces. Actinomycosis has a myriad of clinical presentations, inducing both a suppurative and granulomatous inflammatory response. The infection spreads contiguously through anatomical barriers and frequently forms external sinuses. The most common clinical presentations are cervicofacial, thoracic, abdominal and, in females, genital. Classic features include purulent foci surrounded by dense fibrosis that, over time, cross natural boundaries into contiguous structures, with the formation of fistulas and sinus tracts in some cases. Hepatic actinomycosis presents as single or multiple abscesses or masses. Reported here is the unusual occurrence of actinomycosis of the liver involving the diaphragm and right lung. The present case illustrates the difficulties in diagnosing this rare and unrecognized disease.

Actinomycosis↗
PubMed2000

Pelvic actinomycosis presenting as ureteric and rectal stricture.

BACKGROUND/AIMS: Simultaneous ureteric and rectal stricture due to pelvic actinomycosis is very rare and only a few cases of either rectal or ureteric stricture have been reported. Our aim is to report a case of stricture of the rectum and the right ureter due to pelvic actinomycosis infection in a 63-year-old man. METHODS: Explorative laparotomy and biopsies of the inflammatory pelvic mass were the only procedures that led to the definitive diagnosis of actinomycosis. Temporary diverting colostomy, drainage of the right ureter by a pigtail catheter and postoperative treatment with appropriate antibiotics were successful in eradicating the inflammatory process. CONCLUSIONS: Extensive pelvic masses involving pelvic viscera should be biopsied before undertaking any major surgery because of the possibility of pelvic actinomycosis.

Actinomycosis↗
PubMed2002

Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user.

We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic actinomycosis in a patient fitted with an intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower abdominal pain and slight fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive stenosis of the sigmoid colon were also observed. Blood analysis showed leukocytosis, thrombocytosis, and elevated C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for Actinomyces infection, these findings suggested a pelvic abscess caused by actinomycosis. Benzyl penicillin administration was started immediately. Total hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesion around the ureter were performed. Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and hydronephrosis. The patient is now healthy without evidence of recurrent Actinomyces infection 1 year after treatment. As shown in the present case, pelvic actinomycosis should be considered as a cause of pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD.

Actinomyces↗
PubMed2000

Actinomycosis imitating nasopharyngeal carcinoma.

The incidence of nasopharyngeal actinomycosis is exceedingly rare. To our knowledge, only 1 case has been reported previously. This article presents 4 cases of actinomycosis involving the nasopharynx that imitated nasopharyngeal carcinoma. Acidic gas exposure and farming of aquatic products are possibly involved in the pathogenesis of nasopharyngeal actinomycosis. Patients in the case studies completely recovered after 4 weeks of oral antibiotic treatment. We recommend including actinomycosis in the differential diagnosis of nasopharyngeal neoplasms.

Abscess↗
PubMed2005

A rare case of ascending colon actinomycosis mimicking cancer.

BACKGROUND: Actinomycosis is a rare inflammatory disease caused by an anaerobic bacterium that can rarely affect the large intestine. CASE PRESENTATION: We present a rare case of a cecum and ascending colon actinomycosis in a 72 years old woman, mimicking clinically a malignant inflammatory tumor of the right colon. The patient complained of right lower quadrant pain. Although our first thought was a peri-appendiceal abscess, CT scan suggested a right colon tumor. The patient underwent a right colectomy and the histological examination of the specimen revealed colon actinomycosis. CONCLUSIONS: Preoperative diagnosis in colon actinomycosis is difficult to achieve. Treatment of choice is antibiotics administration. A review of the possible pathogenesis and therapeutic modalities is also presented.

Actinomycosis↗