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Chung YK, Jung BH, Wang HJ. Primary Hepatic Actinomycosis Mimicking Hepatic Malignancy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022. [DOI: 10.4166/kjg.2021.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yong-Kyu Chung
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Bo-Hyun Jung
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hee-Jung Wang
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Maraki S, Mavromanolaki VE, Stafylaki D, Anagnostopoulou E, Moraitis P, Kasimati A, Treptow B. A 60-Year Literature Review on Hepatic Actinomycosis. Med Princ Pract 2022; 31:103-110. [PMID: 35038716 PMCID: PMC9209987 DOI: 10.1159/000521990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatic actinomycosis (HA) is a rare infection with an indolent course, atypical clinical manifestations, nonspecific laboratory and imaging findings, and challenging diagnosis. We describe a case of a 35-year-old female who developed HA 2 weeks after gastrectomy. In addition, we analyzed clinical characteristics and outcome of 157 additional cases of HA identified in a 60-year literature review. Patients with HA were predominantly male (57%) and more than one-half were between 40 and 70 years of age. The infection was cryptogenic in 80.8% of cases. Risk factors for HA were identified in 63.1% of the patients. Clinical presentation included fever (57.7%), abdominal pain (52.1%), weight loss (45.1%), anorexia (27.5%), fatigue and chills (12.7% each), and malaise (12%) over a 2.35 ± 3.5 months period. Leukocytosis, elevated alkaline phosphatase, erythrocyte sedimentation rate, and C-reactive protein were the most frequent laboratory findings. Radiologic imaging revealed that the right lobe was more frequently affected (62.5%) with a single lesion found in two-thirds of cases. Diagnosis was achieved by histopathologic examination in 70.6% of cases. Cultures yielded Actinomyces in 45 instances, with A. israelii being the most frequent species. Less than one-half of the patients were treated only with antibiotics, while the others received combined medical and surgical treatment. The median duration of antibiotic therapy was 135 days. The presence of multiple lesions or solid tumor-like lesions (without liquefaction) was significantly associated with medical therapy alone. The outcome was favorable in most cases (94%). Although rarely encountered, HA should be considered in patients with a chronic or subacute inflammatory process of the liver to promptly diagnose and treat.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
- *Sofia Maraki,
| | | | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Eliza Anagnostopoulou
- Department of Surgical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - Panagiotis Moraitis
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Anna Kasimati
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Boris Treptow
- Department of Surgical Oncology, University Hospital of Heraklion, Heraklion, Greece
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Liang ZJ, Liang JK, Chen YP, Chen Z, Wang Y. Primary liver actinomycosis in a pediatric patient: A case report and literature review. World J Clin Cases 2021; 9:5717-5723. [PMID: 34307630 PMCID: PMC8281436 DOI: 10.12998/wjcc.v9.i20.5717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/19/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary hepatic actinomycosis is a rare infection that can be clinically confused with hepatic pyogenic abscesses or neoproliferative processes. Only a few cases of primary hepatic actinomycosis in children have been reported in the English literature.
CASE SUMMARY We describe a pediatric patient with primary hepatic actinomycosis that involved the base of the right lung and anterior abdominal wall and skin. The patient was diagnosed via histological examination of spontaneously drained material. The patient was successfully treated with an exploratory laparotomy and right posterior segmentectomy of the liver, combined with antibiotic treatment. Following surgery, the patient remains in excellent condition, without evidence of recurrence at the time of drafting this report. To summarize the clinical manifestations, diagnosis, treatment, and outcomes of primary hepatic actinomycosis, 18 case reports in English were reviewed.
CONCLUSION We conclude that actinomycosis clinically features a chronic onset, nonspecific symptoms, and a primarily histologic diagnosis. Prolonged antibiotic treatment combined with invasive intervention provides a good prognosis.
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Affiliation(s)
- Zi-Jian Liang
- Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Jian-Kun Liang
- Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Yun-Pei Chen
- Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Zhen Chen
- Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Yong Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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A systematic review of case reports of hepatic actinomycosis. Orphanet J Rare Dis 2021; 16:192. [PMID: 33931097 PMCID: PMC8086304 DOI: 10.1186/s13023-021-01821-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately. Methods Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline. Results Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection. Conclusion HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01821-5.
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Actinomyces meyeri Popliteal Cyst Infection and Review of the Literature. Case Rep Infect Dis 2017; 2017:9704790. [PMID: 28255479 PMCID: PMC5306961 DOI: 10.1155/2017/9704790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/27/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
A 66-year-old, Caucasian male presented with pain and swelling involving the left knee of one-week duration. Arthrocentesis was negative for evidence of septic arthritis. Magnetic resonance imaging (MRI) study of the left knee showed degenerative arthritis, partial tear of medial meniscus, and a complex fluid collection along the posteromedial aspect of the left knee suggestive of popliteal cyst. He underwent arthroscopy with partial medial meniscectomy. Intraoperative joint fluid was noted to be cloudy but cultures were negative. Arthroscopic procedure provided him with temporary relief but the pain and swelling in the posterior aspect of the left knee recurred in 6 weeks. Repeat MRI showed complex fluid collection in the posterolateral aspect of left knee. Ultrasound guided aspiration of the fluid collection revealed purulent material and cultures grew Actinomyces meyeri. He was treated with 6 weeks of intravenous penicillin regimen followed by 18 months of oral penicillin.
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Ha YJ, An JH, Shim JH, Yu ES, Kim JJ, Ha TY, Lee HC. A case of primary hepatic actinomycosis: an enigmatic inflammatory lesion of the liver. Clin Mol Hepatol 2015; 21:80-4. [PMID: 25834805 PMCID: PMC4379201 DOI: 10.3350/cmh.2015.21.1.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 12/16/2022] Open
Abstract
Primary hepatic actinomycosis is one of the chronic abscess-forming infections of the liver. Accurate diagnosis is frequently delayed due to its indolent course and nonspecific clinical and radiological manifestations. We report a case of a 57-year-old man presenting with asymptomatic multiple hepatic masses on follow-up abdominal computed tomography performed 1 year after stomach cancer surgery. Although a percutaneous liver biopsy procedure was conducted twice in order to obtain confirmative pathology, only a nonspecific organizing abscess with plasma cell infiltration was revealed, without identification of any organism in the tissue cultures. Ultimately, actinomycosis was diagnosed following the detection of sulfur granules on open surgical biopsied tissue. This case suggests that primary hepatic actinomycosis should be considered as one of the possible causes for enigmatic inflammatory lesions of the liver.
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Affiliation(s)
- Yeon Jung Ha
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyun An
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hyun Shim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jae Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Chu Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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First reported case of bacterial endocarditis attributable to Actinomyces meyeri. Can J Infect Dis 2012; 7:71-3. [PMID: 22514421 DOI: 10.1155/1996/761841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/1995] [Accepted: 08/10/1995] [Indexed: 11/18/2022] Open
Abstract
A 48-year-old man presented to the Victoria General Hospital, Halifax, Nova Scotia in severe congestive heart failure. Echocardiographic studies revealed significant aortic valve insufficiency. Two anaerobic blood cultures performed two weeks apart were both positive for Actinomyces meyeri. The patient was treated with high dose intravenous penicillin. Three weeks after antibiotics were begun, he underwent aortic valve replacement. Intraoperative cultures were negative. Histopathological examination revealed findings in keeping with subacute bacterial endocarditis. The patient completed a six-week course of penicillin and was doing well three months after surgery. This is the first case of endocarditis attributable to A meyeri reported in the literature.
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O'Kelly K, Abu J, Hammond R, Jensen M, O'Connor RA, Soomro I. Pelvic actinomycosis with secondary liver abscess, an unusual presentation. Eur J Obstet Gynecol Reprod Biol 2012; 163:239-40. [PMID: 22555405 DOI: 10.1016/j.ejogrb.2012.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 03/26/2012] [Accepted: 04/05/2012] [Indexed: 12/25/2022]
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Fazili T, Blair D, Riddell S, Kiska D, Nagra S. Actinomyces meyeri infection: case report and review of the literature. J Infect 2012; 65:357-61. [PMID: 22406688 DOI: 10.1016/j.jinf.2012.02.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/16/2012] [Accepted: 02/27/2012] [Indexed: 11/19/2022]
Abstract
Actinomyces meyeri is an uncommon cause of actinomycosis. We present a patient with pneumonia and empyema due to A. meyeri. The patient underwent open thoracotomy with decortication and was discharged home on a twelve-month course of oral penicillin. Review of the English literature revealed thirty-two cases of infection due to A. meyeri. The majority of patients were male, and a significant number had poor dental hygiene and a history of alcoholism. More than other Actinomyces species, A. meyeri causes pulmonary infection and has a predilection for dissemination. Prognosis is favorable with prolonged penicillin therapy combined with surgical debridement, if needed.
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Affiliation(s)
- Tasaduq Fazili
- Department of Medicine, Division of Infectious Diseases, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Soós Z, Bakos M, Kovács G, Baranyai L, Jakab F, Winkler G. [Multiple hepatic abscesses due to actinomycosis: difficulties of diagnosis]. Orv Hetil 2011; 152:268-72. [PMID: 21296736 DOI: 10.1556/oh.2011.29027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Authors present the case of a 65 year-old man without any remarkable previous illness, hospitalized because of having prolonged fever caused probably by an infection due to a tick bite. Tularaemia and bartonellosis based on serological results as well as neoplasm of the sigma with multiple metastases to the liver raised by ultrasonography and abdominal CT could be excluded with detailed investigations. Multiple abscesses of the liver were diagnosed, followed by a percutaneuos ultrasonography directed aspiration of one of the abscesses which resulted in 150 ml buffy pus. Microbiological examination evaluated the presence of Actinomyces meyeri. Instead of neoplasm, diverticulosis and diverticulitis of the sigma could be clarified with perforation of one of the diverticuli causing peridiverticulitis, retroperitoneal abscess and probably abscesses in the liver by haematogenous dissemination. Surgical intervention, resection of the liver and the sigma resulted in recovery of the patient. Difficulties of diagnosis are discussed in the article pointing out the importance of interdisciplinary collaboration, involving also infectologist. Diverticulosis of the sigma as presumably origin of hepatic actinomycosis is a literary curiosity. This was the cause of the case presentation.
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Affiliation(s)
- Zsuzsanna Soós
- Fővárosi Szent János Kórház és Észak-budai Egyesített Intézményei II. Belgyógyászat-Diabetológia Budapest Diósárok út 1. 1125
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Chao CT, Liao CH, Lai CC, Hsueh PR. Liver abscess due to Actinomyces odontolyticus in an immunocompetent patient. Infection 2010; 39:77-9. [PMID: 21153043 DOI: 10.1007/s15010-010-0063-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 11/08/2010] [Indexed: 12/27/2022]
Abstract
Liver abscess caused by Actinomyces odontolyticus is rarely reported. We report an immunocompetent patient who developed A. odontolyticus liver abscess, and was successfully treated with antibiotics for 6 weeks and abscess drainage. The isolate could not be identified accurately by one commercial biochemical method and was documented to species level by partial sequencing analysis of 16S rRNA genes.
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Affiliation(s)
- C-T Chao
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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Uehara Y, Takahashi T, Yagoshi M, Shimoguchi K, Yanai M, Kumasaka K, Kikuchi K. Liver abscess of Actinomyces israelii in a hemodialysis patient: case report and review of the literature. Intern Med 2010; 49:2017-20. [PMID: 20847510 DOI: 10.2169/internalmedicine.49.3700] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We had encountered a 74-year-old woman on hemodialysis therapy suffering from liver abscess of Actinomyces israelii. Percutaneous drainage of the abscess before starting antimicrobial therapy followed by correct microbiological identification and susceptibility test led us to determine long treatment with ampicillin and to a successful outcome. Periodontitis was thought to be a possible entry of actinomyces. Hepatic actinomycosis should be recognized as one of the important infectious diseases among patients of end-stage renal disease.
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Affiliation(s)
- Yuki Uehara
- Department of Laboratory Medicine, Nihon University School of Medicine, Tokyo.
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Chiche L, Dargère S, Le Pennec V, Dufay C, Alkofer B. Abcès à pyogènes du foie. Diagnostic et prise en charge. ACTA ACUST UNITED AC 2008; 32:1077-91. [DOI: 10.1016/j.gcb.2008.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 09/04/2008] [Accepted: 09/25/2008] [Indexed: 01/09/2023]
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Guven A, Kesik V, Deveci MS, Ugurel MS, Ozturk H, Koseoglu V. Post varicella hepatic actinomycosis in a 5-year-old girl mimicking acute abdomen. Eur J Pediatr 2008; 167:1199-201. [PMID: 18066595 DOI: 10.1007/s00431-007-0639-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 11/07/2007] [Indexed: 12/15/2022]
Abstract
Actinomycosis is an indolent, slowly progressive infection caused by gram-positive, anaerobic or microaerophilic bacteria. Hepatic involvement is rare and generally secondary to abdominal or thoracic actinomycosis. Hepatic actinomycosis in children may mimic a wide variety of diseases and thus make the diagnosis much more challenging. Here, we report a 5-year-old girl with apparently primary hepatic actinomycosis mimicking acute abdomen 2 weeks after varicella. The diagnosis was made by ultrasonic guided fine needle aspiration biopsy of a hypoechoic lesion of 3.5 cm diameter in the liver showing sulfur granules surrounded by neutrophils. Hepatic actinomycosis should be taken into account when evaluating acute abdomen symptoms in children.
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Affiliation(s)
- Ahmet Guven
- Department of Pediatric Surgery, Gulhane Military Medical Academy, Etlik/Ankara, 06017, Turkey.
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Abstract
Actinomycotic hepatic abscess was diagnosed in a 46-year-old male driver from Ukraine presenting with the symptoms of malaise, loss of appetite, upper right quadrant pain, weight loss, and night sweats which had been present for last 2 months. Computed tomography (CT) of the abdomen revealed a hypodense mass in the left liver lobe which was suspected as hepatocellular carcinoma. Histopathological examination of the CT guided biopsy specimen yielded a diagnosis of actinomycotic abscess of the liver. Treatment with intravenous penicillin for 6 weeks followed by a course of oral penicillin for 14 weeks resulted in complete cure as evidenced by clinical improvement and radiological disappearance of the lesion.
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Palacios Muñoz R, Abarca Costalago M, Arana Romero C, Santos González J. [Suppurative hepatic lesion with extension to soft tissues]. Rev Clin Esp 2006; 206:397-8. [PMID: 16863627 DOI: 10.1157/13090509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- R Palacios Muñoz
- Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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Benkhraba K, Benkabbou A, El Malki HO, Amahzoune M, Mohsine R, Ifrine L, Belkouchi A, Balafrej S. Actinomycose digestive. ACTA ACUST UNITED AC 2006; 30:775-8. [PMID: 16801902 DOI: 10.1016/s0399-8320(06)73313-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Actinomycosis is a chronic suppurative disease. It is caused by an anaerobic bacterium, generally Actinomyces israelii. Cervical and thoracic localizations are most frequent. Digestive actinomycosis is rare and can simulate cancer leading to resection. We report 3 cases of surgical abdominal actinomycosis. Localization was colic in 2 cases and hepatic in 1 case. The diagnosis of actinomycosis was made after resection in the 3 cases. The evolution was favourable under medical treatment. These observations illustrate the difficulty of diagnosing this rare and unrecognised disease which can be cured by long term penicillin therapy.
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Lakshmana Kumar YC, Javherani R, Malini A, Prasad SR. Primary hepatic actinomycosis. Trans R Soc Trop Med Hyg 2006; 99:868-70. [PMID: 16102790 DOI: 10.1016/j.trstmh.2005.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Revised: 05/31/2005] [Accepted: 06/02/2005] [Indexed: 12/26/2022] Open
Abstract
Actinomycotic liver abscess was diagnosed in a 35-year-old alcoholic farmer from southern India with tender hepatomegaly and fever. CT of the abdomen revealed three coalescing hypodense lesions in the liver. The causative organism could be demonstrated on direct microscopy and cultured from the pus. Treatment with i.v. penicillin for 2 months and oral ampicillin for 5 months resulted in cure as evidenced by clinical improvement and radiological disappearance of the lesions.
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Affiliation(s)
- Y C Lakshmana Kumar
- Department of Medicine, Sri Devaraj Urs Medical College, Tamaka, Kolar 563101, Karnataka, India.
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Abstract
Hepatic actinomycotic abscesses are rare and secondary to other intra-abdominal infections. History of intra-abdominal surgery is a principal contributing factor for the abscess formation. Patients with hepatic actinomycotic abscess may suffer from fever, malaise, abdominal pain and bodyweight loss. The clinical progress of actinomycotic abscess is more indolent than the usual course of other pyogenic abscess. It is sometimes diagnosed as malignancy. This report consists of two cases of hepatic actinomycotic abscess mimicking tumours. Laboratory data revealed elevated alkaline phosphatase and leucocytosis. The abdominal computed tomography scan showed multiloculated lesions with peripheral contrast enhancement appearance. Diagnosis confirmation was based on the typical histologic feature of sulfur granules with inflammatory process by echo-guided fine needle biopsy or surgical specimen. These two cases were resolved with extended courses of intravenous and oral penicillin treatment.
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Affiliation(s)
- L-W Chen
- Liver Research Unit, Chang-Gung Memorial Hospital, Keelung, Taiwan
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Hefny AF, Torab FC, Joshi S, Sebastian M, Abu-Zidan FM. Actinomycosis of the Gallbladder: Case Report and Review of the Literature. Asian J Surg 2005; 28:230-2. [PMID: 16024323 DOI: 10.1016/s1015-9584(09)60350-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.
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Affiliation(s)
- Ashraf F Hefny
- Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates
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Balint TD, Bailey BM, Mendelson KG, Pofahl W. Hepatic abscess: Current concepts in diagnosis and treatment. ACTA ACUST UNITED AC 2005; 58:381-4. [PMID: 15727770 DOI: 10.1016/s0149-7944(01)00456-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- T D Balint
- Department of General Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
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Filipović B, Milinić N, Nikolić G, Ranthelović T. Primary actinomycosis of the anterior abdominal wall: case report and review of the literature. J Gastroenterol Hepatol 2005; 20:517-20. [PMID: 15836698 DOI: 10.1111/j.1440-1746.2004.03564.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Actinomycosis of the anterior abdominal wall is a rare infection caused by different Actinomyces species. We report a case of primary actinomycosis localized on the anterior abdominal wall, diagnosed by computed tomography (CT) scan, postoperatively confirmed by histopathological examination and treated by surgical resection combined with postoperative antibiotic therapy. The patient has been free of recurrence after 1 year. A review of the available literature is also presented.
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Affiliation(s)
- Branka Filipović
- Clinical and Hospital Center, Bezanijska Kosa, Belgrade, Serbia and Montenegro.
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Felekouras E, Menenakos C, Griniatsos J, Deladetsima I, Kalaxanisi N, Nikiteas N, Papalambros E, Kordossis T, Bastounis E. Liver resection in cases of isolated hepatic actinomycosis: case report and review of the literature. ACTA ACUST UNITED AC 2004; 36:535-8. [PMID: 15307597 DOI: 10.1080/00365540410020866-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hepatic actinomycosis is an uncommon entity that forms communicating abscesses and fistulae. We report a 53-y-old immunocompetent male patient with hepatic actinomycosis. Symptoms included intermittent fever, abdominal pain, right upper quadrant tenderness and jaundice. A hepatic tumour mass was found on abdominal sonography and computerized tomography. Two preoperative percutaneous core biopsies of the mass were not diagnostic. The above findings were highly suggestive for liver abscess or purulent primary liver neoplasm. Treatment with intravenous antibiotics was continued for 20 d, but both symptoms and liver ultrasound findings remained unchanged. The patient underwent exploratory laparotomy and right posterior segmentectomy of the liver. Pathological examination of the surgically removed specimen disclosed hepatic actinomycosis. Following operation the patient remains in excellent condition without evidence of recurrence.
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Affiliation(s)
- E Felekouras
- Academic Department of Surgery I, School of Medicine and 'Laikon' General Hospital, Athens, Greece
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26
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Castellón Pavón CJ, Foruria Franco AM, González Núñez MA, Morales Artero S, Martínez Sapiña A, del Amo Olea E. [Primary hepatic actinomycosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:464-6. [PMID: 15388050 DOI: 10.1016/s0210-5705(03)70504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes. We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma. After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe. Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy. Prolonged antibiotic treatment produced a complete response. The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.
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Affiliation(s)
- C J Castellón Pavón
- Servicio de Cirugía General y del Aparato Digestivo, Hospital San Pedro de Alcántara, Cáceres, Spain.
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27
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Colmegna I, Rodriguez-Barradas M, Rauch R, Clarridge J, Young EJ. Disseminated Actinomyces meyeri infection resembling lung cancer with brain metastases. Am J Med Sci 2003; 326:152-5. [PMID: 14501233 DOI: 10.1097/00000441-200309000-00010] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thoracic actinomycosis can resemble bronchogenic carcinoma in its clinical presentation and radiographic appearance. We report a case of pulmonary actinomycosis caused by Actinomyces meyeri in which hematogenous dissemination caused multiple brain abscesses resembling metastatic lung cancer. The correct diagnosis was made by thin-needle aspiration of a pleura-based lung mass. The pathogen isolated was further identified with the use of 16S rDNA sequencing. Antibiotic therapy resulted in rapid improvement of the lung lesion; however, the brain lesions required surgical drainage. Antibiotics were continued for more than a year before magnetic resonance images showed complete resolution of the cerebral abscesses.
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Affiliation(s)
- Ines Colmegna
- Medical Service, Veterans Affairs Medical Center, Houston, TX 77030, USA
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28
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Abstract
Intra-abdominal and extraperitoneal actinomycosis are rare infections, caused by different Actinomyces species. However, they have been diagnosed more frequently in the last ten years. We report three cases of abdominal actinomycosis and a literature review of the last eight years. All three patients were diagnosed by means of histopathologic examination only. In one case, an intrauterine device (IUD) was associated with the infection. Therapy consisted of surgical resection of the inflammatory, infected tissue, and long-term antibiotic therapy. All patients are free of recurrence. Abdominal actinomycosis should be included in the differential diagnosis of an abdominal pathology of insidious onset, especially when an IUD is in place. Even when infection had spread extensively, combined operative and antibiotic therapy cured most of the cases.
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29
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Sharma M, Briski LE, Khatib R. Hepatic actinomycosis: an overview of salient features and outcome of therapy. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 34:386-91. [PMID: 12069027 DOI: 10.1080/00365540110080304] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 34-y-old African-American male developed Actinomyces liver abscess 8 months after appendectomy. Review of the English language literature revealed 56 additional cases of hepatic actinomycosis. Affected patients were typically immunocompetent, had a wide age range (4-86 y) and were predominantly male (70.2%). Infection was frequently (80.7%) cryptogenic, presenting with fever (83.3%), abdominal pain (74.5%) and weight loss (50.9%) over a 3.7 +/- 5.1 month period. The most common radiographic finding was a single hypodense mass/abscess (68.4%). Extension to surrounding tissues was evident in 19 cases (33.3%). Diagnosis was usually accomplished microscopically and culture was often (33.3%) negative. Infection was often (35.2%) mixed, usually with anaerobic bacteria. A surgical or percutaneous approach was diagnostic in 29/35 (82.9%) and 24/33 (72.7%) cases, respectively. The overall mortality rate was 8.8%; it was 10.7% with medical therapy alone and 4.0% using a combined medical/intervention approach (p = 0.6). In conclusion, hepatic actinomycosis is a rare subacute infection that may mimic neoplasm. It is usually cryptogenic, is more common among immunocompetent individuals and male subjects and is highly responsive to medical therapy.
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Affiliation(s)
- Mamta Sharma
- Department of Medicine, St John Hospital & Medical Center, Detroit, Michigan 48236, USA
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30
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Riegert-Johnson DL, Sandhu N, Rajkumar SV, Patel R. Thrombotic thrombocytopenic purpura associated with a hepatic abscess due to Actinomyces turicensis. Clin Infect Dis 2002; 35:636-7. [PMID: 12173147 DOI: 10.1086/342327] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Garduño E, Rebollo M, Asencio MA, Carro J, Pascasio JM, Blanco J. Splenic abscesses caused by Actinomyces meyeri in a patient with autoimmune hepatitis. Diagn Microbiol Infect Dis 2000; 37:213-4. [PMID: 10904195 DOI: 10.1016/s0732-8893(00)00133-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of actinomycosis with uncommon localizations that was due to Actinomyces meyeri. Although penicillin is the standard treatment for this condition, our patient was treated successfully with imipenem. Actinomyces organisms are important constituents of the normal flora of mucous membranes and are considered opportunistic pathogens; these organisms may produce infection after local trauma, surgery, or aspiration. The mains forms of actinomycosis are cervicofacial, thoracic, and abdominal; most cases are due to Actinomyces israelii, whereas other Actinomyces species are occasionally implicated. Actinomycosis usually occurs in immunocompetent persons, but may occur in persons with diminished host defenses.
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Affiliation(s)
- E Garduño
- Microbiology Unit and Digestive Unit, Department of Internal Medicine, Hospital Infanta Cristina. Ctra de Portugal, s/n. 06080, Badajoz, Spain.
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32
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33
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Sugano S, Matuda T, Suzuki T, Makino H, Iinuma M, Ishii K, Ohe K, Mogami K. Hepatic actinomycosis: case report and review of the literature in Japan. J Gastroenterol 1997; 32:672-6. [PMID: 9349996 DOI: 10.1007/bf02934120] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatic actinomycosis is rare. We report an 86-year-old Japanese man with a 3-day history of high fever and anorexia who had an actinomycotic liver abscess complicated by disseminated intravascular coagulation (DIC). A definitive diagnosis was made when an Actinomyces species was cultured from aspirated pus. The clinical course was satisfactory. Treatment included prompt percutaneous drainage coupled with long-term intravenous administration of high-dose minocycline and piperacillin, combined with therapy for DIC. We reviewed 11 cases in Japan of Actinomyces involving the liver, including the case reported here. In most patients, there were no predisposing factors. Common symptoms and laboratory findings included fever, abdominal pain, leukocytosis, and elevated C-reactive protein. In 6 of the 11 patients a partial hepatectomy was performed because hepatic tumor was suspected. Five patients presented with a liver abscess. Hepatic actinomycosis should be considered in the differential diagnoses of pyogenic liver abscess and space-occupying lesions of the liver.
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Affiliation(s)
- S Sugano
- Department of Internal Medicine, Saiseikai Wakakusa Hospital, Yokohama, Japan
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34
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Chaumentin G, Pariset C, Stouls T, Boibieux A, Reverdy ME, Baulieux J, Spitalier P, Biron F, Peyramond D. [Actinomyces meyeri disseminated actinomycosis disclosing pulmonary carcinoma]. Rev Med Interne 1997; 18:563-5. [PMID: 9255374 DOI: 10.1016/s0248-8663(97)80808-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The diagnosis of severe actinomycosis parallel to that of neoplasia leads to speculation of a possible fortuitous association. Because underlying conditions such as immuno-suppression are suspected in such disease, and to strengthen this hypothesis, we report one more case of disseminated actinomycosis associated with a malignant disease, namely an epidermoid pulmonary carcinoma. The diagnosis was made by thoracotomy a few months after the infectious episode. Two years later the patient recovered. The analysis of the literature data is in favor of a fortuitous association between both diagnoses.
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Affiliation(s)
- G Chaumentin
- Service de pathologie infectíeuse et tropicale, hôpital de la Croix-Rousse, Lyon, France
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35
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Guerci AP, Merle-Melet M, Mory F, Blum A, Floquet J, Deneuville M, Boissel P, Lederlin P. [Actinomycosis and non-Hodgkin's malignant lymphoma: fortuitous association?]. Rev Med Interne 1996; 17:571-5. [PMID: 8881384 DOI: 10.1016/0248-8663(96)83095-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two cases of actinomycosis associated with non Hodgkin's lymphoma (NHL) are reported. In one case, low grade NHL was diagnosed many years after actinomycosis because of the persistence of abdominal lymphadenopathy in spite of antibiotic therapy. In the second case, hepatic metastasis were initially suspected until actinomycosis diagnosis was made by percutaneous liver biopsy under scanography. High grade NHL was diagnosed by laparotomy and liver biopsy performed 6 weeks after the onset of antibiotic therapy as no improvement in hepatic lesions was obtained. These two case reports outline the difficulties encountered in the diagnosis of actinomycosis and the indication of a repeat biopsy when actinomycosis does not respond to antimicrobial therapy because of the possibility of concomitant malignancy.
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Affiliation(s)
- A P Guerci
- Service de médecine A, CHU Brabois, Vandoeuvre-lès-Nancy, France
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