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PubMed2005

Ovarian actinomycosis mimicking malignancy.

OBJECTIVE: To emphasize the importance of frozen section diagnosis in the treatment of ovarian carcinoma and to remind physicians that it may mimic ovarian carcinoma and occur in women without intrauterine contraceptive devices (IUDs). METHODS: Three cases operated on in Adana University Hospital between the year 2001-2003 with the diagnosis of ovarian actinomycosis were reported. CASE REPORT: Three female patients who had never used IUDs, aged 37, 45 and 47, who presented with pelvic pain and tumoral masses in the pelvis were operated on with the initial diagnosis of ovarian carcinoma between the years 2001 and 2003. Intraoperative frozen-section diagnoses of the pelvic masses were actinomycosis. In the postoperative period the patients received long-term antibiotic therapy initially intravenously (15 days), and later orally with 4 g/day for three months. They were healthy without evidence of actinomycosis infection for two years after the treatment. DISCUSSION: Pelvic actinomycosis is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. The behavior of the disease, which mimics malignancy and urogenital manifestation, poses difficulties in diagnosis and management. Preoperative examinations could not establish the nature of the tumour. An initial diagnosis of ovarian carcinoma is usually considered in all cases. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.

Actinomyces↗
PubMedDate not supplied

Abdominal wall actinomycosis associated with prolonged use of an intrauterine device: a case report and review of the literature.

The relationship between pelvic actinomycosis and the presence of an intrauterine device is well known. Abdominal wall actinomycosis with no involvement of pelvic organs in the presence of an intrauterine device is extremely rare. We report a case of a 32-year-old woman with a long-standing intrauterine device who developed abdominal wall actinomycosis. The diagnosis was established late by histopathological examination after an initial surgical procedure during which the abscess was evacuated and all the necrotic tissue was excised. Postoperatively, the patient developed two intra-abdominal abscesses, which were treated by surgical drainage. The combination of long-term high-dose antibiotic therapy with surgery led to successful management of the condition. We highlight the difficulty in diagnosis, necessity for an early postoperative diagnosis, and the importance of high-dose intravenous antibiotic therapy to prevent recurrence. Abdominal wall actinomycosis should be considered in intrauterine device users who present with abdominal abscesses of unknown origin.

Abdominal Abscess↗
PubMed2006

[Pulmonary actinomycosis developing diffuse phregmone after pneumonectomy].

The patient was a 75-year-old male who consulted the department of respiratory tract internal medicine in our hospital for left chest pain occurring from the beginning of December 2003. Chest X-ray indicated a tumorous shadow in the left lower lung field. A chest CT also revealed an irregularly shaped mass shadow in the left lower lobe. Since bronchoscopy failed to establish a definitive diagnosis, the patient was referred to our department for surgery to undertake thoracotomy. After left pneumonectomy being performed based on a suspicion of lung abscess, pathological examination of specimen from the resected left lung showed sulfur granules which led to the diagnosis of pulmonary actinomycosis. Because of the diffuse phregmone developing around the surgical wound, benzylpenicillin potassium administration was started, and was continued for a further 6 months on an outpatient basis. Pulmonary actinomycosis is a relatively rare chronic pulmonary infection. It is often difficult to distinguish pulmonary actinomycosis from other pulmonary disease such as lung cancer because of the similarity of their appearance on X-ray or CT, and almost all cases of pulmonary actinomycosis are diagnosed by thoracotomy.

Actinomycosis↗
PubMed1985

[Actinomycosis. What describes the pathological events referred to by this term?].

The disease named "actinomycosis" hadn't found its final position in infections pathology. Many terms were successively created to describe in a better way similar entities: actinomycosis, pseudo-actinomycosis, actinobacteriosis, corynebacteriosis, ramibacteriosis... is just a part of the terminology. After the analysis of the classical conception of the "actinomycosis" and, also, the latest data, the author came to the conclusion that the facts are just a clinical manifestation, related to the germ, of the large syndrome of the Infections of the soft tissues.

Actinomyces↗
PubMed1980

[Pleuro-pulmonary actinomycosis. Report of 4 cases].

Four cases of pulmonary actinomycosis are reported. Two cases (1978, 1979) were diagnosed on microscopic examination of lung parenchyma excised on suspicion of bronchogenic carcinoma. The third case was diagnosed retrospectively by reexamining the slides of a patient operated on in 1965, who presented with a similar history and chest X-ray. The fourth was diagnosed at autopsy in a patient who committed suicide. Actinomycosis is a rare disease which affects the lung in 15--20% of cases. Despite its name, actinomycosis is not due to a fungus but to an anaerobic gram-positive bacillus. The germ is a saprophyte of the human digestive tract and is very sensitive to penicillins. It may become pathogenic in a compromised host and usually produces cervico-facial lesions which develop by continuity from mouth mucosa. Abdominal or, more rarely, pulmonary lesions are due to ingestion or inhalation of infected material. Chest X-ray appearance of pulmonary actinomycosis mimics that of bronchogenic carcinoma. Actinomyces culture is difficult, and diagnosis is often based on microscopic examination of the surgical specimen only. Antibiotic therapy is a mandatory complement to surgical treatment.

Actinomyces↗
PubMed1994

Unusual manifestations of thoracic actinomycosis.

Actinomycosis is a chronic, suppurative bacterial infection characterized by multiple abscesses, sinus tracts, fibrosis, and granulation involving the face, neck, thorax, or abdomen. Thoracic actinomycosis probably results from aspiration of oropharyngeal secretions. Its description in the literature is extensive. Reported herein are two cases of thoracic actinomycosis with unusual manifestations exemplifying the organism's lack of regard for fascial planes. The authors present a comprehensive review of actinomycosis in order to encourage early diagnosis. The importance of bedside examination and inspection of available material stained by Gram's method are emphasized. Computed tomography scanning is a useful adjunct for assessing the anatomic extent of this disease.

Actinomycosis↗
PubMed1993

Pediatric actinomycosis of the head and neck.

Actinomycosis is a rare soft tissue infection caused by a gram-positive, anaerobic bacteria. It is seen only approximately once a year in major medical centers, and is rarer still in the pediatric population. About 50% of all cases of actinomycosis involve the head and neck. The organism is very difficult to isolate in culture and the differential diagnosis is extensive, prompting one reviewer to name actinomycosis the "masquerader" of the head and neck. We review three cases of actinomycosis over the past ten years (1981-1990) at Texas Children's Hospital, Houston, Texas.

Actinomyces↗
PubMed1994

Cervicofacial actinomycosis (a case report).

Actinomycosis is now a very uncommonly diagnosed human disease. Major medical centers report approximately one case a year. The pathogenesis of actinomycosis is unclear, but trauma provides a portal of entry. The cervicofacial form is the most common and usually appears as a chronic swelling with one or more draining sinus tracts. For treatment, penicillin in high doses is suggested. This case report presents a case of cervicofacial actinomycosis in a 14 year old boy which was misdiagnosed for a long time and the treatment of the disease with mezlocillin, a new antibiotic in the treatment of actinomycosis.

Actinomyces↗
PubMedDate not supplied

[Pediatric cervicofacial actinomycosis - case report and review of the literature]

OBJECTIVE: To emphasize important features in the diagnosis and monitoring of patients with childhood cervical actinomycosis. SUBJECT AND METHODS: We report the case of a patient with cervicofacial actinomycosis. We also carried out a review of the literature from the past few years (Lilacs and Medline). RESULTS: We followed a male patient admitted to the pediatric infectious disease ward. Diagnosis was carried out through biopsy of a cervical node and isolation of bacteria. Specific penicillin treatment for actinomycosis was administered for 14 days. Subsequently, we observed remission of the node. The patient was discharged from the hospital. At least 6 months of amoxycillin therapy with simultaneous outpatient follow-up were recommended. CONCLUSION: Early diagnosis of actinomycosis enables appropriate and prompt treatment, thus preventing the involvement of other areas such as CNS, face, and neck.

Journal Article↗
PubMed1984

Actinomycosis: diagnostic and therapeutic considerations and a review of 32 cases.

Actinomycosis was at one time a common diagnosis in this country. It still is fairly common in some parts of the world. As the numbers of antibiotics and indications for their use have increased, the disease has almost become a medical rarity in the United States. This fact might be thought a paradox in view of the universal presence of the actinomyces organisms in every human mouth. However, it is perhaps not well recognized that the actinomyces are true bacteria, and that they are particularly sensitive to most of the common antibacterials in current usage. These facts have combined to decrease the clinical frequency of the disease as well as effectively reduce the opportunity for securing a satisfactory specimen for laboratory culture in suspected cases. Actinomycosis can present in a variety of forms and may mimic other infections or even neoplasms. The clinical pattern of remission and exacerbation of symptoms occurring in parallel sequence with initiation and cessation of antibiotic administration is a phenomenon which should increase suspicion for actinomycosis in any of its manifestations.

Actinomyces↗
PubMed1964

ACTINOMYCOSIS OF THE BRAIN; CASE REPORT AND REVIEW OF THE LITERATURE.

The available world literature (since Friedman's and Levy's comprehensive report in 1937) regarding actinomycosis of the central nervous system is reviewed. Only cases proved by culture were included in this analysis. A total of 17 cases was collected and an additional patient with this entity is described.The important differences between actinomycosis and nocardiosis are discussed. A definite diagnosis of actinomycosis was possible only when anaerobic cultures of cerebrospinal fluid or material obtained from a brain abscess yielded colonies of typical Actinomyces organisms. The characteristic result of infection of the brain by this fungus was abscess formation, and this occurred in all except one of the cases reviewed. Penicillin appears to be the drug of choice in treatment and, where possible, surgical excision of the cerebral abscess should be undertaken.

Abscess↗
PubMed1991

[Actinomycosis--clinical and therapeutic considerations based on 2 personal case reports].

We report on two patients with actinomycosis. The first case was a 45-year-old cachectic man with extensive bilateral pulmonary infiltrates. The lesions remained unclear for 18 months and only open lung biopsy with microscopic and cultural evaluation led to the diagnosis of actinomycosis. In the second case, classic cervico-facial actinomycosis in a 69-year-old farmer is described. Diagnosis was established on the basis of microscopic findings of "sulphur granules" eroding the mandible. Furthermore, the clinical presentation, with an indurated swelling of the jaw and intraoral fistula formation, was typical. The patient had a severe combined aortic valve lesion and died after ventricular fibrillation during hospitalization. Diagnosis could not be confirmed by culture, probably due to antibiotic prophylaxis against endocarditis during tooth extraction on the first day of admission. Diagnostic difficulties and microbiologic aspects are discussed, with special focus on the rare species of Actinomyces meyeri which was cultured from biopsy specimens from the lung of the first patient. So far this species has been described in only 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinomycosis↗
PubMed1999

Atypical presentations of actinomycosis.

BACKGROUND: Actinomycotic infections of the cervicofacial region are uncommon. Most major medical centers report approximately one case per year. Presenting clinical manifestations are confusing because they often mimic other disease processes. Diagnosis may be difficult due to a general lack of familiarity with the disease and the fastidious nature of the organism in culture. The cervicofacial manifestations of actinomycosis are varied, and a high index of suspicion is required to make an accurate and timely diagnosis. METHODS: Retrospective chart review with the presentation of four unusual cases of actinomycosis were performed. RESULTS: Two patients were initially seen with dysphagia from a tongue base mass. The third patient was initially seen with a 3-week history of worsening hoarseness and stridor. Examination revealed an ulcerative lesion of the left hemilarynx and pyriform sinus. All three patients were thought to have a neoplastic process. Diagnosis was made on histologic examination of a tissue biopsy. The fourth patient was initially seen with a buccal space mass that was draining externally. Culture of the purulent drainage revealed Actinomyces. In all four cases, symptoms resolved after appropriate antimicrobial therapy. CONCLUSIONS: Actinomycosis of the head and neck, although rare, is an important entity to the otolaryngologist. A confusing clinical presentation combined with the fastidious nature of the organism make for a difficult diagnosis. A high index of suspicion is required to make an accurate diagnosis and institute the appropriate antibiotic therapy.

Actinomycosis, Cervicofacial↗
PubMed1996

Abdominal actinomycosis associated with intrauterine device: CT features.

Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with marked contrast enhancement and infiltration of the adjacent mesenteric fat. Laparoscopy confirmed the presence of intraperitoneal abscesses which contained Actinomyces israelii. High doses of amoxicillin and clavulanic acid (Augmentine) were given and following CT scan after 2 and 6 weeks showed a slow, but complete, resolution of the lesions. Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD. Abdominal CT is a useful method for diagnosis and for follow-up.

Actinomyces↗
PubMed1995

Colonic actinomycosis: report of a case and review of the literature.

Abdominal actinomycosis is a rare entity which presents some difficulty in establishing a correct preoperative diagnosis. We report herein the case of a 41-year-old woman who developed abdominal actinomycosis involving the left colon and the surrounding retroperitoneum. The patient, who had an intrauterine contraceptive device (IUCD) in situ, presented with left flank pain and the signs and symptoms of an intraabdominal mass, which was initially diagnosed as a neoplasm originating from the left colon or the retroperitoneal space. Thus, a left colectomy was performed, but the histopathological pathological diagnosis revealed abdominal actinomycosis. We evaluated the diagnosis and treatment of this disease in light of the knowledge acquired from the available literature on this rare entity.

Actinomycosis↗
PubMed1997

Abdominal actinomycosis: barium enema and computed tomography findings.

A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manifestation of these symptoms. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.

Abdominal Abscess↗
PubMed1994

Perianal actinomycosis--a complication of a fistula-in-ano. Report of a case.

Perianal actinomycosis is a rare complication of fistula-in-ano. We report a case of an 82-year-old male with an atypical fistula that had an internal opening at a posterior crypt and, over an extense perianal and gluteal area, induration with multiple suppurative draining sinus tracts. He underwent fistulotomy and an ample excision of the diseased areas. The pathology report was actinomycosis. Further treatment with antibiotics was continued until the patient was clinically cured. The diagnosis of perianal actinomycosis requires a high degree of suspicion, and should be kept in mind when a fistula presents the aforementioned characteristics or in case of a recurrence after adequate surgical therapy.

Actinomycosis↗
PubMed2000

Rare presentation of actinomycosis as an abdominal mass: report of a case.

PURPOSE: The purpose of this article was to report an unusual presentation of abdominal actinomycosis masquerading as a tumor. METHODS: The patient was a 54-year-old male who presented with vague abdominal discomfort and a palpable left lower quadrant mass defined on CT scan. Multiple intraoperative core biopsies were nondiagnostic, and he underwent en bloc resection of the mass and adjacent organs for a presumed tumor. RESULTS: Examination of tissue from deep within the excised specimen revealed sulfur granules diagnostic for actinomycosis. CONCLUSION: Abdominal actinomycosis is an extremely rare infection that can mimic multiple disease processes and requires accurate diagnosis for successful therapy. This novel presentation and a review of the literature are reported.

Abdomen↗