Appendecular actinomycosis: A case series of 14 patients.

OBJECTIVE: This study aims to assess the clinical, radiological, and histological characteristics of Actinomyces infection identified in appendectomy specimens. MATERIAL AND METHODS: Between January 2013 and November 2023, 5834 patients underwent appendectomy in our clinic, and their pathology reports were retrospectively reviewed. RESULTS: Actinomyces appendicites were reported in 14 specimens (0.23%). It was determined that appendectomy was performed in only 10 patients (71.4%), ileocecal resection was performed in two patients (14.2%) and right hemicolectomy in two patients (14.2%). The operations on five patients were performed by laparoscopy, and the operations on the other nine patients were performed by open surgery. Laparoscopy was started in three patients and converted to open surgery due to suspicion of an ileocecal mass and cecal perforation. It was found that the white blood cell count of three patients was within the normal range of reference (8-9.77mg/dL); leukocytosis was detected in other patients (10.2-18.7mg/dL). C-reactive protein was normal in one patient and high in the rest of the patients. While the first-hour erythrocyte sedimentation rate was normal in five patients, it was found to be high in the other patients. Findings on radiological imaging were reported as acute appendicitis, appendicular plastron, and ileocecal mass. As a result of the pathology findings, the patients were given oral penicillin or semi-synthetic penicillin derivatives during one month. CONCLUSION: Ileocecal and appendecular actinomycosis are rare, and preoperative diagnosis is difficult. A definitive diagnosis is usually made after a histopathological examination. After surgery, long-term antimicrobial treatment of the patient is possible with penicillin.

Incidental actinomycosis in a 44-year-old female during total abdominal hysterectomy for abnormal uterine bleeding: A case report.

Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy in treating actinomycosis. The case underscores the importance of considering uncommon infections in pelvic pathology, particularly in patients with prolonged intrauterine contraceptive device usage. It prompts further exploration of actinomycosis in relation to intrauterine contraceptive device use and highlights the need for timely intervention and histopathological confirmation for optimal patient care.

Dot-in-circle sign in cervical actinomycotic mycetoma: An extremely rare case report.

Actinomycosis is an unusual, chronic granulomatous infection caused by Actinomycetes spp. The organism also causes mycetoma, a neglected tropical disease in endemic regions. We present a very uncommon case of extensive actinomycosis of the soft tissues in the neck with perivertebral extension that showed the dot-in-circle sign on magnetic resonance imaging. A 29-year-old male patient presented with progressively enlarging hard posterior neck swelling of 4 years duration. Subsequently, magnetic resonance imaging showed the dot-in-circle sign in an avidly enhancing infiltrative lesion with extensive involvement of the neck and perivertebral soft tissue. The pathologic examination was in line with actinomycosis. The patient responded to high doses of combination parenteral and oral antibiotics.

Cerebral actinomycosis following a facio-cranial trauma: A case report.

Cerebral actinomycosis is a rare, chronic, but curable bacterial brain infection. We report the case of an 18-year-old male patient with a history of facio-cranial trauma, admitted in our institution with severe headaches and behavioral disorders. Magnetic resonance imaging (MRI) was performed showing the presence of contiguous multiple small round and ovoid lesions in the right frontal lobe with "the dot in circle" appearance. The diagnosis of cerebral actinomycosis was confirmed by histological study of the biopsy sample. Despite it being a rare condition, it is important to consider this diagnosis in patients with atypical post-traumatic neurological symptoms.

A rare case report of liver masses caused by Actinomyces species.

Actinomycosis is a rare infection caused by Actinomyces spp. Of all actinomycosis infections, only 5% of Hepatic Actinomycosis (HA) infection has been reported. This disease is often misdiagnosed as a malignancy. This case report presents a 45-year-old woman with diabetes, initially suspected of intrahepatic cholangiocarcinoma, but after careful tissue staining, we found the results supported HA infection.

[Non-viral infections of the liver]. / Nichtvirale Infektionen der Leber.

Non-viral infections of the liver are rare to very rare compared to viral infections. They can be caused by various bacteria, helminths, protozoa, and fungi, often leading to liver involvement during dissemination. Some of these infections affect in particular immunocompromised individuals, while others need to be considered in the differential diagnostic work-up in patients returning from tropical countries. In cases where the infection occurs through oral ingestion of eggs, such as in cystic and alveolar echinococcosis, the liver is often the most commonly affected organ. Due to the diversity of non-viral liver infections and their varied clinical manifestations, a comprehensive discussion of all potential pathogens and their effects is not within the scope of this article. Therefore, only a few of these conditions will be discussed in more detail.

An overview of case reports and case series of pulmonary actinomycosis mimicking lung cancer: a scoping review.

Background: Pulmonary actinomycosis (PA) is a rare type of Actinomyces infection that can be challenging to diagnose since it often mimics lung cancer. Methods: Published case reports and case series of PA in patients with suspicion of lung cancer were considered, and data were extracted by a structured search through PubMed/Medline. Results: After analyzing Medline, 31 studies were reviewed, from which 48 cases were extracted. Europe had the highest prevalence of reported cases with 45.1%, followed by Asia (32.2%), America (19.3%), and Africa (3.2%). The average age of patients was 58.9 years, and 75% of all patients were above 50 years old. Male patients (70%) were predominantly affected by PA. The overall mortality rate was 6.25%. In only eight cases, the causative agent was reported, and Actinomyces odontolyticus was the most common isolated pathogen with three cases. Based on histopathological examination, 75% of the cases were diagnosed, and the lobectomy was performed in 10 cases, the most common surgical intervention. In 50% of the cases, the selective antibiotics were intravenous and oral penicillin, followed by amoxicillin (29.1%), amoxicillin-clavulanic acid, ampicillin, levofloxacin, and doxycycline. Conclusion: The non-specific symptoms resemble lung cancer, leading to confusion between PA and cancer in imaging scans. Radiological techniques are helpful but have limitations that can lead to unnecessary surgeries when confusing PA with lung cancer. Therefore, it is important to raise awareness about the signs and symptoms of PA and lung cancer to prevent undesirable complications and ensure appropriate treatment measures are taken.

Actinomycosis of the Middle Ear Mimicking Cholesteatoma: A Case Report and Literature Review.

Actinomycosis is a rare infection of the middle ear. Actinomyces is an anaerobic, filamentous bacterium causing granuloma formation and suppurative infection. We present a young male with a nine-month history of unilateral, yellow-coloured otorrhoea and hearing loss. Swabs showed no growth, with the infection not responding to oral or topical antibiotics. Computed tomography of temporal bones was consistent with cholesteatoma and ossicular disruption. Surgical exploration revealed a yellow, cystic mass within the middle ear. Cortical mastoidectomy and washout were performed. Histological diagnosis confirmed Actinomyces clusters with positive gram stain. Actinomycosis of the middle ear typically presents as chronic otitis media. It likely reaches the middle ear via the eustachian tube. It is often misdiagnosed due to culture insensitivity; however, clinical suspicion can aid labs in providing an optimum culture environment. Tympanomastoidectomy allows for histopathological diagnosis. Surgical resection should be followed by a prolonged course of antibiotics.

Surgical Management of Severe Mandibular Actinomycosis: Segmental Mandibulectomy and Fibula Free Flap for Optimal Outcomes.

Actinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.

Appendiceal actinomycosis mimicking malignant tumor: a rare case report.

Introduction: Actinomycosis is an uncommon bacterial infection caused by Actinomyces bacteria that typically progresses slowly and leads to the formation of masses. Although it commonly affects the cervicofacial area, about 20% of cases occur in the abdominopelvic region. Because the disease can be mistaken for a tumour due to its infiltrative mass-like nature on imaging, over 90% of cases are only diagnosed following surgery and histological confirmation. This report describes a case of an appendicular mass, initially suspected to be a malignant tumour, but eventually diagnosed as appendiceal actinomycosis. Presentation of case: Upon initial presentation, a 53-year-old woman with type II diabetes mellitus and no prior surgical history, displayed abnormal appendiceal uptake during a PET-computed tomography (CT) scan conducted for a suspected spinal tumour. Colonoscopy did not indicate any notable observations, and the patient chose to defer immediate action. Several months later, a CT scan revealed an increased mass-like appearance of the appendix compared to the previous PET-CT scan. After multidisciplinary discussions, a right laparoscopic hemicolectomy was recommended due to suspected malignancy. However, histological staining on microscopy confirmed actinomycosis originating from the appendix. Discussion: Chronic appendicitis with radiologic features similar to appendiceal carcinoma, or abdominal masses located in the ileocecal area, in patients with or without a previous surgical history should raise suspicion of actinomycosis. Conclusion: Appendiceal actinomycosis should be considered in the differential diagnosis in the aetiology of chronic appendicitis mimicking appendiceal carcinoma. Awareness and accurate diagnosis of appendiceal actinomycosis can prevent unnecessary extended surgery as was performed in this case.

Cervical Facial Actinomycosis Complicated by Bacteremia After 30 Years of Dental Neglect: Successful Treatment With Ceftriaxone and Metronidazole.

Actinomycosis is an uncommon bacterial infection, caused by the Actinomyces species, and it most commonly presents as cervicofacial actinomycosis. The most common risk factors for actinomycosis are poor dental hygiene, oral surgery, maxillofacial trauma, local tissue inflammation, and diabetes. We discuss a case of a male patient in his 50s with 30 years of poor dental hygiene, complicated by tobacco use, who presented with septic shock and was found to have cervicofacial actinomycosis and bacteremia. The treatment of severe actinomycosis often involves prolonged penicillin-based antibiotic therapy. This is the first case in the literature to describe the successful treatment of cervicofacial actinomycosis and bacteremia with intravenous cefepime (later narrowed to ceftriaxone) and oral metronidazole.

Delayed Presentation of Actinomycosis Following Orthognathic Surgery: An Old Nemesis and a Difficult Diagnosis: Case Presentation and Review of the Literature.

Study Design: Review of the literature with report of Case. Objective: To review the presentation of Actinomycosis specifically as it occurs with mandibular osteotomies. Methods: A review of the literature and report of an additional case. Results: While minor infections secondary to local factors are usually seen 2-3 weeks after surgery, late infections are rare. Host factors may play a role. When actinomycosis is diagnosed, long-term antibiotics are necessary. Conclusions: Actinomycosis is very rare following orthognathic surgery. It usually occurs in the mandible and following a sagittal split. Time of presentation for actinomycosis can vary from 6 weeks to 4 months as in our case. Infections occurring this late after surgery should be treated with suspicion of actinomycosis obtaining both cultures and tissue biopsies. Treatment involves an incision and drainage and long-term antibiotics.

Actinomyces-induced Osteomyelitis of the Mandible - A Rare Disease.

BACKGROUND: Actinomyces species are commensal oral cavity flora that can cause jaw osteomyelitis. Osteomyelitis of the jaw by Actinomyces is rare, and its presentation can be confused with many different pathologies. CASE PRESENTATION: This is the case of a 61-year-old female with breast cancer and on chemotherapy as well as non-invasive carcinoma of the tongue who initially presented to the dentist with white spots in the right mandible near the incisors associated with right mandible pain and swelling. Actinomyces-induced osteomyelitis of the mandible was diagnosed. The patient was treated with penicillin V for 6 weeks along with a course of hyperbaric oxygen therapy, which resulted in the complete resolution of the infection. CONCLUSION: In summary, jaw osteomyelitis caused by Actinomyces should always be part of the differential diagnosis; as these organisms are commensal flora, the symptoms manifested are nonspecific, and such a diagnosis could be easily missed, resulting in delay of care and disease progression.

Imaging findings in inflammatory disease of the genital organs.

This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.

Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature.

BACKGROUND: Actinomyces turicensis is rarely responsible of clinically relevant infections in human. Infection is often misdiagnosed as malignancy, tuberculosis, or nocardiosis, therefore delaying the correct identification and treatment. Here we report a case of a 55-year-old immunocompetent adult with brain abscess caused by A. turicensis. A systematic review of A. turicensis infections was performed. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases MEDLINE, Embase, Web of Science, CINAHL, Clinicaltrials.gov and Canadian Agency for Drugs and Technology in Health (CADTH) were searched for all relevant literature. RESULTS: Search identified 47 eligible records, for a total of 67 patients. A. turicensis infection was most frequently reported in the anogenital area (n = 21), causing acute bacterial skin and skin structure infections (ABSSSI) including Fournier's gangrene (n = 12), pulmonary infections (n = 8), gynecological infections (n = 6), cervicofacial district infections (n = 5), intrabdominal or breast infections (n = 8), urinary tract infections (n = 3), vertebral column infections (n = 2) central nervous system infections (n = 2), endocarditis (n = 1). Infections were mostly presenting as abscesses (n = 36), with or without concomitant bacteremia (n = 7). Fever and local signs of inflammation were present in over 60% of the cases. Treatment usually involved surgical drainage followed by antibiotic therapy (n = 51). Antimicrobial treatments most frequently included amoxicillin (+clavulanate), ampicillin/sulbactam, metronidazole or cephalosporins. Eighty-nine percent of the patients underwent a full recovery. Two fatal cases were reported. CONCLUSIONS: To the best of our knowledge, we hereby present the first case of a brain abscess caused by A. turicensis and P. mirabilis. Brain involvement by A. turicensis is rare and may result from hematogenous spread or by dissemination of a contiguous infection. The infection might be difficult to diagnose and therefore treatment may be delayed. Nevertheless, the pathogen is often readily treatable. Diagnosis of actinomycosis is challenging and requires prompt microbiological identification. Surgical excision and drainage and antibiotic treatment usually allow for full recovery.

Sigmoid colon pseudotumor of actinomycosis: a rare case.

Actinomycosis is a chronic suppurative infection caused by gram-positive bacteria, Actinomyces, which commonly colonize the oral cavity, urogenital tract and gastrointestinal tract. It causes opportunistic infection where the mucosal barrier is compromised and is often misdiagnosed as malignancy. We report a case of a 58-year-old female with severe abdominal pain and a palpable tender mass in the left lower quadrant. Computed tomography scan with contrast showed thickening of the transverse, descending to sigmoid colon wall and intense contrast enhancement resembling colitis with mesenteritis. At laparotomy, we found an adherent mass involving sigmoid colon with adjacent small bowel and peritoneum. We decided to perform adhesiolysis and Hartmann procedure. The culture result was negative, whereas the biopsy of sigmoid colon revealed characteristic sulfur granules of actinomycosis colony. Intravenous antibiotic combination of ceftazidime and metronidazole was administered for 14 days followed by complete resolution of symptoms. Histopathological and bacteriological examinations are keys to diagnose actinomycosis. Patients require long-term antibiotic therapy, but surgery is often required because preoperative diagnosis is difficult. Main novel aspects?: We presented the rare case of intra-abdominal actinomycosis in IndonesiaThe case was challenging to diagnose pre-operatively based on physical examination andExploratory laparotomy revealed pseudotumor mimicking advanced stage of colon neoplasm.

Exploring the link between long-term intrauterine contraceptive device usage and abdominal actinomycosis in a middle-aged female: A case report.

Actinomycosis is a rare, chronic, and suppurative disease caused by Actinomyces species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of anterior abdominal actinomycosis in a 40-year-old female with a history of intrauterine contraceptive device placement. The patient presented with severe abdominal pain, an abdominal mass, low-grade fever, and weight loss. Imaging studies revealed thickening of the left rectus abdominis muscle and pericolic fat stranding. An exploratory laparotomy confirmed dense adhesions from the transverse colon and omentum to the abdominal wall with a purulent discharge. Resection of the affected colon segment and primary anastomosis were performed. Histopathological examination revealed characteristic colonies of Actinomyces within abscesses, confirming the diagnosis of actinomycosis. The patient received appropriate antibiotic therapy and showed improvement. This case highlights the rare occurrence of abdominal wall actinomycosis associated with an intrauterine contraceptive device and emphasizes the importance of considering actinomycosis in the differential diagnosis of abdominal pathologies. Thus, medical history related to intrauterine contraceptive device use should be regarded as in differentials if a patient presents vague abdominal mass and pain, and small details in history should be emphasized and looked upon so that a timely decision can be made for the betterment of the patient.

[18F]FDG PET/CT Findings of Mass-Forming Actinomycosis in an Uncontrolled Diabetic Patient.

We report a case of cervicofacial actinomycosis mimicking malignant sarcoma in a 78-year-old man with diabetes. High lesion uptake and decreased cerebral uptake on [18F]FDG PET/CT provide a potentially important diagnostic clue suggesting infectious disease in a poorly controlled diabetic patient.