Case report: percutaneous drainage of periappendiceal actinomycosis

Spontaneous Bacterial Peritonitis Because of Actinomyces

Actinomycosis is a rare chronic granulomatous disease that manifests with nonspecific symptoms of abdominal pain, anorexia, and weight loss. The disparity in the presentation of this condition presents a tremendous diagnostic challenge. There are few reports of Actinomyces species causing spontaneous bacterial peritonitis without previous localized masses or abscesses have been published. We provide a case of spontaneous bacterial peritonitis secondary to Actinomyces species in a 46-year-old woman with uterine fibroids and a lack of preceding abscess. Although rare, spontaneous bacterial peritonitis because of Actinomyces should be considered in differential in female patients without pre-existing liver disease presenting with spontaneous bacterial peritonitis.

Mediastinal Mass, Cancer, or Infection, Atypical Paraesophageal Actinomycosis Infection, Clinical and Surgical Approach

Actinomyces israelii (AI) is a Gram-positive, rod-shaped bacterium that lives commensally on and within humans as a typical colonizer within the gastrointestinal tract, including the mouth. As an opportunistic pathogen, infection often results from tissue injury or breach of the mucosal barrier (ie, during various dental or GI procedures, aspiration, or specific pathologies such as diverticulitis). Symptoms generally present slowly as a non-tender, indurated mass that evolves into multiple abscesses, fistulae, or draining sinus tracts without regard for anatomical barriers, including fascial planes or lymphatic drainage. However, it may also present as an acute suppurative infection with pain and rapid progression to abscess formation.

Pelvi-abdominal as a complication of long-term use of intrauterine device (IUD). The important role of imaging in diagnosis and follow-up

ACTINOMYCOSIS is a rare chronic granulomatous disease caused by anaerobic filamentous gram-positive bacteria, the most common of which is Actinomyces israelii. Actinomycetes are commensal inhabitants of the oral cavity and gastrointestinal tract, but they may become pathogenic through invasion of breached or necrotic tissue. Pelviabdominal ACTINOMYCOSIS is uncommon and can mimic a variety of disease processes, including abdominal mass mimicking malignancy, acute abdomen, asthenia, and weight loss. We describe a 38-year-old woman who presented with acute abdominal pain and tenderness, as well as constitutional manifestations and elevated inflammatory markers. On initial computerized tomography (CT) and MRI, a large fluid collection underlining the anterior abdominal wall at the false pelvic cavity, as well as parietal peritoneal enhancement and smudging of the mesenteric fat and a bulky fibroid uterus with an implanted IUD, were identified. The ultrasound guided aspiration and anaerobic culture revealed positive growth for Actinomyces bacteria. An exploratory laparoscopy revealed extensive adhesions between the abdominal wall and the small intestine, as well as hyperemic and thickened peritoneum, and peritoneal biopsy confirmed ACTINOMYCOSIS. After the diagnosis was established, the IUD was removed and the patient was given Ceftriaxone 2 gm once daily for 6 weeks before switching to oral doxycycline 100 mg twice daily for another 3 months. A significant regression of the suprapubic fluid collection, and peritoneal-mesenteric changes were confirmed on follow-up. The case is discussed, and the relevant literature reviewed and analyzed.

Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease

Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence.

Abdominal actinomycosis mimicking malignancy: A case report

Actinomycosis is the infection caused by Actinomyces bacilli; subtypes include cervicofacial, pulmonary, and abdominal/pelvic actinomycosis. Abdominal actinomycosis can mimic intra-abdominal malignancies by causing manifestations like chronic lower abdominal pain, weight loss, and palpable mass(es). Treatment usually requires three to six months of high-dose penicillin G or amoxicillin. This report discusses an 88-year-old female who presented with chronic abdominal pain, weight loss, and other nonspecific symptoms without palpable abdominal mass. However, computed tomography (C.T.) imaging revealed multiple intra-abdominal soft tissue masses in the greater omentum, anterior abdominal wall, and small bowel mesentery. On biopsy, filamentous bacilli suspicious of Actinomyces was identified. The patient received prolonged antimicrobial treatment, underwent multiple CT-guided aspirations of recurrent abscesses, and had surgical intervention for sigmoid stricture. On subsequent imaging, the patient showed significant amelioration of omental and anterior abdominal wall masses. This case highlights the importance of prompt recognition and subsequent management of Actinomyces as an etiology of malignancy-like symptoms.

Abdominal actinomycosis mimicking a transverse colon malignancy: a case report and review of the literature

Background

Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy.

Case presentation

A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months’ duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy.

Conclusions

Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention.

Actinomyces in Crohn's-like appendicitis

AIMS

Appendicitis with a Crohn's-like histological appearance generally raises concern for Crohn's disease, Yersinia infection, and interval appendectomy. Actinomyces infection is a recognised cause of chronic appendicitis that can histologically mimic Crohn's disease.

METHODS AND RESULTS

We report on 20 cases of appendicitis with Crohn's-like histological features that were due to Actinomyces. Most patients presented with acute or chronic abdominal pain. Imaging studies suggested a mass in five cases. Two patients had interval appendectomy. Histological features showed Crohn's-like appendicitis in 16 cases, with moderate to marked fibrosis and granulomas in seven cases. The other four cases had less consistent histological findings. None of the patients developed Crohn's disease during the follow-up interval (median, 37 months).

CONCLUSIONS

Actinomyces can be associated with Crohn's-like appendicitis with marked fibrosis, transmural inflammation, lymphoid hyperplasia, and granulomas.

Actinomycosis of cecum associated with entamoeba infection mimicking perforated colon cancer

Actinomycosis is a granulomatous disease caused by Actinomyces that mimics other intra-abdominal pathologies especially neoplasms. Correct diagnosis can be rarely established before radical surgery. On the other hand Entamoeba infection affects a considerable number of people worldwide. To our knowledge only one case has been reported to be affected by both organisms. We report a man who has been operated for a mass in the cecum mimicking a perforated colon cancer. Abdominal CT revealed a mass with features of an invading neoplasm. After radical surgery, definitive pathology revealed that the mass was due to actinomycosis associated with Entamoeba infection. The postoperative period was uneventful and the patient was on long-course antibiotherapy. It is important to consider actinomycosis especially in patients with intra-abdominal masses with unusual aggressiveness to prevent unnecessary surgery. However, surgery can be unavoidable especially in the presence of complicated disease or high index of suspicion for malignancy.

Primary actinomycosis of the foot: a case report and literature review

Actinomycosis is an indolent, slowly progressive, suppurative infection caused by gram-positive branching bacteria of the genus Actinomyces. The organism is a member of the oral and gastrointestinal microflora of humans. The disease actinomycosis most commonly occurs in 3 body regions: cervicofacial (55% of patients), abdominopelvic (20%), and pulmonothoracic (15%). Involvement of other parts of the body is uncommon and usually secondary to a lesion in one or the other of the above sites. Extremity disease can occur by secondary involvement through direct extension or hematogenous spread. However, primary actinomycosis of an extremity is very rare. A case of primary actinomycosis of the foot in a Hispanic male and a literature review with an emphasis on primary actinomycosis of the extremity are presented in this article.

Abdominal actinomycosis

Abdominal actinomycosis has been recognised for over 150 years yet remains largely unknown to most clinicians. It's varied presentations are usually considered to represent malignancy rather than an infective process - and was once described as 'the most misdiagnosed disease'. Actinomyces are gram positive bacilli of the Actinomycetales genus, and A. israelii is responsible for the majority of human disease. They are normal commensal inhabitants of the human bronchial and gastrointestinal tracts and seem to only cause pathological infection after preceding mucosal breakdown. Patients who have undergone appendicectomy, have had a missed perforated appendicitis or women with a history of intrauterine contraceptive device use are at an increased risk. Florid abscess formation with fistulation, abundant granulation and dense surrounding fibrosis are common. Diagnosis prior to, or even during, surgery is rare and the findings are usually mistaken for acute inflammatory pathologies or malignancy. The treatment of choice is prolonged antibiotic therapy, usually with penicillin to which the organisms remain exquisitely sensitive, although delayed recurrence is possible. This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis.

Actinomycoses and Nocardia pulmonary infections

PURPOSE OF REVIEW

Actinomycosis and nocardiosis are uncommon pulmonary infections with distinct morphologic features. Both infections most commonly present as chronic, debilitating illnesses with radiographic manifestations simulating lung cancer or tuberculosis. Immunocompromised hosts, however, may develop fulminant disease resembling acute bacterial pneumonia. The purpose of this review is primarily to review the clinical features, diagnosis, and management of actinomycosis and nocardiosis.

RECENT FINDINGS

Treatment of actinomycosis is usually simple, requiring long-term, high-dose intravenous penicillin. Short-course chemotherapy, however, has recently been reported to be successful. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. The sulfonamides are still first-line agents in the management of nocardiosis, but resistance is most common among N. farcinica and N. otitidiscaviarum isolates. Carbapenems should be used as an alternative treatment for severely ill patients. Broth microdilution, E-test (AB Biodisk, Solna, Sweden) and BACTEC (Becton Dickinson, Sparks, Maryland, USA) radiometric method may be more useful in the routine clinical laboratory for antimicrobial testing of aerobic actinomycetes.

SUMMARY

The practical distinction between the two diseases is in the matter of therapy. Diagnosis depends on a high degree of suspicion so as to alert the microbiology and pathology laboratories to employ special methods to identify the organisms. Early recognition and prompt treatment usually results in complete cure.

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.

Actinomycose pelvienne révélée par une pelvipéritonite

Pelvic actinomycosis is an infection due to actinomyces organism associated with an intra-uterine contraceptive device. This infection is often revealed by an uni- or bilateral adrenal lesion. Lesions are sometimes more extensive and affect next pelvic organs: rectum, ureter, bladder. Diagnosis is often histologic with percutaneous biopsy or surgical biopsy (laparotomy or coelio surgery). Treatment is mainly medical with prolonged use of penicillin (6 months in severely cases). Surgery must be thrifty and conservative.

Periappendiceal actinomycosis mimicking malignancy report of a case

A case of a periappendiceal actinomycosis, seen in an 83-year-old woman, clinically mimicking a right ovarian neoplasm penetrating the right colon, is presented. The patient's complaints led to the discovery of a right abdominal mass. Explorative laparotomy and right hemicolectomy were done. Histological examination revealed periappendiceal actinomycotic abscesses. We discuss a possible pathogenesis and the therapeutic modalities.

[Actinomycosis of the appendix. Report of two cases]

INTRODUCTION

We report two patients with actinomycosis of the appendix extending to the caecum and the ileum, and diagnosed postoperatively on histological analysis, the authors reviewed the literature.

EXEGESIS

Actinomycosis of the appendix can be acute or chronic. Diagnosis may be obtained preoperatively on the analysis of aspiration or biopsy material under CT scan control. It is frequently done postoperatively on the analysis of surgical specimen. Actinomycosis can be treated with antibiotics only during six months if the diagnosis is made preoperative, by surgery followed by antibiotics during 6-12 months, according to the extension of the actinomycosis, if the diagnosis is made after surgery, and by a combination of a surgery and antibiotics in complex forms.

CONCLUSION

Actinomycosis of the appendix is an infrequent pathology that merits to be known. With antibiotic therapy, we can avoid surgery or wide resections.

Gastrointestinal actinomycosis: an unusual presentation with obstructive uropathy: report of a case and review of the literature

A 55-year-old female patient is described who had recurrent retroperitoneal infections without an apparent focus. After a protracted period of illness the infection proved to be caused by actinomycosis. An unusual feature of the inflammatory process consisted of obstruction of the ureters, ultimately resulting in destruction of the left kidney. Hydronephrosis resulting from inflammatory fibrosis has not been reported in the literature before.

Ultrasound-guided transvaginal aspiration in the management of actinomyces pelvic abscess

BACKGROUND

Increasing reports of intrauterine device (IUD)-related abdominopelvic actinomycosis have been described recently. Surgical therapy has been the usual treatment when tubo-ovarian abscess is identified.

CASE

A 38-year-old woman suffering from Actinomyces pelvic abscess unresponsive to medical treatment underwent transvaginal ultrasound-guided needle aspiration. It resulted in marked improvement and avoided surgical treatment.

CONCLUSION

Transvaginal needle aspiration of Actinomyces pelvic abscess may be an alternative to surgical therapy, thereby allowing the preservation of pelvic organs.

Abdominal actinomycosis

PURPOSE

Actinomyces israelii are normal inhabitants in the oral cavity and upper intestinal tract of humans. They rarely cause disease and are seldom reported as pathogens. As a pathogen it causes fistulas, sinuses, and may appear as an abdominal mass and/or abscess. The abdominal mass can masquerade as a malignant process that is very difficult to differentiate, often requiring surgical intervention with resection. Because of difficulty in making a preoperative diagnosis, we undertook this review to determine if all patients require surgical intervention and whether other adjunctive modalities may improve preoperative diagnosis.

METHODS

We report two patients with abdominal actinomycosis, one affecting the sigmoid colon and the other the retroperitoneum, iliac crest region. Both simulated a malignant process and required operations for diagnosis and treatment.

RESULTS

As reported, actinomycotic abdominal masses and strictures can be treated by penicillin alone. Long-term medical treatment seems to be very successful and avoids surgical resection. The difficulty is obtaining a definitive diagnosis.

CONCLUSION

The computed tomographic scan is the most helpful diagnostic modality. Appearance of abdominal actinomycosis is usually a contrast enhancing multicystic lesion as was found in these two patients. Needle aspiration cytology can be fairly accurate in obtaining the diagnosis and is recommended for suspicious lesions.