[A case of abdominal wall actinomycosis].

Actinomycosis is a chronic suppurative granulomatous infectious disease caused by actinomyces species that is characterized by formation of characteristic clumps called as sulfur granules. Abdominal actinomycosis is a rare disease and is often difficult to diagnose before operation. Abdominal actinomycosis infiltrating into the abdominal wall and adhering to the colon is even rarer. Most abdominal actinomycosis develops after operation, trauma or inflammatory bowel disease, and is also considered as an opportunistic infection in immunocompromised patient with underlying malignancy, diabetes mellitus, human immunodeficiency virus infection, etc. Actinomycosis is diagnosed based on histologic demonstration of sulfur granules in surgically resected specimen or pus, and treatment consists of long-term penicillin based antibiotics therapy with or without surgical resection. Herein, we report an unusual case of abdominal wall actinomycosis which developed in a patient after acupuncture and presented as abdominal wall mass that was first mistaken for abdominal wall invasion of diverticulum perforation.

Primary actinomycosis of the breast caused by Actinomyces turicensis with associated Peptoniphilus harei.

Actinomycosis of the breast is a rare disease which may mimic malignancy in presentation. Clinical presentation may make it difficult to distinguish primary actinomycosis from mastitis and inflammatory carcinoma. A 22-year-old lady presented with a 3-week history of right breast pain and greenish discharge through her nipple piercing. Physical examination revealed a palpable fluctuant lump in the upper inner quadrant of the right breast and a nipple jewelry in-situ in the upper inner quadrant of the right breast with an abscess at the edge of the areola. Needle aspiration was performed and microbiological examination of the aspirate isolated Actinomyces turicensis and Peptoniphilus harei. Actinomycosis of the breast is rare and the specie, Actinomyces turicensis, is even rarer especially in association with Peptoniphilus harei. Actinomyces is a difficult organism to treat due to its relative indolent course with potential scarring and disruption of local tissue. However, surgical intervention could be avoided with an intensive course of high-dose intravenous antibiotics and prolonged oral antibiotics afterwards.

A Case of Abdominal Wall Actinomycosis / 대한소화기학회지

Actinomycosis is a chronic suppurative granulomatous infectious disease caused by actinomyces species that is characterized by formation of characteristic clumps called as sulfur granules. Abdominal actinomycosis is a rare disease and is often difficult to diagnose before operation. Abdominal actinomycosis infiltrating into the abdominal wall and adhering to the colon is even rarer. Most abdominal actinomycosis develops after operation, trauma or inflammatory bowel disease, and is also considered as an opportunistic infection in immunocompromised patient with underlying malignancy, diabetes mellitus, human immunodefidiency virus infection, etc. Actinomycosis is diagnosed based on histologic demonstration of sulfur granules in surgically resected specimen or pus, and treatment consists of long-term penicillin based antibiotics therapy with or without surgical resection. Herein, we report an unusual case of abdominal wall actinomycosis which developed in a patient after acupuncture and presented as abdominal wall mass that was first mistaken for abdominal wall invasion of diverticulum perforation.

Invasive sinonasal actinomycosis: case report and literature review.

Actinomycosis is a rare anaerobic bacterial infection typically caused by Actinomyces israelii. Although part of normal flora in the oral cavity, and respiratory and digestive tracts, A israelii can give rise to pathologic infections most commonly reported in the oral cavity from odontogenic causes. We present a rare case of invasive actinomycosis presenting with extensive midface destruction involving the maxilla and paranasal sinuses, with mucosal necrosis mimicking an aggressive neoplasm. The diagnosis is usually reached only after histopathologic analysis showing characteristic sulfur granules with filamentous gram-positive, non-acid-fast bacteria. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Pulmonary Actinomyces graevenitzii infection presenting as organizing pneumonia diagnosed by PCR analysis.

We report what is believed to be the first case of pulmonary Actinomyces graevenitzii infection presenting as organizing pneumonia. Fever and night sweats developed in a 69-year-old male. The only abnormal laboratory data were an elevated erythrocyte sedimentation rate and C-reactive protein level. On chest images, multiple consolidations with air bronchograms were seen in the bilateral lungs. Histological examination from lung biopsy revealed a pattern of organizing pneumonia with microabscesses, but definitive diagnosis was not obtained because culture from lung specimen was negative. A. graevenitzii was eventually identified in the lung biopsy specimen by detection of an Actinomyces-specific PCR product followed by 16S rRNA gene sequencing. The patient was treated with high-dose ampicillin intravenously for 1 month, followed by oral amoxicillin and clarithromycin for 6 months, and recovered. We suggest that actinomycosis can present as organizing pneumonia, and identification of infection by PCR analysis and rRNA gene sequencing is a useful strategy in cases that are difficult to diagnose.

Canaliculite: relato de caso e conduta / Canaliculitis: case report and conduct

A canaliculite é uma infecção rara e crônica do canalículo lacrimal, cuja etiologia mais comum é o Actinomyces israelli (bactéria gram positiva, anaeróbica). Esta afecção não apresenta cura espontânea. O diagnóstico diferencial se faz com: conjuntivite crônica recorrente, blefarite e hordéolo. O tratamento definitivo é o cirúrgico (canaliculotomia), sendo realizado sob anestesia local.

The canaliculitis is a rare infection and chronicle lachrymal pathology, whose commoner etiology is Actinomyces israelli ( bacteria anaeroby positive gram). This pathology does not present cure espontany The diagnosis differential with is done: Recurring chronic conjunctivitis, blefarity and hordeoly. The definitive treatment is the surgical (canaliculotomy)), being accomplished under location anesthetizes.

Identification and treatment of bisphosphonate-associated actinomycotic osteonecrosis of the jaws.

Osteonecrosis of the jaws (ONJ) is a condition characterized by necrotic exposed bone in the jaws of patients receiving intravenous or oral bisphosphonate therapy. A review of the medical and dental literature reveals that the pathoetiology of ONJ remains unknown and there is no established link that bisphosphonates are the primary cause of this bone pathology. However, there is clinical evidence that Actinomyces may play a critical role in the pathogenesis of bisphosphonate-associated ONJ. Identification and a prolonged course of oral antimicrobial therapy may lead to complete resolution of this actinomycotic osteonecrosis.

Actinomyces in chronic granulomatous disease: an emerging and unanticipated pathogen.

BACKGROUND: Chronic granulomatous disease (CGD) is a rare inherited disease of the phagocyte NADPH oxidase system that causes defective production of toxic oxygen metabolites, impaired bacterial and fungal killing, and recurrent life-threatening infections, mostly by catalase-producing organisms. We report for the first time, to our knowledge, chronic infections with Actinomyces species in 10 patients with CGD. Actinomycosis is a chronic granulomatous condition that commonly manifests as cervicofacial, pulmonary, or abdominal disease, caused by slowly progressive infection with oral and gastrointestinal commensal Actinomyces species. Treatment of actinomycosis is usually simple in immunocompetent individuals, requiring long-term, high-dose intravenous penicillin, but is more complicated in those with CGD because of delayed diagnosis and an increased risk of chronic invasive or debilitating disease. METHODS: Actinomyces was identified by culture, staining, 16S ribosomal DNA polymerase chain reaction, and/or a complement fixation test in 10 patients with CGD. RESULTS: All 10 patients presented with a history of fever and elevated inflammatory signs without evident focus. Diagnosis was delayed and clinical course severe and protracted despite high-dose intravenous antibiotic therapy and/or surgery. These results suggest an unrecognized and unanticipated susceptibility to weakly pathogenic Actinomyces species in patients with CGD because these are catalase-negative organisms previously thought to be nonpathogenic in CGD. CONCLUSIONS: Actinomycosis should be vigorously sought and promptly treated in patients with CGD presenting with uncommon and prolonged clinical signs of infection. Actinomycosis is a catalase-negative infection important to consider in CGD.

[Actinomycosis of the kidney: a case report]. / Aktinomykose der Niere: Ein Fallbericht.

Actinomycosis is a rare infection mainly of the head and neck region (cervicofacial actinomycosis). The cause of this infection is bacterial invasion of the host's mucosal barrier with consecutive infiltration of the surrounding tissues. The treatment of choice after diagnosis is a prolonged course of high-dose antibiotics. The presence of abdominal actinomycosis is at a maximum of 25%, whereas renal involvement appears only sporadically. Aggravating causes for early diagnosis are the appearance of abscesses, fistulae and a debilitating illness resembling carcinoma and leading to surgery as the treatment of choice. Renal actinomycosis is a diagnostic challenge because it is included in the differential diagnosis of renal masses with coexisting B-symptoms. The suspicion requires surgical treatment--nephrectomy. We report on a patient who was transferred to our department for nephrectomy because of radiologically diagnosed renal and perirenal abscesses. The histological result showed renal actinomycosis.

Actinomycosis: a differential diagnosis for appendicitis. A case report and review of the literature.

Actinomyces is a genus of gram-positive anaerobic or microaerophilic bacteria that colonize the upper respiratory and gastrointestinal tracts and the female genital tract. These organisms cause disseminated disease in the mouth, the respiratory system, and rarely in the gastrointestinal tract. The diseases produced by Actinomyces species result from the disruption of the barriers that allow the dissemination of the bacteria through the surrounding tissues. The appendix is often a nidus of Actinomyces infection, but a prompt diagnosis cannot be made without the results of histologic examination of the appendix. The treatment of choice for actinomycosis of the appendix is the high-dose parenteral administration of penicillin G for 2 weeks immediately after the diagnosis has been made and continued oral treatment with that agent for at least the next 6 months. We present the case of a 13-year-old adolescent boy with actinomycosis of the appendix that was identified by histologic examination after appendectomy.

A case of pelvic actinomycosis with hepatic actinomycotic pseudotumor.

Pelvic actinomycosis in women most commonly occurs during ascending infections, usually associated with intrauterine devices (IUDs). However, secondary hepatic actinomycosis is very rare. A 47-year-old woman using IUDs for 18 years was referred under the impression of ovarian cancer. Further investigation revealed a hepatic tumor diagnosed as an inflammatory pseudotumor by fine needle aspiration biopsy, and a pelvic mass diagnosed as pelvic actinomycosis by sulfur granules in bilateral adnexa gained by an explorative laparotomy. Long-term therapy with high-dose intravenous penicillin and oral amoxicillin resulted in clinical and radiological improvement. The management of pelvic actinomycosis is based on a medical approach, although it sometimes requires surgical intervention. However, the necessity for surgical treatment is controversial in cases of secondary hepatic actinomycosis.

Abdominal mass secondary to actinomyces infection: an unusual presentation and its treatment.

Abdominal actinomycosis may appear as an abdominal mass and/or abscess. This mass can mimic a malignant tumour. The diagnosis and management of abdominal actinomycosis will be discussed through a review of the literature and a case report from our own institution. The patient was a 17-year-old boy who presented with abdominal discomfort and a palpable right lower quadrant mass defined on CT scan. He underwent en bloc resection of the mass for a presumed diagnosis of tumour of uncertain type with intestinal involvement. The diagnosis was reversed, when histology revealed filamentous organisms consistent with actinomyces. He was treated with high dose penicillin for several weeks and was discharged from the hospital taking penicillin orally. Preoperative diagnosis of abdominal actinomycosis is difficult. An accurate diagnosis is always obtained in a histological or microbiological examination, often requiring surgical resection. Recognition is important because successful treatment requires combined surgery and prolonged penicillin treatment.

Primary actinomycosis of the urinary bladder. Case report and review of the literature.

The case of a female patient, aged 37, with signs of partial intestinal obstruction, repeated cystitis and a tumoral mass in the hypogastrium is reported. Preoperative examinations could not establish the nature of the tumour. Colonoscopy as well as barium enema stopped at a sharp angulation of the sigmoid. Laparotomy evidenced an inflammatory tumour, with departure point in the urinary bladder, which involved the sigmoid and the uterus. After adhesiotomy a partial cystectomy was performed. The macroscopic aspect of the bladder was pseudopolypoid, while the microscopic one was typical for actinomycosis. The patient was discharged cured and was prescribed a penicillin course for 4 weeks.

Pelvic actinomycosis associated with intrauterine devices.

The authors describe two women with pelvic pain, long-term use of an intrauterine device, and a pelvic mass due to Actinomyces israelii. The diagnostic imaging findings were nonspecific but included mass effect and mucosal irregularity of the rectosigmoid colon at barium enema examination and complex masses and inflammatory changes at computed tomography and magnetic resonance imaging. Radiologists should be aware of the imaging findings of this potentially lethal but curable condition.

PIP: 2 cases of pelvic Actinomycosis both in women 40 years of age, with IUDs in place for 8 and 10 years respectively, were diagnosed with the aid of radiologic techniques including barium enema, computed tomography (CT) and magnetic resonance imaging (MR). The 1st woman had experienced malaise, night sweats and a weight loss of 15 lb. over 2-3 months, then felt an epigastric mass for 5 days. She has endometritis, elevated white blood cell count, and large, tender, bilateral adnexal masses. Inflammatory changes and multilocular fluid collections were demonstrated by enhanced CT. Aspiration of the epigastric mass yielded sulfur granules and anaerobic bacteria. She was successfully treated with penicillin, gentamycin and clindamycin. The 2nd woman had a 2-month history of abdominal pain, a pelvic mass and an elevated white blood cell count. Enhanced CT, barium enema and sigmoidoscopy demonstrated a mass between the uterus and bowel, with mural invasion of the sigmoid colon. A 5 x 6 cm left-sided tubo-ovarian abscess adhering to the colon, bladder and left pelvic sidewall was excised at laparotomy. She remained asymptomatic at 6 months. This lethal but curable condition is caused by Actinomyces israelii, an opportunistic gram-positive bacteria usually introduced by foreign bodies, surgery or trauma. CT and MR were helpful in diagnosing the relatively nonspecific signs and symptoms in these cases.

Successful single antibiotic therapy in Actinomyces septicemia and liver abscess.

We are reporting on a 36-year-old man with septicemia and a liver abscess due to Actinomyces sp. The infection was most probably acquired while eviscerating a deer he had shot. The possibility of an infection involving Actinomyces bovis is discussed. The liver abscess was diagnosed on the basis of non-invasive procedures. Therapy consisted of high-dose penicillin without surgical drainage of the abscess. The infection did not recur during the three-and-a-half year follow-up period. No previous reports of successful antibiotic therapy for actinomycotic liver abscess without surgical procedures are known.

Actinomycosis: the disease and its treatment.

A case of pulmonary actinomycosis is described in a patient who presented with fever, weight loss, and a painful mass on his lower anterior left rib cage. Gram-stain and culture and sensitivity tests performed on the fluid drawn of the chest wall mass revealed Actinomyces israelii as the infecting organism. The patient was successfully treated with long-term penicillin therapy. A review of this rare bacterial disease is presented, emphasizing its treatment and its similarities and differences to other bacterial and fungal diseases.