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PubMedDate not supplied

Pericardial actinomycosis: case report and review.

Pericardial actinomycosis is rare and frequently goes unrecognized during life, a circumstance due in part to a paucity of clinical manifestations and to a low rate of positivity in cultures. We present a case report of pericardial actinomycosis and a review of 18 other cases reported in the literature since 1950. Possible risk factors include aspiration pneumonia, alcohol abuse, and periodontal disease. Actinomyces may cause purulent pericarditis that evolves into cardiac tamponade or constrictive pericarditis. Clues to the identity of the causative organism (e.g., draining sinus tracts and the presence of sulfur granules) are frequently absent, and cultures often fail to yield the organism. Histologic examination of material obtained by biopsy is often necessary to make the diagnosis. Most cases originate from a thoracopulmonary site of actinomycosis and spread directly to the pericardium. Widespread dissemination to extrathoracic organs is uncommon. Treatment consists of high-dose, long-term antimicrobial therapy as well as drainage of the pericardial space.

Actinomycosis↗
PubMedDate not supplied

Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device.

Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Asymptomatic colonization of the cervix with this organism has been noted in users of an intrauterine device (IUD), and its prevalence ranges between 1.6% and 36%. Rarely, symptomatic infection may occur, with the potential for extensive morbidity and even death. Herein we report a patient who survived severe disseminated actinomycosis yet presented with the clinical picture of a metastasized malignancy. This is the first report of disseminated pelvic actinomycosis presenting as an external lesion of the abdominal wall and in which a Progestasert IUD (Alza, Palo Alto, CA) was present. The common difficulty, and thus delay, in diagnosing this disease led to considerable morbidity due to an infection considered curable with penicillin. We recommend that all patients with an IUD or a history of IUD use have such information made known to those responsible for interpreting the Papanicolaou smear. Such knowledge may heighten suspicion and focus attention on the identification of these organisms before onset of clinical disease. It is important to consider this disease when caring for patients with an IUD or when counseling those contemplating its use as a contraceptive.

Abdominal Muscles↗
PubMedDate not supplied

Primary actinomycosis of an extremity: a case report and review.

Primary infection of an extremity is an uncommon feature of actinomycosis and can readily be confused with actinomycetoma caused by aerobic actinomycetes such as Nocardia and Streptomyces. A case of primary actinomycosis of the leg is reported, and 35 cases published in the English-language literature are reviewed. There were 14 cases of upper extremity infections and 22 cases of lower extremity infections. Antecedent trauma had occurred in 21 cases. Lesions began in the skin, subcutaneous tissue, muscle, bone, and joint space. Spread to contiguous structures was characteristic, and most lesions eventually involved all of the aforementioned structures. The lesions were typical of actinomycosis with sinus formation and granules in the pus. Cultures were positive in 17 cases. Surgical therapy was necessary in most instances; penicillin remains the drug of choice. Pending results of culturing, a lesion with granules of branching gram-positive bacteria would best be treated empirically with penicillin and a sulfonamide. Prognosis is excellent.

Actinomyces↗
PubMed2001

Actinomycosis of the frontal and parotid regions.

Cervicofacial actinomycosis still occurs infrequently and should be included in the differential diagnosis of neoplasms, and chronic suppurative and granulomatous lesions of the head and neck region. The authors present two cases of actinomycosis. Patient 1 was a 32-year-old man who was first seen with a firm, suppurative mass at his left frontal region. Patient 2 was a 36-year-old woman with an indurated mass at her left parotid area. Both patients were diagnosed histopathologically with cervicofacial actinomycosis, but each patient had a different clinical course and different response to antimicrobial and surgical treatments.

Actinomycosis, Cervicofacial↗
PubMed2004

Nasopharyngeal actinomycosis: a rare cause of nasal airway obstruction.

Nasopharyngeal actinomycosis is a rare clinical disease. It can occur after nasal trauma or surgical manipulation. It is also reported to occur without prior trauma, making diagnosis difficult. We report a case of nasopharyngeal actinomycosis that presented as nasal airway obstruction causing snoring and mimicking nasopharyngeal carcinoma. To our knowledge, only a few other cases of nasopharyngeal actinomycosis have previously been published, most coming after mucosal trauma. Diagnosis is made by observing the bacteria or its associated sulfur granules in the biopsy specimen. This anaerobic organism is difficult to culture. Treatment consists of wide debridement and prolonged antibiotic therapy, with good prognosis.

Actinomycosis↗
PubMed1998

Cervical actinomycosis causing spinal cord compression and multisegmental root failure: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Epidural invasion and the resulting cord compression are clinical entities not usually associated with actinomycosis, and we found only 11 reported cases of cord compression caused by Actinomyces infection in the literature. Only one reported case was described as actinomycosis with epidural granuloma (14, 16), whereas in the other cases, epidural macroabscess (phlegm) formation caused the symptoms. Histopathological demonstration of the inflammatory granulation tissue and gram-positive sulfur-containing filamentous bacteria are important for the diagnosis of actinomycosis, because the clinical and microbiological studies cannot always demonstrate the causative microorganism and primary infection source. CLINICAL PRESENTATION: In this article, a case of Actinomyces infection causing cervical cord compression is presented. Precise diagnosis was accomplished using specific histopathological studies of the surgical specimens; such a precise diagnosis cannot always be achieved using preoperative investigations and microbiological studies. The treatment modalities and the patient's outcome are also discussed. CONCLUSION: As shown by hematoxylin and eosin stain, in contrast to the Nocardia species, Actinomyces filaments histopathologically are basophilic in nature and terminate in eosinophilic clubs as a predictive feature. The clinical and radiological findings closely resemble metastatic tumors and other infectious processes. A differential diagnosis is also emphasized in this article, along with a review of the literature.

Actinomycosis, Cervicofacial↗
PubMed1995

Intramural gastric actinomycosis.

We report a case of intramural gastric actinomycosis and review the features of the additional 16 cases of this uncommon infection reported in the literature. The patient had gastrointestinal symptoms, weight loss, and fever after gastric operation. At laparotomy, an infiltrating gastric tumor-like lesion was found. Histology revealed actinomycosis, and the patient was successfully treated with oral penicillin. Because of its rarity, intramural actinomycosis is an entity overlooked by most surgeons. Reporting of such cases may help increase the awareness of this important and curable disease.

Actinomycosis↗
PubMed2004

Renal actinomycosis mimicking renal tumor: case report.

A 68-year-old man was admitted after fever and general fatigue with severe inflammatory signs and anemia. T1- and T2-weighted magnetic resonance imaging showed low- to isointensity and low-intensity tumor in the right kidney, respectively, suggesting renal actinomycosis. However, the right kidney was explored transabdominally because the possibility of renal malignant lymphoma could not be excluded. After nephrectomy, characteristic colonies of Actinomyces were seen microscopically, and the histologic diagnosis was renal actinomycosis. The patient was treated with antibiotics and made good progress after operation. This case highlights the importance of magnetic resonance imaging for the diagnosis of renal actinomycosis.

Actinomycosis↗
PubMed2005

Actinomycosis esophagitis in a patient with persistent dysphagia.

Many causes of esophagitis exist in immunocompromised patients. Uncommon pathogens must be considered to facilitate timely and appropriate therapy. A limited number of cases of esophageal actinomycosis have been reported. This report describes an unusual case of esophageal actinomycosis in a patient with persistent dysphagia. The broad differential may have delayed definitive diagnosis in the case study patient. Biopsy and culture are essential for accurate diagnosis. Although actinomycosis is a rare disease, it should be included in the differential diagnosis of patients presenting with oral or esophageal complaints. It may also be considered as an opportunistic infection in immunocompromised patients. The treatment of choice is parenteral penicillin G, 18 to 24 million units for 2 to 6 weeks followed by oral therapy for 6-12 months.

Actinomycosis↗
PubMedDate not supplied

A rare case of primary actinomycosis of the breast caused by Actinomyces viscosus: diagnosis by fine-needle aspiration cytology under ultrasound guidance.

We report the case of a 27-year-old woman with primary actinomycosis of the breast. Diagnosis was established by culture examination of specimen recovered by fine-needle aspiration cytology (FNAC) under ultrasound guidance. To our knowledge, this is the first description in the literature of a case of primary actinomycosis of the breast caused by Actinomyces viscosus. Twenty-nine previous cases of primary actinomycosis of the breast have been published, but these were caused by the more common species Actinomyces israelii. Targeted antibiotic therapy did not ameliorate the condition, thus drainage and excision of the mass were carried out. No other medical therapy was administered. Six years after surgery, no recurrence has been observed on both ultrasonographic and mammographic examinations.

Actinomyces viscosus↗
PubMed1999

Pilonidal sinus of the penis. A report of two cases, one of them associated with actinomycosis.

Pilonidal sinus is a long-standing chronic inflammatory condition which occurs most commonly in the sacrococcygeal area and it is rare in the penis. Two cases of penile pilonidal sinus in patients aged 25 and 28 years are reported and the literature is reviewed. The lesion is acquired and has to be distinguished from balanoposthitis, epidermal cyst and carcinoma. For pilonidal sinus to occur at this site, it is hypothesized that the coronal sulcus acts as a cleft where hair may accumulate and be driven into the shaft and prepuce by the natural movement between these two surfaces. One of our cases was associated with actinomycosis. Actinomycosis associated with pilonidal sinus of the penis is extremely rare and there are only two previous reports. It is suggested that pilonidal sinus may have been predisposed to the infection with the actinomyces organisms. Information stating that penile pilonidal sinus and actinomycosis may occur simultaneously is necessary to accomplish an early diagnosis.

Actinomyces↗
PubMed1996

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

This case of periapical actinomycosis presented the clinical picture of chronic periapical inflammation. The diagnosis was based on the histological examination of the periapical lesions suggesting the necessity for routine histological examination. Although root canals provide a primary port of entry the Actinomyces organisms into the periapical tissue, periapical actinomycosis, is considered extremely rare. This may be due to the omission of routine histological examination of periapical lesions and the clinical behavior of the disease. The large number of cases reported during the last decade indicates that periapical actinomycosis is more frequent than what it is believed and this is important in the daily dental practice.

Actinomyces↗
PubMedDate not supplied

Thoracic, abdominal, and vertebral actinomycosis. Diagnosis and long-term therapy in three dogs.

The clinical, laboratory, radiographic, and histologic features and the response to therapy in three dogs with actinomycosis are reported. One dog (dog 1) had a 12-cm nonresectable mass extending from the ventrolateral chest wall into the left ventricular myocardium. Another dog (dog 2) had a diffuse peritonitis with "sulfur granules" and two large masses. One of these masses was nonresectable involving adjacent abdominal structures. A third dog (dog 3) had a subvertebral mass at T1-3 producing quadraplegia. Two dogs had periosteal reactions involving adjacent sternebrae (dog 1) or ribs and vertebral bodies (dog 3) that are characteristic of Actinomyces spp infections. In dogs 1 and 2 the diagnosis was based on the morphologic and tinctorial properties of free sulfur granules and/or tissue granules. Culture results were variable. Tissue from dog 1 yielded no growth, while polymicrobial infections, which included Actinomyces spp, were identified in dogs 2 and 3. Actinomyces odontolyticus was isolated from dog 3. Although the actinomycotic granulomas were either not excised or only partially excised from dogs 1 and 2, both animals were cured by the oral administration of high doses of penicillin G for 19 and 6 months, respectively. Dog 3 responded dramatically to the same antibiotic therapy given for 5 months. However, within 4 months of discontinuing treatment an abscess and draining fistulous tracts developed in the left axillary region. Two surgical fistulectomies and additional penicillin therapy were required to cure this animal. These cases and the current veterinary and human literature on actinomycosis are used to propose a rational approach to the treatment of actinomycosis in the dog.

Actinomyces↗
PubMed1996

Pulmonary actinomycosis appearing as a "ball-in-hole" on chest radiography and bronchoscopy.

A 40 year old diabetic man with pulmonary actinomycosis was admitted to hospital with recurrent haemoptysis. The chest radiograph showed an air meniscus in the left upper lobe, a rare presentation of pulmonary actinomycosis. Bronchoscopic examination revealed a mass in a cavity which has never been reported previously. He underwent lobectomy and the surgical specimen revealed sulphur granules, the typical pathological finding of actinomycosis, without evidence of fungal or mycobacterial infection.

Actinomycosis↗
PubMed1992

Thoracic actinomycosis: CT findings in eight patients.

The chest radiographs and computed tomographic (CT) scans obtained in eight patients with pathologically proved cases of thoracic actinomycosis were independently reviewed by two observers. All patients were alcoholic men aged 42-62 years. Air-space consolidation, seen on the radiograph and CT scan in each case, was present in the lower lobes in seven patients (88%) and upper lobes in three (38%). Pleural effusion was present in five (62%). Pleural thickening adjacent to the air-space consolidation was identified on the radiograph in four (50%) and CT scan in all eight. Cavitation or central areas of low attenuation not apparent on the radiograph were seen on the CT scan in five cases (62%). Hilar or mediastinal lymphadenopathy was identified on the radiograph in three cases (38%) and on the CT scan in six (75%). Chest-wall invasion occurred in only one case (12%). Thoracic actinomycosis is characterized on CT scans by air-space consolidation with adjacent pleural thickening. CT is superior to radiography in assessing the thoracic manifestations of actinomycosis.

Actinomycosis↗
PubMed1998

Thoracic actinomycosis: CT findings.

PURPOSE: To characterize computed tomographic (CT) findings of thoracic actinomycosis. MATERIALS AND METHODS: Chest CT scans and radiographs obtained in 22 patients with histopathologically proved thoracic actinomycosis were retrospectively reviewed. All patients were immunocompetent; they were aged 12-73 years (mean, 42.6 years; 14 male, eight female). CT findings were correlated with histopathologic findings in nine patients who underwent surgery (lobectomy [n = 8] or segmental resection [n = 1]). RESULTS: All of the lesions were unilateral, with an average diameter of 6.5 cm (range, 2-12 cm). Patchy air-space consolidation (n = 20) or a mass (n = 2) was seen on CT scans. Fifteen (75%) of the 20 patients with air-space consolidation had central areas of low attenuation (5-30 mm in diameter) within the consolidation. Thirteen of the 15 patients underwent contrast medium-enhanced CT. Ten (77%) of the 13 patients showed ring-like rim enhancement. Adjacent pleural thickening was seen in 16 patients (73%). At histopathologic examination, central low-attenuation areas at CT were seen as microabscesses with sulfur granules or a dilated bronchus that contained inflammatory cells and Actinomyces colonies. Peripheral enhancement of the low-attenuation areas was wall of the microabscess or surrounding parenchyma composed of granulation tissue rich in vascularity. CONCLUSION: Findings of chronic segmental air-space consolidation that contained low-attenuation areas with peripheral enhancement or adjacent pleural thickening at CT were suggestive of thoracic actinomycosis.

Actinomycosis↗
PubMed2001

Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features.

PURPOSE: To assess the computed tomographic (CT) features of abdominopelvic actinomycosis involving the gastrointestinal tract. MATERIALS AND METHODS: CT scans were analyzed in 18 patients with pathologically proved abdominopelvic actinomycosis involving the gastrointestinal tract. Eight patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness, length, bowel involvement patterns, inflammatory infiltration, and features of peritoneal or pelvic mass, if present, were evaluated at CT. RESULTS: Of the gastrointestinal tract, the sigmoid colon was most commonly involved (50%). All patients showed concentric (n = 15) or eccentric (n = 3) bowel wall thickening, with a mean thickness of 1.2 cm and a mean length of 8.3 cm. The thickened bowel enhanced homogeneously in nine patients and heterogeneously in the other nine. Inflammatory infiltration was mostly diffuse and severe. In 17 patients, a peritoneal or pelvic mass (mean maximum diameter, 3.2 cm) was seen adjacent to the involved bowel and appeared to be heterogeneously enhanced in most cases; infiltration into the abdominal wall was seen in four patients. CONCLUSION: Actinomycosis should be included in the differential diagnosis when CT scans show bowel wall thickening and regional pelvic or peritoneal mass with extensive infiltration, especially in patients with abdominal pain, fever, leukocytosis, or long-term use of intrauterine contraceptive devices.

Actinomycosis↗