Infections caused by Actinomyces viscosus

Proteomic analysis of sialoliths from calcified, lipid and mixed groups as a source of potential biomarkers of deposit formation in the salivary glands

Salivary stones, also known as sialoliths, are formed in a pathological situation in the salivary glands. So far, neither the mechanism of their formation nor the factors predisposing to their formation are known despite several hypotheses. While they do not directly threaten human life, they significantly deteriorate the patient's quality of life. Although this is not a typical research material, attempts are made to apply various analytical tools to characterise sialoliths and search for the biomarkers in their proteomes. In this work, we used mass spectrometry and SWATH-MS qualitative and quantitative analysis to investigate the composition and select proteins that may contribute to solid deposits in the salivary glands. Twenty sialoliths, previously characterized spectroscopically and divided into the following groups: calcified (CAL), lipid (LIP) and mixed (MIX), were used for the study. Proteins unique for each of the groups were found, including: for the CAL group among them, e.g. proteins from the S100 group (S100 A8/A12 and P), mucin 7 (MUC7), keratins (KRT1/2/4/5/13), elastase (ELANE) or stomatin (STOM); proteins for the LIP group-transthyretin (TTR), lactotransferrin (LTF), matrix Gla protein (MPG), submandibular gland androgen-regulated protein 3 (SMR3A); mixed stones had the fewest unique proteins. Bacterial proteins present in sialoliths have also been identified. The analysis of the results indicates the possible role of bacterial infections, disturbances in calcium metabolism and neutrophil extracellular traps (NETs) in the formation of sialoliths.

Gut microbiome and anti-viral immunity in COVID-19

SARS-CoV-2 mainly affects the respiratory system, but the gastrointestinal tract is also a target. Prolonged gut disorders, in COVID-19 patients, were correlated with decreased richness and diversity of the gut microbiota, immune deregulation and delayed viral clearance. Although there are no definitive conclusions, ample evidence would suggest that the gut microbiome composition and function play a role in COVID-19 progression. Microbiome modulation strategies for population stratification and management of COVID-19 infection are under investigation, representing an area of interest in the ongoing pandemic. In this review, we present the existing data related to the interaction between gut microbes and the host's immune response to SARS-CoV-2 and discuss the implications for current disease management and readiness to face future pandemics.

Periapical Actinomycosis: A Rare Subdivision of Cervicofacial Actinomycosis, Review of the Literature, and a Case Report

Background

Periapical actinomycosis, which is reckoned as a subgroup of cervicofacial actinomycosis, is an uncommon, more indolent, less invasive, and limited type of actinomycosis infection. However, it can be considerably underreported due to the low number of periapical surgical specimens that are submitted for histopathological analysis after excision of the lesion with the preliminary diagnosis of typical periapical infections. It is believed that during root canal treatment, the organisms are displaced from the oral cavity into the periapical regions as a result of failure to establish aseptic techniques which can further result in actinomycosis infections and, in rare instances, lead to more severe events and can even be life-threatening. Case Presentation. We intend to report a case of periapical actinomycosis in a 34-year-old female who presented with the chief complaint of pain and slight mobility of the mandibular right second premolar and first molar with no significant issues in the patient's medical history. Initial orthopantomography revealed a uniloculated, radiolucent lesion engulfing the apices of the aforementioned teeth. An incisional biopsy was then obtained which revealed fragments of fibroconnective tissue including few crushed bone particles severely infiltrated by acute inflammatory cells and some foamy macrophages. The suppurative exudate focally surrounds colonies of filamentous bacteria as round basophilic masses with radial configuration resembling “sulfur granules.” Surgical approach consisted of curettage accompanied with peripheral ostectomy and cautious burnishing of the two involved tooth roots.

Conclusion

This case report emphasizes the importance of aseptic techniques during endodontic and more invasive treatments, as they can cause penetration of Actinomyces into the periapical region which in some cases can lead to more serious complications and even life-threatening situations.

Infective endocarditis by Actinomyces species: a systematic review

Actinomycosis, is a slowly progressive infection that may mimic malignancy due to the invasiveness of tissues and the ability to form sinus tracts. Infective Endocarditis (IE) is a rare disease with significant morbidity and mortality. Interestingly, even though there are scarce data of IE by Actinomyces spp. in the literature, a review adequately summarizing all available evidence on the topic in a systematic way is lacking. The aim of this study was to systematically review all cases of IE by Actinomyces spp. in the literature and describe the epidemiology, microbiology, clinical characteristics, treatment and outcomes of this infection. A systematic review of PubMed, Scopus and Cochrane library (through 19 August 2021) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE by Actinomyces spp. was performed. A total of 31 studies providing data for 31 patients were included. A prosthetic valve was present in 12.9%, while the most common microorganism was A. meyeri. Aortic valve was the most commonly infected intracardiac site, followed by the mitral valve. Diagnosis was most commonly performed with transesophageal echocardiography, while the diagnosis was made at autopsy in 16.1%. Penicillin, cephalosporins and aminopenicillins were the most commonly used antimicrobials. Clinical cure was noted in 80.6%, while mortality was 19.4%. Development of heart failure was associated with mortality by IE. This systematic review thoroughly describes IE by Actinomyces and provides information on epidemiology, clinical presentation, treatment and outcomes.

Clinical Characteristics of Actinomyces viscosus Bacteremia

Background and Objectives: Actinomyces species are part of the normal flora of humans and rarely cause disease. It is an uncommon cause of disease in humans. The clinical features of actinomycosis have been described, and various anatomical sites (such as face, bones and joints, respiratory tract, genitourinary tract, digestive tract, central nervous system, skin, and soft tissue structures) can be affected. It is not easy to identify actinomycosis because it sometimes mimics cancer due to under-recognition. As new diagnostic methods have been applied, Actinomyces can now more easily be identified at the species level. Recent studies have also highlighted differences among Actinomyces species. We report a case of Actinomyces viscosus bacteremia with cutaneous actinomycosis. Materials and Methods: A 66 years old male developed fever for a day with progressive right lower-leg erythematous swelling. Blood culture isolates yielded Actinomyces species, which was identified as Actinomyces viscosus by sequencing of the 16S rRNA gene. In addition, we searched for the term Actinomyces or actinomycosis cross-referenced with bacteremia or "blood culture" or "blood stream" from January 2010 to July 2020. The infectious diseases caused by species of A. viscosus from January 1977 to July 2020 were also reviewed. Results: The patient recovered well after intravenous ampicillin treatment. Poor oral hygiene was confirmed by dental examination. There were no disease relapses during the following period. Most cases of actinomycosis can be treated with penicillin. However, clinical alertness, risk factor evaluation, and identification of Actinomyces species can prevent inappropriate antibiotic or intervention. We also compiled a total of 18 cases of Actinomyces bacteremia after conducting an online database search. Conclusions: In summary, we describe a case of fever and progressive cellulitis. Actinomyces species was isolated from blood culture, which was further identified as Actinomyces viscosus by 16S rRNA sequencing. The cellulitis improved after pathogen-directed antibiotics. Evaluation of risk factors in patients with Actinomyces bacteremia and further identification of the Actinomyces species are recommended for successful treatment.

Challenge dilemma of actinomycosis in the tongue: Review and case report

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Rare presentation of actinomycosis of the tongue makes it challenge.

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Actinomycosis should be kept as a differential diagnosis in bewildering cases.

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Histopathology consider as important diagnostic aids in challenged cases.

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Varied clinical manifestations of the disease.

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Treatment should implement in harmony according to each diseases solely.

Introduction

Rare presentation of tongue actinomycosis makes it challenge, less than 3% of all recorded cases of actinomycosis can be proved in the English literature. In this study we clarify the unexpected presence of actinomycosis wishing that it assist our practitioner colleagues in diagnosing such lesions perfectly.

Case presentation

Sixty five years old female was complaining from mass in the tongue submucosally since 1 year last with no history of fever, pain and trauma. It’s situated in the anterior third of the tongue, mild discomfort with percussion. Benign neoplasm was the clinical diagnosis. Decision was excisional biopsy. So patient underwent surgery under local anesthesia. Complete excision was done. Specimen sends for histopathological examination. Good healing process. Patient advice to keep on tetracycline capsule 250 mg for 1 month precautionary. Histopathological examination of the biopsy specimen diagnosis was mycetoma, with no malignancy.

Discussion

Clinically actinomycosis can be challenge too when it be silent not manifest as infection more over similarity to other pathological conditions at that time detailed patient history will be invaluable to exclude neoplastic pathology. Surgeons should pay attention to that prolonged antibiotic therapy is usually required is mandatory in some cases, and excellent prognosis confirmed. With better oral hygiene, availability of antibiotics, and advanced surgical techniques, the outcome, and mortality have improved.

Conclusion

Varied clinical manifestations of the disease are make achievement of clinical diagnosis of actinomycosis is difficult. Treatment should implement in harmony according to each diseases solely.

A sticky situation: a case of Actinomyces viscosus vertebral osteomyelitis

Actinomyces viscosus is an oral bacterium that is rarely virulent in humans, with most case presentations involving dental and maxillofacial infections. We describe the first reported case of A. viscosus vertebral osteomyelitis in a patient who had a significant response to penicillin after minimal response to cephalosporin therapy.

Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management

For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.

Actinomyces viscosus causing disseminated disease in a patient on methotrexate

Actinomycosis is an uncommon infectious disease caused predominantly by Actinomyces israelii. Actinomycosis usually involves the cervicofacial, thoracic, abdominal, and pelvic region, dissemination is uncommon. Actinomyces viscosus are commensal organisms that make up the normal flora of the oropharynx of humans and has rarely been reported to cause disease. Here, we report a unique case of disseminated actinomycosis with lung and brain lesions caused by Actinomyces viscosus resembling lung cancer with metastasis in a 74 year old male. Cultures from skin lesions confirmed A. viscosus. Although the patient was immunocompromised, antibiotic treatment with a penicillin-based regimen was effective.

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature

Purpose

Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.

Methods

This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.

Results

From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.

Conclusion

Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

[Actinomycosic mycetoma of the foot in Morocco due to Actinomycetes viscosus]

We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.

Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also that actinomycosis may mimic the malignancy process in various anatomical sites. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. Preventive measures, such as reduction of alcohol abuse and improvement of dental hygiene, may limit occurrence of pulmonary, cervicofacial, and central nervous system actinomycosis. In women, intrauterine devices must be changed every 5 years in order to limit the occurrence of pelvic actinomycosis.

Bacterial Infections

In Osier’s time, bacterial pneumonia was a dreaded event, so important that he borrowed John Bunyan’s characterization of tuberculosis and anointed the pneumococcus, as the prime pathogen, “Captain of the men of death.”1 One hundred years later much has changed, but much remains the same. Pneumonia is now the sixth most common cause of death and the most common lethal infection in the United States. Hospital-acquired pneumonia is now the second most common nosocomial infection.2 It was documented as a complication in 0.6% of patients in a national surveillance study,3 and has been reported in as many as 20% of patients in critical care units.4 Furthermore, it is the leading cause of death among nosocomial infections.5 Leu and colleagues6 were able to associate one third of the mortality in patients with nosocomial pneumonia to the infection itself. The increase in hospital stay, which averaged 7 days, was statistically significant. It has been estimated that nosocomial pneumonia produces costs in excess of $500 million each year in the United States, largely related to the increased length of hospital stay.

Pyothorax Caused by Anaerobic Organisms

Pyothorax was caused by anaerobic organisms including Actinomyces viscosus, anaerobic streptococcus species, and Bacteroides species in a 67-year-old man. Despite administration of antibiotics and continuous irrigation of the abscess cavity with a povidone iodine solution, the pyothorax was complicated by pneumonia and the patient died of sepsis caused by methicillin-resistant Staphylococcus aureus on the 44th hospital day. This case is the 10th report of thoracic Actinomyces viscosus infection in English literature.

Rothia dentocariosa endocarditis complicated by brain abscess

A 27-year-old woman is described with Rothia dentocariosa endocarditis, the fourth such case described in the literature. Her course was complicated by brain abscess, which was treated successfully with antibiotics. It is believed this represents the first case of R. dentocariosa with central nervous system involvement.

Isolation of Wolinella recta and Actinomyces viscosus from an actinomycotic chest wall mass

In this Note we describe a patient with an actinomycotic chest wall mass from which large numbers of Wolinella recta and Actinomyces viscosus organisms were isolated. This is the first reported association of W. recta with extraoral infection and the tenth report of lung infection by A. viscosus.