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The use of an intrauterine device (IUD) is associated with the presence of actinomyces in the female genital tract. Since IUD use is currently so prevalent, IUD-related pelvic inflammatory disease occasionally spreads to the rest of the abdomen. Two patients with abdominal actinomycosis in association with an IUD illustrate the problem; we review the general problem.
A case of actinomycosis of the uterine tube occuring in a 29-year-old clerk is reported. The disease became manifest clinically a month after the introduction of IUD. In spite of intensive antiinflammatory therapy the disease was in progress and cachexia developed. The case was cured only after radical surgical intervention and antibiotic treatment.
A recent patient with actinomycosis of the middle ear has stimulated us to call attention to this very rare disease. The differential diagnosis, pathophysiology, the pathways of spread, diagnosis and therapy of this disease are discussed. Combined therapy by antibiotics such as ampicillin with clindamycin is the best treatment currently available. Surgery is confined to taking a biopsy for histology and to the draining of inflammatory foci.
Primary actinomycosis of the thyroid was diagnosed in a 59 year old farmer who presented with a hard, non-tender, thyroid nodule. The difficulties encountered in the diagnosis of actinomycetal infections, its pathogenesis, and treatment are discussed.
Two cases of primary pulmonary actinomycosis had a radiologic and clinical picture of malignancy. The cases were diagnosed by microscopic examination of sputum that had been embedded in paraffin. The sputum samples were sent to the cytology laboratory for screening for neoplastic cells, and colonies of Actinomyces were seen in all samples. The authors emphasize the difficulties that can be encountered by the cytopathologist in identifying classic actinomycotic colonies in debris.
Concerning five observations of cervico-facial actinomycosis in two hospital wards, the authors recall that this pathology, although rare, still exists. It appears as a chronic cellulitis, usually occurring among subjects lacking in dental hygiene. The authors insist on the necessity of asking for a bacteriological test by taking a sample of pus with a pipette to look for the responsible actinomyces. The cure consists in the extracting of the teeth concerned, the removal of the necrosed tissues, a drainage, and an antibiotic treatment based on high doses of Penicilline for about three months.
A case report is given of a 61 year old female patient, who came to the hospital with chronic pain in the right upper abdominal quadrant, fever, chills, dyspnea, and general weakness. 4 days later she died in hemorrhagic shock after having had melena. At postmortem an actinomycotic abscess of the size of a childs head was found in the left lobe of the liver; in addition there was a highly differentiated leiomyosarcoma of the duodenum. Isolated visceral actinomycosis is rare; it should however be thought of when the causes of liver abscesses are being scrutinized. Diagnosis can be established only bacterioiogically or histologically.
Sixteen cases of actinomycosis seen at the University of Georgia were reviewed. Treatment in 15 cases consisted of long-term antibiotic therapy combined with lavage and drainage of the affected area. Surgical debridement was used in several cases. Treatment was successful in 12 cases.
Actinomycotic infections are unusual, but the actual incidence is likely to be significantly higher than records indicate. The disease may complicate trauma of many types to the respiratory and digestive tracts, including operative procedures. This possibility should encourage more frequent use of anaerobic cultures in inflammatory diseases, particularly posttraumatic, and should prompt consideration of actinomycosis in the differential diagnosis of infections, especially in the cervicofacial area. We report four cases that demonstrate the variable course of this infection. Treatment is highly successful with appropriate use of antibiotics and surgery. A plea is made to use the least expensive, effective antibiotic in view of the prolonged course of therapy that is necessary to eradicate this infection.
Fever of 10 mo duration in a man of 35 yr was discovered at the time of a second laparatomy to be caused by actinomycotic infection of the liver. Actinomycosis of the liver usually presents as large single or as multiple abscesses. In this patient only nonspecific cellular infiltrates of the liver were found in liver biopsies performed after 4 mo of fever. Not until 10 mo had elapsed were miniscule liver abscesses detected. It took an average of 8 mo to make a diagnosis in our patient and in 6 others like him reported since 1928. Exploratory surgery was required for diagnosis in all of them.
Disseminated actinomycosis with hematogenous spread to the lungs is rare. A fatal case is reported, with the primary site of infection in the pelvis, in a woman with an intrauterine contraceptive device.
Diagnosis of actinomycosis as a specific infection is rather difficult. By a case report it is described that preoperative diagnostics and intraoperative situs do not always exactly clarify the situation. In most cases the definite diagnosis can only be achieved by histological findings followed by an adequate therapy.
We report a case of hepatic actinomycosis in a woman with previous duodenal ulcer. The findings of ultrasound, computed tomography and abscess imaging are presented. The diagnosis was made by thin needle aspiration biopsy under computed tomography guidance. The treatment consisted in percutaneous drainage and intravenous antibiotic therapy.
Abdominal actinomycosis was localized in the liver with intra-abdominal abscesses. The disease had evolved for several years before diagnosis. Percutaneous interventional radiology allowed taking biopsies which confirmed the diagnosis. Percutaneous drainage of the intra-abdominal abscesses with antibiotherapy was successful without iterative surgery.
We present two cases of thoracic actinomycosis which bronchoscopically resembled a bronchial tumoration, existing simultaneously in both cases a foreign body located at the intermediate bronchium. We discuss the characteristics of the disease and we review the literature on this topic.
The authors report an atypical case of actionomycosis implanted in the nasal cavity and occurring twenty years after septum surgery. Treatment by penicillin and surgical excision gave a good result. Cervicofacial actinomycosis is caused by actinomyctes which usually lives as a saprophyte in the oral cavity. A trauma is often found in the previous history. Diagnosis with tumors and abscess may be difficult. The histopathological examination shows typical aspects of the granuloma (gram+ and Grocott+) and the bacteriological isolation of the germ is difficult to obtain. Penicillin associated with surgical excision is the best therapy, but high doses must be used for a long time. The literature is reviewed without finding such a case.
In a 44-year-old woman on the basis of short hospital medical observation and gynaecological consultations, malignancy of reproductive organs was preliminarily diagnosed. During the operation the gynaecological-surgical team confirmed the presence of generalized neoplastic process in the abdominal cavity. In the obtained surgical specimens actinomycosis was diagnosed by histological examination. Longterm antibiotic therapy caused an improvement of the patient's condition, increase of body weight, improvement of blood morphologic picture, regression of tumour-like changes in the liver. The case reminds the necessity of taking into account actinomycotic infection in the differential diagnosis of conditions suggesting a neoplastic process in the abdominal cavity.
Endobronchial actinomycosis was found to be the cause of right-sided atelectasis and haemoptysis in a 57 year old man without predisposing conditions. Fibreoptic bronchoscopy revealed occlusion of the intermediate bronchus by yellow-white masses. The diagnosis was confirmed histologically and by positive Actinomyces culture from bioptic material. Prolonged antibiotic treatment resulted in complete recovery, without need for surgical resection.