Actinomycotic osteomyelitis of the maxilla in a female patient: A rare case report with the review of the literature

Actinomycotic osteomyelitis is a rare chronic suppurative, granulomatous, fibrosing saprophytic infection. It is an endogenous infection caused by the Actinomyces species, which are part of the normal oral microflora. There is a male predilection for this type of infection, with the male to female ratio of 4:1. Though the etiopathogenesis of the infection is unclear, it is mostly attributed to the disruption of the normal oral microflora and the invasion of the microorganism into deeper tissues through a break in the mucosal barrier due to damage from trauma, extraction or previous injury. The portal of entry can be through the pulpal, periodontal or mucosal route, causing the purulent and necrotic infection of soft tissue, bone, or both. The diagnosis is usually considered when there is a persistent infection without the presence of regional lymphadenopathy and is usually confirmed through the histopathological depiction of the bacterial colonies - 'ray fungus' - as obtaining the positive culture of the causative microorganisms is difficult and is reported to be effective in less than 50%. Patients with such infections are managed with surgical debridement, followed by antibiotic therapy for a longer time period. Recent advances have been emphasized for an early diagnosis and a better prognosis of the therapy. Therefore, this paper aimed to present a rare case of actinomycotic osteomyelitis of the maxilla in a 45-year-old female patient, and also to review the literature on this rare infection.

Pediatric appendicular actinomycosis: a case report and literature review

BACKGROUND

Actinomycosis (ACM) is a rare infectious granulomatous disease caused by Actinomyces, a Grampositive, filamentous, saprophytic bacteria. There are several types of pediatric ACM, such as orocervicofacial (55%) and other less common forms: abdominopelvic and thoracic. We report a case of a 16-year-old who presented with abdominal ACM in the setting of acute appendicitis. After the case report, we provide a short literature review of pediatric appendicular ACM cases published.

CASE

A 16-year-old boy presented with nausea, vomiting, pain in the upper part of the abdomen and fever (37.5°C) lasting for 24 hours. On physical examination, the patient`s epigastrium and lower right abdominal quadrant were tender. White cell count and C-reactive protein (CRP) were elevated at 16,300/μL and 48.6mg/L respectively. Ultrasonography (US) showed appendicolith and edema of the appendiceal wall, focally with stratification as well as periappendiceal inflammation. The patient underwent a classic appendectomy, and the postoperative course was without complications. Histopathological analysis showed diffuse transmural neutrophilic infiltration of the appendix, focally with areas of necrosis and abscesses. There were numerous brightly eosinophilic colonies made of filamentous bacteria, located predominantly in submucosa. Special stains Grocott-Gomori`s Methenamine Silver and Gram were positive and a diagnosis of ACM was made.

CONCLUSIONS

Although appendicitis is very common in the general population, appendicitis associated with ACM is very rare, accounting for 0.02% - 0.06%, especially in the pediatric population. Diagnosis can be very challenging because they usually present with non-specific symptoms, and can form masses that mimic malignancies. Although rare, clinicians and pathologists should be aware of this entity. Satisfactory results and complete cure are achieved with adequate antibiotic therapy and surgery. In most cases, if there are no associated diseases, early and accurate diagnosis ensure an excellent prognosis.

Laryngeal and pharyngeal actinomycosis: a systematic review and report of 3 cases

INTRODUCTION

Actinomycosis is a granulomatous infection that rarely involves the larynx or pharynx. Three cases of actinomycosis of the larynx or pharynx from our institution were reviewed and a systematic literature review was performed to better define surgical management, antibiotic therapy, risk factors, and incidence of recurrence or complications.

MATERIALS AND METHODS

PubMed/Medline, Cochrane, Embase, and Google Scholar were searched on November 30, 2021 using the terms "laryngeal actinomycosis", "pharyngeal actinomycosis", "actinomycosis AND larynx", and "actinomycosis AND pharynx." Articles which did not describe appropriate sites or were non-English were excluded. Results were collected for demographic information, site(s) of infection, comorbidities, lesion characteristics and treatments.

RESULTS

Along with three cases reported from our institution, 40 unique cases were reviewed from 37 studies for a total of 43 patients (Table 1). 34 (81.0 %) of the patients were male with the highest incidence of infection in the seventh decade (54.8 %). The most common site for the infection was the larynx (69.0 %) followed by the pharynx (16.7 %). Risk factors included a history of radiation therapy, immunosuppression, inhalational irritant, and diabetes (Table 3). The duration of antibiotic therapy varied greatly, from one month to one year and total follow up ranged from 1 month to 2.5 years (Table 1).

CONCLUSIONS

A comprehensive review of the literature on pharyngolaryngeal actinomycosis shows that this infection has increased prevalence within the head and neck cancer patient population. Similar to cervicofacial actinomycosis, these atypical sites have shown favorable responses to extended antibiotic therapy and generally do not require aggressive surgical management.

Visible-Light-Induced Photocatalytic and Antibacterial Activity of TiO2 Codoped with Nitrogen and Bismuth: New Perspectives to Control Implant-Biofilm-Related Diseases

Biofilm-associated diseases are one of the main causes of implant failure. Currently, the development of implant surface treatment goes beyond the osseointegration process and focuses on the creation of surfaces with antimicrobial action and with the possibility to be re-activated (i.e., light source activation). Titanium dioxide (TiO₂), an excellent photocatalyst used for photocatalytic antibacterial applications, could be a great alternative, but its efficiency is limited to the ultraviolet (UV) range of the electromagnetic spectrum. Since UV radiation has carcinogenic potential, we created a functional TiO₂ coating codoped with nitrogen and bismuth via the plasma electrolytic oxidation (PEO) of titanium to achieve an antibacterial effect under visible light with re-activation potential. A complex surface topography was demonstrated by scanning electron microscopy and three-dimensional confocal laser scanning microscopy. Additionally, PEO-treated surfaces showed greater hydrophilicity and albumin adsorption compared to control, untreated titanium. Bismuth incorporation shifted the band gap of TiO₂ to the visible region and facilitated higher degradation of methyl orange (MO) in the dark, with a greater reduction in the concentration of MO after visible-light irradiation even after 72 h of aging. These results were consistent with the in vitro antibacterial effect, where samples with nitrogen and bismuth in their composition showed the greatest bacterial reduction after 24 h of dual-species biofilm formation ( Streptococcus sanguinis and Actinomyces naeslundii) in darkness with a superior effect at 30 min of visible-light irradiation. In addition, such a coating presents reusable photocatalytic potential and good biocompatibility by presenting a noncytotoxicity effect on human gingival fibroblast cells. Therefore, nitrogen and bismuth incorporation into TiO₂ via PEO can be considered a promising alternative for dental implant application with antibacterial properties in darkness, with a stronger effect after visible-light application.

[Pulmonary actinomycosis. Diagnostic and therapeutic features]

INTRODUCTION

Actinomycosis is a rare suppurative infection, subacute or chronic caused by bacteria of the genus Actinomyces.

OBSERVATIONS

A case study of 4 patients with prolonged respiratory symptoms. The clinical examination was poor in all cases. The CT-scan showed, in all cases, a suspicious tissue mass. The bronchoscopy diagnosis showed, in 2 cases, a tumor budding and was normal for the 2 other cases. Bronchial biopsies were negative in all cases. Before the prolonged symptomatology, the poor general condition, the endoscopic and the CT aspects; there was a suspect around a pulmonary neoplasia diagnosis, thus raising the need of a surgical treatment for diagnostic and therapeutic purposes. The anatomopathological examination of the resected specimen was in favour of the actinomycosis. The aim of these observations is to draw the attention to the radio-clinical, histological, therapeutic and evolutive aspects as well as the diagnostic difficulties of this condition.

CONCLUSION

The radio-clinical presentation of the actinomycosis is often misleading, thus a diagnostic confirmation is required before any useless surgical resection.

Brain abscess caused by chronic invasive actinomycosis in the nasopharynx: A case report and literature review

RATIONALE

Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is part of the normal flora in the oral cavity and respiratory and female genitourinary tracts. The cervicofacial area is the most common site of involvement, and involvement of the central nervous system is rare.

PATIENT CONCERNS

We report a case involving a 51-year-old woman who developed an actinomycotic brain abscess 15 months after the treatment of noninvasive nasopharyngeal actinomycosis, which recurred as an invasive form.

DIAGNOSES

Histopathological examination of the surgical specimens revealed actinomycosis.

INTERVENTIONS

The patient was treated by surgical drainage of the brain abscess and long-term antibiotic treatment.

OUTCOMES

Follow-up brain imaging performed 12 months after surgery showed complete resolution of the brain abscess, and there were no further signs or symptoms of infection.

LESSONS

Physicians should be aware of the typical clinical presentations of cervicofacial actinomycosis. Moreover, they should know that actinomycosis may mimic the process of malignancy at various anatomical locations.

The role of surgery in necrotizing otitis externa

This retrospective case review describes a subset of 5 patients with necrotizing otitis externa (NOE) with a refractory disease course who underwent surgery as part of their management plan between 2008 and 2013. Surgery promoted the cure of 4 of the 5 patients, and a fungal pathogen was recovered in 4 of 5 surgical samples. We conclude that surgery may be a necessary diagnostic and treatment adjunct in selective cases of NOE, especially in patients with a refractory disease course or with a suspected fungal etiology.

PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT

We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses.

Chronic Actinomyces Infection Caused by Retained Cervical Cerclage: A Case Report

BACKGROUND

Historically, Actinomyces infection has been associated primarily with the intrauterine device. Recently, case reports associating Actinomyces with other implants have been described, including nonwoven polypropylene mesh used for urethral slings and Mersilene cerclage placements. However, there are no reported cases of chronic Actinomyces infections associated with retained Mersilene cerclage.

CASE

A 51-year-old woman, gravida 3, para 3, presented with a 10-year history of vaginal discharge and Actinomyces identified on endometrial biopsy. After failing medical treatment and undergoing a hysterectomy, the patient was found to have a retained Mersilene cerclage.

CONCLUSION

This is the first case to report persistent Actinomyces infection with a retained Mersilene cerclage. No current recommendations exist for assessing full removal of cerclage. Clinicians should have a high suspicion of Actinomyces infection in a patient who presents with persistent vaginal discharge and history of cerclage placement.

Hepatic actinomycosis: Report of one case and analysis of 32 previously reported cases

Hepatic actinomycosis is rare, with few published cases. There are no characteristic clinical manifestations, and computed tomography (CT) shows mainly low-density images, making clinical diagnosis difficult, and leading to frequent misdiagnosis as primary liver cancer, metastatic liver cancer or liver abscess. Diagnosis normally requires examination of both the aetiology and pathology. This article reports one male patient aged 55 who was hospitalized because of repeated upper abdominal pain for more than 2 mo. He exhibited no chills, fever or yellow staining of the skin and sclera, and examination revealed no positive signs. The routine blood results were: haemoglobin 110 g/L, normal numbers of leukocytes and neutral leukocytes, serum albumin 32 g/L, negative serum hepatitis B markers and hepatitis C antibodies, normal tumour markers (alpha-fetoprotein and carcinoembryonic antigen). An abdominal CT scan revealed an 11.2 cm × 5.8 cm × 7.4 cm mass with an unclear edge in the left liver lobe. The patient was diagnosed as having primary liver cancer, and left lobe resection was performed. The postoperative pathological examination found multifocal actinomycetes in the hepatic parenchyma, which was accompanied by chronic suppurative inflammation. A focal abscess had formed, and large doses of sodium penicillin were administered postoperatively as anti-infective therapy. This article also reviews 32 cases reported in the English literature, with the aim of determining the clinical features and treatment characteristics of this disease, and providing a reference for its diagnosis and treatment.

Paediatric ventriculoperitoneal shunt infection caused by Actinomyces neuii

We present the first reported case of ventriculoperitoneal shunt infection secondary to Actinomyces neuii in a paediatric patient. Our patient was managed with temporary shunt removal, intrathecal antibiotics and a prolonged course of intravenous and then oral antibiotics. She went on to make a complete recovery. Subsequent cerebrospinal fluid analysis at 5 months post-treatment demonstrated no evidence of residual infection.

[Rare infection--prolonged A. naeslundii bacteremia caused by severe caries]

Actinomyces is an anaerobic, gram positive, rod shape bacteria that doesn't create spores. Actinomyces is part of the mouth, intestines, vagina and upper respiratory system flora. The infection appears mostly on the face, neck, abdomen and pelvis in cases of mucosa injury and most common in immunosuppressed patients. The spread of Actinomyces through the blood system is rare. In this article we present a 9 year old male patient with no history of diseases who was diagnosed with prolonged bacteremia of A. naeslundii without specific infection excluding severe caries. Characterization of bacteria from the blood culture was performed by molecular biology and the patient was treated with Ampicillin and tooth extraction that led to the disappearance of the bacteremia.

Identification of coryneform Actinomyces neuii by MALDI-TOF MS: 5 case reports and review of literature

OBJECTIVES

We describe five cases of Actinomyces neuii, isolated from different clinical specimens over a period of five months (from June to October 2011), followed by a review of literature on infections with this micro-organism.

METHODS

All Actinomyces neuii strains were cultured or subcultured on horse blood agar. Identification took place using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Identification was confirmed by conventional biochemical tests and API Coryne test strips (BioMérieux SA). Susceptibility testing was performed on Mueller-Hinton agar supplemented with horse blood, using E-tests (BioMérieux SA). The minimal inhibitory concentrations were determined after 24 and 48 hours of incubation in a 5% CO2 environment.

RESULTS

Isolation of this micro-organism was associated with abscesses in two patients and chronic osteomyelitis in one patient. The remaining two patients had positive blood cultures which grew Actinomyces neuii, either as contamination or as catheter-related infection. All Actinomyces neuii identifications were obtained by MALDI-TOF MS and were confirmed by conventional biochemical and API Coryne tests. Identification of one isolate was also confirmed by 16S rRNA sequencing. All strains were susceptible to penicillin. One strain showed heteroresistance for macrolides and lincosamides. Minimal inhibitory concentrations were more reliable and easier to read after 48 hours of incubation, as compared to 24 hours.

CONCLUSION

MALDI-TOF MS analysis allows rapid and reliable identification of Actinomyces neuii, even at subspecies level.

[Solitary actinomycotic brain abscess: case report]

Actinomycotic brain abscess is a rare condition with uncertain clinical features. Here we report the case of a 66-year-old immune-competent woman with an actinomycotic brain abscess who presented with sensory aphasia and mild right hemiparesis. She had no febrile episode or headache. Moreover, she did not have any periodontal or oto-rhino-laryngological disease, and the results of laboratory tests were normal. A computed tomography scan showed an irregular, low-density area in the left parietal lobe. Subsequent magnetic resonance imaging showed low-signal intensity in a T1 weighted image, high-signal intensity in a T2 weighted image, and mixed intensity on a diffusion weighted image. Thallium-201 chloride scintigraphy showed definite accumulation of thallium in the lesion and the patient's condition gradually deteriorated. Ten days after gadolinium administration, a T1 weighted image showed a multi- lobulated irregular mass in the left parietal lobe. The patient subsequently underwent craniotomy and evacuation of the yellowish abscess. Gram staining of the tissue showed the presence of gram-positive filamentous rods, and abscess cultures were positive for Actinomyces and Prevotella disiens. The abscess resolved after treatment with a high dose of intravenous penicillin G (24 million units/day) for 8 weeks, followed by an oral dose of amoxicillin for 4 months. The patient was discharged with a rudimentary limitation of the visual field.

[Actinomyces empyema treated with decortications]

Actinomyces infections are rare infections, involving the head and neck, abdominal cavity, and the lung. We report a case of a 66 year old woman with shortness of breath and a pleural effusion from which Actinomyces meyeriwas cultured. The diagnosis was confirmed by the polymerase chain reaction technique. The infection was successfully treated with a combination of ampicillin and surgical decortication. Due to their rarity, Actinomyces infections are not often suspected. These infections are difficult to diagnose due to specific microbiologic requirements for isolation of Actinomyces. In many reviewed cases of Actinomyces infection, patients underwent surgery for presumed cancer but were eventually diagnosed as being infected with actinomycosis. Due to lack of improvement of our patient, surgical decortication was performed, which led to a successful outcome.

Actinomyces meyeri infection: case report and review of the literature

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.

Implant therapy and apical actinomycosis: case report

Treatment of periapical actinomycosis includes extraction of the involved tooth; however, indications for and timing of implant therapy remain unclear. In this case report, we describe treatment of apical actinomycosis in a 63-year-old woman following tooth extraction. After monitoring the patient for 6 months, implant therapy was carried out and remained successful after 1 year follow-up.

[Actinomycosis associated with perforation of jejunum in patient after cholecystectomy--a case report]

Actinomyces is endogenic infection with rare abdominal manifestations. Diagnosis is very difficult and not always taken into account in differential diagnosis. Disease is recurrent and treatment is mostly pharmacologic and takes a long time. The aim of the paper was to present a case of patient operated on acute cholecystitis with intraabdominal actinomycosis. The 66 years old patient 28 days after cholecystectomy appeared to have jejunal perforation in the course of actinomycosis. Patient regarded two interventions due to intraabdominal abscesses. Since last discharge, a year ago, we do not observe recurrence. Intraabdominal actinomycosis is often recurrent and should be considered in patients with purulent complications after surgical procedures.

Focal intracranial infections due to Actinomyces species in immunocompetent patients: diagnostic and therapeutic challenges

OBJECTIVE

Actinomyces spp. are often underestimated as causes of central nervous system infection because they are not looked for routinely and are difficult to detect. We try to determine the optimal management of these problematic intracranial infectious diseases in neurosurgical practice.

METHODS

Five cases of intracranial suppurations due to Actinomyces spp. treated between December 2007 and February 2009 are reported. The relevant clinicobacteriologic features and treatment outcomes are analyzed.

RESULTS

There were two brain abscesses, two subdural empyemas, and one frontal sinus pyomucocele with intracranial extension. Among them, three cases were previously operated and two patients were previously treated for otorhinolaryngeal infection. All cases were immunocompetent. In addition to Actinomyces sp., three patients had coinfectious bacteria (Pseudomonas aeruginosa, Staphylococcus warneri, and Escherichia coli). Complete resolution of the infection was achieved by means of aggressive surgical treatment and relatively short course of antibiotic therapy with a full recovery.

CONCLUSION

Actinomycotic focal cerebral infections may occur with greater frequency than previously recognized. Polymicrobial bacteria may be seen. This rare anaerobic organism should be considered in patients with a history of head trauma, previous surgery, or otorhinolaryngeal infection who present with a long duration of neurologic symptoms with or without an accompanying fever. Patients may be candidates for surgical debridement with relative shorter term of antibiotic therapy (ciprofloxacin).

[Intrauterine device and pelvic tumor: two case reports of pelvic actinomycosis with pseudotumor from tropical zones]

Pelvic actinomycosis is a rare chronic disease caused by actinomycete species. The pseudotumorous form is the most common and often leads to misdiagnosis. The purpose of this report is to describe two cases of pelvic actinomycosis involving women with a history of intrauterine contraceptive device (IUD) use. Diagnosis was based on pelvic mass and the findings of surgery undertaken for suspicion of an advanced ovarian tumor with hepatic metastasis in one case and for a tumor of the right ovary in the other case. Diagnosis was confirmed by histological examination of a biopsy specimen in the first case and of the surgical specimen (right ovariectomy) in the second case. Long-term antibiotic therapy was effective in both patients. Based on these two cases and review of the literature, discussion focuses on diagnostic pitfalls, natural course, and therapeutic options for this particular infection.

Actinomycotic canaliculitis: resolution following surgery and short topical antibiotic treatment

PURPOSE

This study aimed to study the incidence and clinical characteristics of patients diagnosed with actinomycotic canaliculitis in Iceland.

METHODS

We present a nationwide, retrospective case series for which cases were identified by searches of hospital diagnostic registries and pathology databases. Case histories were reviewed and histopathological analysis repeated to confirm the diagnosis.

RESULTS

Nine cases of actinomycotic canaliculitis were diagnosed in Iceland during 1988-2007. Subjects included six women and three men and represented 16% of all patients diagnosed with actinomycosis in the country. The incidence was 0.16 cases/100 000 inhabitants/year. Age-specific incidence rates were 0.59 cases/100 000 inhabitants/year for the 40-59-year-old age group and 1.37 cases/100 000 inhabitants/year for individuals aged 60-79 years. All patients underwent a three-way snip procedure and 1 week of topical antibacterial therapy.

CONCLUSIONS

Actinomycotic canaliculitis is an uncommon condition which frequently eludes diagnosis. Topical antibiotics for 1 week may be sufficient following surgery, a finding which contrasts with previous reports.

Dormant primary cutaneous actinomycosis: Acute exacerbation after 16 years

Actinomycosis of head and neck are secondary to a nidus in the oral cavity and the aero-digestive tract. Primary actinomycosis without such predisposition is mostly due to trauma. We are presenting a case of this rare variant involving the forehead. The patient had a swelling over the forehead after a windscreen injury, which was asymptomatic for 17 years. However, 1 year ago, there was a repeat blunt trauma on the same site, but there was no breach of skin. Following this, the swelling became tender and started increasing in size. There was no response to a course of antibiotic and the patient had no concomitant history of any systemic illness. The swelling was excised and the biopsy revealed actinomycosis. This presentation of primary actinomycosis after such a long dormancy has never been reported before. This is yet another unusual presentation of actinomycosis, which is notoriously misdiagnosed owing to its rarity and numerous differential diagnoses.

[Hepatic actinomycosis ; presentation a case in a diabetic patient]

We report the case of an Hispanic female diabetic patient admitted to our hospital complaining of progressive abdominal pain, weight loss, nausea and vomiting. Work-up included an abdominal computed tomography (CT) scan which reported a large liver mass consistent with atypical abscess. Serum alpha-fetoprotein value was normal, so a fine needle aspiration biopsy of the liver was performed and the report was consistent with an actinomycosis-induced abscess. Patient was treated with intravenous and oral amoxicillin with satisfactory clinical response.

Endobronchial Actinomycosis Secondary to a Tooth Aspiration

We report a middle aged smoker with recurrent pneumonia caused by endobronchial actinomycosis secondary to a tooth aspiration. Unlike previously reported cases, our patient was not chronically debilitated. The case suggests that a follow-up bronchoscopy is beneficial after the initiation of antibiotic therapy for endobronchial actinomycosis.

Tuboovarian abscess mimicking intraligamentar uterine myoma and a intrauterine device: A case report

A case study is presented of tubo-ovarian abscess (pathohystological-verified actinomycosis) in a 41-year-old woman with an intrauterine device (IUD), which on US was found to be imposed upon an intraligamentary degenerated myoma (pyomyoma). The patient was afebrile, with normal vital functions (diuresis, blood pressure and pulse). Exposure of the abdominal cavity by lower transverse laparotomy performed under general endotracheal anaesthesia revealed slight uterus enlargement with normal left adnexa, whereas right adnexa were not exposed due to the soft tumour in the region of the right ligamentum latum, which displaced the urinary bladder and uterus leftward. The peritoneum fold was incised and deprepared, revealing a tumorous formation imposed onto the myoma or onto the 'cold' tubo-ovarian abscess. Total hysterectomy was then performed. Left adnexa showed a normal finding. Hemalaun-eosin staining of the preparation of the tumour capsule and tumour content showed colonies of threads extending radially to the surrounding tissues (drusen), surrounded by pus corpuscles, polymorphonuclears and macrophages containing lipids (sulfur granules). The patient was free from disease relapse at 2 years after the procedure. Thus, total abdominal hysterectomy and salpingoophorectomy, along with antibiotic therapy, were the definite mode of treatment for pelvic actinomycosis.

[A case report of pulmonary actinomycosis and review of the literature]

OBJECTIVE

To improve the awareness of primary pulmonary actinomycosis.

METHOD

One case of primary endobronchial actinomycosis was reported and 187 cases of primary pulmonary actinomycosis reported in the literature were reviewed.

RESULTS

A 66-year-old female had had recurrent cough, sputum production and fever for 4 years. Chest X-ray showed pneumonia in the right middle lobe. The diagnosis of pulmonary actinomycosis was confirmed by histopathological examination. The incidence of bronchopulmonary actinomycosis was 2 times higher in males than in females. The common clinical presentations included cough, sputum and chest pain with a shadow or shadows on chest radiograph. The findings on CT included patchy air-space consolidation, multifocal nodular appearance, cavitation, pleural effusions or thickening and hilar and/or mediastinal lymphadenopathy. Accurate diagnosis was generally made by histopathological examination of transbronchoscopic biopsy or surgical samples. Penicillin, tetracycline, erythromycin, sulphanilamide, lincomycin and surgical resection remained to be the treatment of choice over the last 50 years.

CONCLUSION

Primary bronchopulmonary actinomycosis is a rare infectious disease. Early diagnosis and proper treatment can lead to good outcomes with a low mortality.

[Tumoral form of abdominal and retroperitoneal actinomycosis]

We present a case of abdominal and retroperitoneal actinomycosis, clinicaly evidenced by a large tumor in the left inferior abdominal quadrant, in a 72-year-old male. Following clinical and laboratory investigations (imaging), strong suspicion of a left colon neoplasm was raised. Surgery consisted in an exploratory laparotomy and multiple biopsies of the great omentum and retroperitoneal space, the case being considered above the therapeutic resources. Histopathological diagnosis was a surprise by setting actinomycotic etiologies and enabled the establishment of a proper antibiotic treatment, followed by a favorable evolution. Postoperative follow-up revealed disappearance of lesions and healing.

[Present trends in abdominal actinomycosis]

BACKGROUND

Actinomycosis is a chronic infectious disease caused by bacteria in the Actinomyces genus. The pathologic, clinic and imagistic polymorphism and the rare incidence of this disease make it so frequent misdiagnosed.

MATERIAL AND METHOD

Single unit retrospective nonrandomized clinical study on over 40 years of experience in diagnosing and treating abdominal actinomycosis.

RESULTS

First case of abdominal actinomycosis was diagnosed in our clinic in 1968. During the next 36 years, between 1968 and 2004, there were registered only 3 cases, all ileo-cecal actinomycosis. In the next 3 years interval, 5 more cases were diagnosed: 4 associated with intrauterine devices (IUDs) and 1 associated with intraperitoneal remnant calculi after laparoscopic cholecystectomy. We present these last 5 cases, the first 3 having been reported elsewhere.

CONCLUSIONS

Abdominal actinomycosis is a rare disease, with variable and deceiving clinical and imagistic characters. In Romania we witness a shift in the epidemiology of this disease as a result of the introducing of the IUDs for the first time after 1990. Confronted with a female patient carrying an IUD that has an inflammatory and a pelvic tumoral syndrome of variable intensity, one should consider also the diagnosis of abdominal actinomycosis. Preoperative establishing of this diagnosis may allow, by a long antibiotic therapy, the elimination of the need for surgery or at least the decrease of its limits. A very rare cause of intraperitoneal actinomycosis is intraperitoneal gallstones remnant after laparoscopic cholecystectomy. To our knowledge, our case is the first reported in the medical literature.

Bronchopulmonary actinomycosis associated with hiatal hernia

OBJECTIVES

To describe clinicoradiologic and histopathologic features of bronchopulmonary actinomycosis and to determine whether hiatal hernia (HH) is a potential predisposing factor for bronchopulmonary actinomycosis.

PATIENTS AND METHODS

We reviewed the medical charts of 10 patients who had bronchopulmonary actinomycosis between November 1, 2002, and January 31, 2008. Complete clinical data, radiologic studies (chest radiographs and computed tomographic scans), and histopathologic features were assessed to investigate clinical manifestations and predisposing factors related to bronchopulmonary actinomycosis.

RESULTS

The series consisted of 6 men and 4 women, with a mean age of 63.5 years; 8 of the patients were smokers. Cough and fever were the most common symptoms. Chest imaging showed mass-like consolidation in 4 patients, bronchial thickening or lung atelectasis with pleural thickening in 2 patients each, and perihilar irregular mass or multiple bilateral nodules in 1 patient each. Primary or metastatic lung cancer was suspected clinically in 8 of the 10 patients. Foreign body-related endobronchial actinomycosis was diagnosed in 6 patients, 5 of whom had HH; only 1 had gastroesophageal reflux-related symptoms. Because of bronchial obstruction, rigid bronchoscopy was performed in 3 patients, lobectomy in 2, and atypical resection in 1. Antibiotic therapy with amoxicillin was given to all patients, with resolution of actinomycosis.

CONCLUSION

Bronchopulmonary actinomycosis is a rare condition that mimics pulmonary malignancy on clinical and radiologic grounds. Diagnosis relies on an accurate patient history and histopathologic examination. Although further confirmation is required, esophageal HH appears to be a potential predisposing factor.

Bronchopulmonary actinomycosis associated with hiatal hernia

OBJECTIVES

To describe clinicoradiologic and histopathologic features of bronchopulmonary actinomycosis and to determine whether hiatal hernia (HH) is a potential predisposing factor for bronchopulmonary actinomycosis.

PATIENTS AND METHODS

We reviewed the medical charts of 10 patients who had bronchopulmonary actinomycosis between November 1, 2002, and January 31, 2008. Complete clinical data, radiologic studies (chest radiographs and computed tomographic scans), and histopathologic features were assessed to investigate clinical manifestations and predisposing factors related to bronchopulmonary actinomycosis.

RESULTS

The series consisted of 6 men and 4 women, with a mean age of 63.5 years; 8 of the patients were smokers. Cough and fever were the most common symptoms. Chest imaging showed mass-like consolidation in 4 patients, bronchial thickening or lung atelectasis with pleural thickening in 2 patients each, and perihilar irregular mass or multiple bilateral nodules in 1 patient each. Primary or metastatic lung cancer was suspected clinically in 8 of the 10 patients. Foreign body-related endobronchial actinomycosis was diagnosed in 6 patients, 5 of whom had HH; only 1 had gastroesophageal reflux-related symptoms. Because of bronchial obstruction, rigid bronchoscopy was performed in 3 patients, lobectomy in 2, and atypical resection in 1. Antibiotic therapy with amoxicillin was given to all patients, with resolution of actinomycosis.

CONCLUSION

Bronchopulmonary actinomycosis is a rare condition that mimics pulmonary malignancy on clinical and radiologic grounds. Diagnosis relies on an accurate patient history and histopathologic examination. Although further confirmation is required, esophageal HH appears to be a potential predisposing factor.

Actinomycosis of the temporal bone with labyrinthine and facial nerve involvement

OBJECTIVES

To demonstrate the clinical, radiologic, and pathologic findings of actinomycosis of the temporal bone.

STUDY DESIGN

Case report and literature review.

METHODS

Analysis of a case through medical records and literature review.

RESULTS

Actinomycosis is a rare cause of subacute-chronic suppurative infection of the temporal bone. We present an 11-year-old male with a history of ciliary dyskinesia presenting with a 6-week history of right-sided otorrhea, otalgia, and a 1-week history of progressive facial weakness. Final histopathology revealed a diagnosis of actinomycosis. A review of the literature showed 25 cases of temporal bone actinomycosis. This is the first reported case of actinomycosis causing facial nerve palsy and labyrinthine invasion. Effective treatment includes aggressive surgical debridement followed by long-term administration of appropriate antibiotic.

CONCLUSIONS

Actinomycosis can be a cause for bone erosive lesions of the temporal bone and can result in significant morbidities. Prompt tissue diagnosis with suspicion for nonmalignant causes of bone erosive disease can help in implementing appropriate treatment.

Clinical manifestations of actinomycosis in Southern Taiwan

BACKGROUND AND PURPOSE

Actinomycosis is an uncommon and frequently misdiagnosed infection that may present as an acute or indolent process. Even when clinical suspicion is high, the disease is commonly confused with other chronic inflammatory diseases and malignancy. An early diagnosis helps the clinician in deciding treatment and can avoid physical morbidity such as unwarranted surgery.

METHODS

We retrospectively evaluated the histopathology and selected clinical information on all cases of actinomycosis that occurred at Kaohsiung Veterans General Hospital in Taiwan from 1993 to 2005. Data on the demographic characteristics, predisposing conditions, clinical presentations, diagnosis and treatment were analyzed.

RESULTS

A total 36 cases of actinomycosis were identified and evaluated. The mean age of patients was 52.14 +/- 13.28 years, and the male-to-female ratio was 1:1.1. Only three types of actinomycosis were found in this study: cervicofacial, at an incidence of 31%; thoracic (33%); and pelvic (36%). The clinical manifestations depended upon the region of infection; the most frequent presentations of cervicofacial, thoracic and pelvic actinomycosis were cutaneous soft tissue swelling with drainage sinus formation (55%), hemotypsis (75%) and abnormal vaginal spotting (54%), respectively. The most common initial laboratory abnormalities were normochromic anemia (69%) and leukocytosis (25%). While most patients had no history of a foreign body, all pelvic actinomycotic patients had a history of intrauterine device use. Nineteen patients (53%) had no comorbid conditions and 11 patients (31%) had malignancy. Most patients were initially diagnosed as malignancy (56%). All patients with actinomycosis were diagnosed by histopathologic findings. Twenty two patients (61%) were treated by surgery combined with antibiotics, 11 patients (31%) by surgery only and 3 patients (8%) by antibiotics only. No recurrence or mortality occurred.

CONCLUSIONS

Actinomycosis should be included in the differential diagnosis when patients present with chronic drainage sinus, chronic hemoptysis and abnormal vaginal spotting with use of intrauterine devices.

Persistent subumbilical discharge associated with actinomycosis caused by intrauterine contraceptive device: a case report

Intrauterine devices are a very effective form of contraception used worldwide for more than 2 centuries. One of the serious, but rare, complications of intrauterine contraception is perforation through the uterine wall into the pelvic or abdominal cavity. In this report we describe, persistent periumbilical discharge associated actinomycosis caused by migration of a copper intrauterine contraceptive device. To our knowledge, this is the first report of persistent periumbilical discharge caused by migration of a copper intrauterine contraceptive device. We recommend consideration of this minor possibility during evaluation of women with chronic abdominal discharge.

[Two cases of actinomycosis]

Actinomycosis is a bacterial infection due to Gram-positive bacteria of the Actinomyces genus. The authors describe two cases: one of them occurred in a woman with a clinical presentation of a right submandibular indurative mass. After surgery, histological examination showed a granulomatous tissue with many actinomycetes. The second case was observed in a man admitted to hospital with a diagnosis of pulmonary heteroplastic lesion. Also in this case, histological examination showed many actinomycotic colonies. Actinomycosis is an uncommon disease. Establishment of definite diagnosis requires a high index of suspicion in all cases of relapsing cervical lesions. Pulmonary actinomycosis is a rare diagnosis; respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing.

Secondary bronchial botryomycosis due to foreign body aspiration

Botryomycosis is recognised mainly as a visceral disorder with rare cases of pulmonary manifestation. The most frequent cause of pulmonary Botryomycosis is aspiration of a foreign body which induces bacteria to group together instead of spreading out forming conglomerates resembling the granules of Actinomyces. Here we report on the clinical and pathologic findings of a 38-year-old patient without any further predisposing factors. It should be mentioned that the disease was cured following the extraction of a foreign body without the need for any surgery or antibiotic therapy. Factors influencing the course of the disease are discussed below.

[Clinical symptoms and treatment of cervicofacial actinomycosis. Literature survey and case report]

Actinomycosis is a chronic, specific inflammation which is characterized by suppuration, abscess formation, tissue fibrosis and granuloma formation. Actinomycosis has three main forms (cervicofacial, which is the most frequent, approximately 60%, pulmonary and abdominal), but other regions of the body can be involved, too (e.g. neck, ovaries, bones), that is why its differential diagnosis becomes more and more relevant. Regarding its treatment, the majority of authors recommends the combination of surgical and antibiotic treatment. The authors of this article present a typical case of cervicofacial actinomycosis, in which the authors used the combination of surgical and antibiotic treatment. As a result of the treatment the healing process was completed successfully and without complications.

Pharyngeal actinomycosis: a case report

Actinomycetes are saprophytic bacteria of the oral cavity. They can produce a rare, chronic, and suppurative process that usually originates from the teeth and mandible and then involve the cervical region, especially in the sub-mandibular area. A case of actinomycosis occurring in the retropharyngeal space in a 74 year-old man is reported. It arose as a swelling behind the third lower left molar that had no lesion. The patient was treated successfully with antibiotic therapy. The clinical presentation and management of the case are discussed and the relevant literature is reviewed.

Infective endocarditis due to Actinomyces neuii

Actinomyces endocarditis is very rare. At present the only Actinomyces species identified causing endocarditis are A. israelii, A. bovis, A. viscosus, A. pyogenes, A. meyeri and A. funkei. We here report the first case of endocarditis caused by Actinomyces neuii.

Pelvic actinomycosis with retained intrauterine fetal bone: a case report

BACKGROUND

Pelvic actinomycosis is a rare infection that can manifest as pelvic inflammatory disease and in severe cases can cause extensive fibrosis. Most cases are associated with long-standing use of an intrauterine device (IUD).

CASE

A 30-year-old woman presented with abdominal pain, fever and a pelvic mass. She underwent removal of an intrauterine foreign body, surgical drainage of a tuboovarian abscess and intravenous antibiotic therapy. Pathology studies revealed that the foreign body consisted of bone tissue, and the agent of infection was identified as Actinomyces israelii.

CONCLUSION

Pelvic actinomycosis, although usually occurring in women using an IUD, may result from retained intrauterine fetal bone through a similar pathogenesis.

Abdominal Abscesses Due to Actinomycosis after Laparoscopic Cholecystectomy: Case Reports and Review

We describe 2 patients who presented to a health care facility with abdominal abscesses years after undergoing laparoscopic cholecystectomy that was complicated by gallstone spillage. In both patients, sample cultures yielded Actinomyces species and enteric organisms. In 1 patient, crystallographic analysis of abscess debris confirmed the presence of gallstones. Actinomyces species is a rare cause of abdominal abscesses that should be considered in this patient population.

Actinomycose pelvienne : à propos de deux cas

INTRODUCTION

Actinomycosis is a chronic suppurative granulomatous disease caused by different Actinomyces species, mostly bacillus: the Actinomyces israeli. The pelvis location of this infection is rare.

OBSERVATIONS

We report two cases of actinomycosis that were diagnosed after the surgical treatment of a suspected ovarian tumor and a suspected acute peritonitis. Diagnosis in both cases was based on the histopathologic findings.

CONCLUSION

The incidence of pelvic actinomycosis is increasing since 1960 related to the frequent use of intra uterine device. The clinical symptomatology is not specific, simulating a neoplastic or an inflammatory process. The treatment combines operative and antibiotic therapy.

A case of nasopharyngeal actinomycosis leading to otitis media with effusion

Nasopharyngeal actinomycosis is extremely rare, and to our knowledge, only seven cases have previously been reported. Diagnosis of actinomycosis is made by clinical finding, observation of the bacteria and histopathological examination. Treatment for actinomycosis is surgical debridement and administration of antibioticus, especially penicillin for several weeks with good prognosis. We report a case of nasopharyngeal actinomycosis, which lead to otitis media with effusion. Endoscopic surgery and prolonged penicillin administration for 2 months were effective for treatment of actinomycosis in the nasopharynx.

A case of actinomycosis causing unilateral tonsillar hypertrophy

We report a case of unusual presentation of actinomycosis in the tonsil causing massive unilateral enlargement in a 78-year-old female. To our knowledge, only three cases of actinomycosis causing unilateral tonsillar enlargement have been published previously. Since this anaerobic organism is difficult to culture, the diagnosis is made by observing its associated sulfur granules in the biopsy specimen. In the present case, treatment consisting of tonsillectomy and antibiotic therapy (penicillin) for several days produced a good prognosis.

Pseudo-tumoral renal actinomycosis

Actinomycosis is a rare granulomatous chronic infection that is localized most frequently in the cranio-cervical region. Renal localization is exceptional. The authors report a new case of pseudo-tumoral actinomycosis and discuss diagnostic and treatment issues of this disease.