RESUMO
Actinomycosis is a rare chronic granulomatous disease characterized by granuloma formation and tissue fibrosis with sinus tracts, often misdiagnosed due to its similarity to many infectious and non-infectious diseases. This report presents a case of a 60-year-old female with more than 10 years history of rheumatoid arthritis who developed actinomycosis infection after long-term treatment with immunosuppressants and biologics, including methotrexate, leflunomide, and infliximab, leading to recurrent joint pain, poorly controlled rheumatoid arthritis activity, and persistent elevation of white blood cell counts. Abdominal CT revealed a pelvic mass and right ureteral dilation. Pathological examination of cervical tissue showed significant neutrophil infiltration and sulfur granules, indicating actinomycosis. The patient received 18 months of doxycycline treatment for the infection and continued rheumatoid arthritis therapy with leflunomide, hydroxychloroquine sulfate, and tofacitinib, resulting in improved joint symptoms and normalized white blood cell counts. After 2 years of follow-up, the patient remained stable with no recurrence. This case highlights the importance of clinicians being vigilant for infections, particularly chronic, occult infections from rare pathogens, in rheumatoid arthritis patients on potent immunosuppressants and biologics, advocating for early screening and diagnosis.
Assuntos
Actinomicose , Artrite Reumatoide , Obstrução Ureteral , Humanos , Feminino , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Pessoa de Meia-Idade , Actinomicose/diagnóstico , Actinomicose/complicações , Actinomicose/tratamento farmacológico , Obstrução Ureteral/etiologia , Imunossupressores/uso terapêuticoRESUMO
A 73-year-old man was referred to our hospital with a right pleural effusion. Chest computed tomography( CT) showed multifocal pleural effusion, and chest drainage was performed. Actinomyces meyeri was detected in the pleural fluid culture. Despite antibiotic treatment, the patient's condition did not improve, and a curettage was performed for empyema. The chest tube was removed on postoperative day 7 and the patient was discharged home uneventfully on day 21. Intravenous antibiotics were given for 16 days, followed by oral antibiotics for 6 months. Actinomycosis empyema is a rare disease with no established duration of treatment, but a total of 6 to 12 months of treatment is generally recommended.
Assuntos
Actinomicose , Empiema Pleural , Humanos , Masculino , Idoso , Actinomicose/diagnóstico por imagem , Actinomicose/cirurgia , Empiema Pleural/microbiologia , Empiema Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagemAssuntos
Actinomicose , Humanos , Diagnóstico Diferencial , Actinomicose/diagnóstico , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
Actinomycosis is a rare infectious disease characterized by slowly progressive, chronic suppurative lesions, often mistaken for malignancies due to its ability to mimic them. It is caused by Actinomyces bacteria, which are part of the normal flora of the human oropharynx, gastrointestinal, and urogenital tracts. This case report describes a 51-year-old male with a history of mandibular rhabdomyosarcoma presenting with severe shoulder and hip pain, dysphagia, and headaches, initially suspected to be a cancer recurrence. However, after further investigation, including a PET-CT and tonsillectomy, the diagnosis of actinomycosis was confirmed through histopathological examination. The case highlights the diagnostic challenges of actinomycosis, especially in patients with complex clinical histories, emphasizing the importance of considering it as a differential diagnosis in similar presentations. The patient was treated with long-term antibiotic therapy, predominantly beta-lactams, demonstrating the necessity of a comprehensive diagnostic approach and the implications of a delayed diagnosis. This case underscores the critical need for high clinical suspicion and awareness among healthcare professionals regarding the potential for actinomycosis to mimic more common diseases, ensuring timely and accurate treatment.
Assuntos
Actinomicose , Rabdomiossarcoma , Humanos , Masculino , Pessoa de Meia-Idade , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Diagnóstico Diferencial , Rabdomiossarcoma/diagnóstico , Antibacterianos/uso terapêutico , Tonsila Palatina/microbiologiaRESUMO
Actinomycosis is a rare endogenous infection characterised by indolent progression, contiguous spreading, abscess formation and draining sinuses. Here, we present a case of Schaalia odontolytica causing a mediastinal abscess that is unique in its acuity and location. Our patient presented with worsening dysphagia, and CT of her chest revealed a new mass in the posterior mediastinum displacing the oesophagus. Oesophagram revealed mild motility disorder, but no masses or ulcers within the oesophagus. Oesophagogastroduodenoscopy with endoscopic ultrasound revealed extrinsic compression of the oesophagus. Fine-needle aspiration of the mass yielded purulent fluid, which was cultured. A single colony of S. odontolytica was isolated. Initially, medical treatment was favoured, but as she developed worsening dysphagia, the abscess was drained. She continued on long-term antibiotic therapy after drainage and had complete resolution of the abscess at 1 year.
Assuntos
Actinomicose , Transtornos de Deglutição , Hospedeiro Imunocomprometido , Doenças do Mediastino , Humanos , Feminino , Actinomicose/diagnóstico , Actinomicose/complicações , Actinomicose/tratamento farmacológico , Transtornos de Deglutição/etiologia , Doenças do Mediastino/diagnóstico , Diagnóstico Diferencial , Abscesso/diagnóstico , Abscesso/microbiologia , Antibacterianos/uso terapêutico , Tomografia Computadorizada por Raios X , Drenagem , Pessoa de Meia-Idade , MediastinoRESUMO
Actinomycosis is a very rare, infectious disease, which is especially difficult to diagnose due to non-specific symptoms and the ability to emulate neoplasms or inflammatory changes. Due to those facts, it is often misdiagnosed or diagnosed too late to be successfully treated. This article presents the case of 31-year-old Caucasian female with recurrent upper respiratory tract infections and tonsillitis as the potential risk factors of actinomycosis. Upon examination of material collected through the course of tonsillectomy, the patient was diagnosed with actinomycosis of the left palatine tonsil. Despite the introduction of antibiotic therapy, initial progression was noted with the appearance of numerous, hypodense changes in the liver and the spleen, which regressed during further antibiotic treatment. According to our team's knowledge, this is the first described case of a patient with actinomycosis occurring simultaneously in the cervico-facial and abdominal area. The unusual localization and potential dissemination of actinomycosis should be considered in clinical practice.
Assuntos
Actinomicose , Tonsilite , Humanos , Feminino , Adulto , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Tonsilite/microbiologia , Tonsilite/tratamento farmacológico , Tonsilite/diagnóstico , Antibacterianos/uso terapêutico , Actinomicose Cervicofacial/diagnóstico , Actinomicose Cervicofacial/tratamento farmacológico , AbdomeRESUMO
Pulmonary actinomycosis is a rare infectious disease that can be difficult to diagnose due to nonspecific imaging abnormalities and to a need for repeated lung sampling by CT-guided biopsy or bronchoscopy. It may present with hemoptysis, which can occur with or without antibiotic therapy and bronchial artery embolization may be required. We report here a case of pulmonary actinomycosis with imaging by thoracic CT, digital subtraction angiography, and pathological specimens.
Assuntos
Actinomicose , Artérias Brônquicas , Embolização Terapêutica , Tomografia Computadorizada por Raios X , Humanos , Actinomicose/diagnóstico , Actinomicose/diagnóstico por imagem , Embolização Terapêutica/métodos , Tomografia Computadorizada por Raios X/métodos , Artérias Brônquicas/patologia , Artérias Brônquicas/diagnóstico por imagem , Masculino , Hemoptise/etiologia , Hemoptise/terapia , Hemoptise/diagnóstico , Pessoa de Meia-Idade , Broncoscopia/métodos , Feminino , Angiografia Digital/métodosRESUMO
Actinomycetes are predominantly pathogenic bacteria that lack aerial hyphae and do not form spores. They are generally anaerobic or facultative anaerobic Gram-positive bacteria, belonging to the prokaryotic group. Actinomycetes are widely distributed in nature, similar to other bacteria, and are mostly saprophytic, with a few being parasitic. They are named as such due to their colony's radial form. The symptoms and signs of actinomycosis are atypical and rarely manifest in the nasopharynx. Consequently, it can be challenging to distinguish actinomycosis from nasopharyngeal carcinoma, making diagnosis difficult. Histopathology is usually relied upon for diagnosis, although culture may pose challenges. Fortunately, actinomycetes are highly sensitive to penicillin. Therefore, timely treatment with high doses of penicillin is crucial for successful recovery. In this case study, we present the details of a 53-year-old female patient with no history of mucosal damage or tooth decay but with a previous partial thyroidectomy. The patient experienced recurring neck pain accompanied by progressive limitation of neck movement. Nasopharyngoscopy revealed the presence of a smooth-surfaced mass. Subsequent biopsy, clinical imaging, microbiological analysis, and histological findings confirmed the diagnosis of actinomycosis.Following a comprehensive treatment plan involving a combination of penicillin and doxycycline for a duration of two months, the disease was successfully eradicated.
Assuntos
Actinomicose , Humanos , Actinomicose/diagnóstico , Feminino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Diagnóstico DiferencialRESUMO
BACKGROUND: Pediatric actinomycosis studies are limited to case reports or small case series. In this retrospective cohort study, we aimed to describe characteristics of skin and soft tissue actinomycosis in adolescents and children. METHODS: We conducted the study from January 2019 to December 2022, including patients ≤21 years of age with at least 1-year follow-up data. All clinical cultures obtained under sterile conditions with Actinomyces growth were included. RESULTS: One hundred four patients met inclusion criteria; median age 19 (interquartile range: 17-20) years, 68.3% female, 46.2% Black and 47.1% Hispanic. The median antibiotic treatment duration was 10 (7-10) days, and majority of patients received treatment with non-first-line Actinomyces antibiotics. Infectious disease consultation was requested for only 7 patients during their initial skin and soft tissue actinomycosis treatment. One-third of the patients with skin and soft tissue actinomycosis had documented recurrence within a median of 10 (interquartile range: 6-16) months of the initial episode. Monobacterial culture growth (85.7% vs. 63.8%, P = 0.02), patients with body mass index >25 (75% vs. 52.6%, P = 0.04) and patients with prior abscess in the same area (18.8% vs. 51.4%, P = 0.001) were significantly higher in patients with recurrent actinomycosis compared to the nonrecurrent group. In a univariate logistic regression model, they were found to be significantly associated with recurrence; monobacterial growth [odds ratio (OR): 3.4; 95% confidence interval (CI): 1.2-9.9], body mass index >25 (OR: 2.7; 95% CI, 1.1-7.0) and prior abscess (OR: 4.6; 95% CI: 1.9-11.2). CONCLUSIONS: Our study results highlight the importance of considering Actinomyces species in skin and soft tissue infections, especially in recurrent ones, and risk factors for recurrence. Suboptimal antibiotic utilization, very low numbers of consultations with infectious diseases and high recurrence rate suggest that providers should be informed and updated regarding this rare but hard-to-treat infection.
Assuntos
Actinomyces , Actinomicose , Antibacterianos , Infecções dos Tecidos Moles , Humanos , Adolescente , Feminino , Masculino , Actinomicose/tratamento farmacológico , Actinomicose/microbiologia , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Criança , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Actinomyces/isolamento & purificação , Adulto Jovem , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/epidemiologia , Recidiva , Pré-EscolarRESUMO
Esophageal stenosis can cause vomiting or dysphagia in children and is commonly treated with esophageal balloon dilation. However, surgery may be required if the stenosis does not respond to dilation. Although esophageal actinomycosis can cause severe esophageal strictures and be refractory to balloon dilation, it has been reported to respond effectively to antimicrobial therapy in adults. However, the course of the disease and appropriate treatment strategies in children are not well understood. We present a case of a previously healthy 2-year-old boy diagnosed with esophageal stenosis because of actinomycosis. The patient was treated with intravenous penicillin G, followed by oral amoxicillin for 8 weeks and 6 months, respectively. After completion of the antimicrobial treatment, the patient showed improvement in symptoms and endoscopic findings. At the 1-year follow-up, the patient showed consistent weight gain and normal growth without further intervention. This case highlights the importance of considering esophageal actinomycosis as a potential cause of esophageal stenosis in children and the potential effectiveness of antimicrobial therapy in avoiding surgical intervention.
Assuntos
Actinomicose , Amoxicilina , Estenose Esofágica , Humanos , Masculino , Estenose Esofágica/etiologia , Estenose Esofágica/tratamento farmacológico , Actinomicose/tratamento farmacológico , Actinomicose/diagnóstico , Actinomicose/complicações , Pré-Escolar , Amoxicilina/uso terapêutico , Amoxicilina/administração & dosagem , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Penicilina G/uso terapêutico , Penicilina G/administração & dosagemAssuntos
Actinomicose , Hérnia Umbilical , Humanos , Diagnóstico Diferencial , Actinomicose/diagnóstico , Actinomicose/diagnóstico por imagem , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/cirurgia , Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/diagnóstico , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Actinomicose , Apendicectomia , Humanos , Actinomicose/diagnóstico , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Idoso , Apendicite/diagnóstico , Apendicite/cirurgia , Adulto Jovem , Doenças do Ceco/diagnóstico , Doenças do Ceco/cirurgia , Doenças do Ceco/microbiologia , Laparoscopia , Actinomyces/isolamento & purificação , AdolescenteAssuntos
Actinomicose , Radioisótopos de Gálio , Neoplasias Pulmonares , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Actinomicose/diagnóstico por imagem , Diagnóstico Diferencial , Masculino , Actinomyces , Pessoa de Meia-Idade , Feminino , IdosoRESUMO
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.
Assuntos
Actinomyces , Actinomicose , Humanos , Actinomicose/diagnóstico , Actinomicose/microbiologia , Actinomicose/patologia , Actinomicose/tratamento farmacológico , Feminino , Pessoa de Meia-Idade , Actinomyces/isolamento & purificação , Fígado/patologia , Fígado/microbiologia , Hepatopatias/microbiologia , Hepatopatias/diagnóstico , Hepatopatias/patologia , Histocitoquímica , Tomografia Computadorizada por Raios XRESUMO
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 non-specific, and such a diagnosis could be easily missed, resulting in delay of care and disease progression.
Assuntos
Actinomyces , Actinomicose , Osteomielite , Humanos , Osteomielite/microbiologia , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Feminino , Pessoa de Meia-Idade , Actinomicose/diagnóstico , Actinomicose/microbiologia , Actinomicose/tratamento farmacológico , Actinomicose/complicações , Actinomyces/isolamento & purificação , Antibacterianos/uso terapêutico , Mandíbula/microbiologia , Oxigenoterapia Hiperbárica , Diagnóstico Diferencial , Doenças Mandibulares/microbiologia , Doenças Mandibulares/tratamento farmacológico , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológicoAssuntos
Actinomicose , Gastroscopia , Humanos , Biópsia , Estômago/patologia , Actinomicose/patologiaRESUMO
We report a 77-year-old man with a skin abscess caused by Actinomyces radingae. Targeted antibiotic therapy with amoxicillin/clavulanic acid for 6 weeks resulted in clearing of the infection. A. radingae is a rare pathogenic agent of skin and soft tissue infections. As with other Actinomyces infections, the early identification of the pathogen and specific antibiotic therapy is crucial for successful resolution of the infection because of the chronic course and the long treatment time needed. Usually, A. radingae is sensitive to ßlactam antibiotics.
Assuntos
Abscesso , Actinomyces , Actinomicose , Antibacterianos , Dermatopatias Bacterianas , Humanos , Masculino , Idoso , Abscesso/microbiologia , Abscesso/tratamento farmacológico , Abscesso/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/diagnóstico , Actinomicose/microbiologia , Actinomicose/patologia , Actinomyces/isolamento & purificação , Antibacterianos/uso terapêutico , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/diagnóstico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Resultado do TratamentoRESUMO
Actinomycosis is an uncommon infection caused by Actinomyces species, and the diagnosis is often challenging owing to low prevalence and diverse clinical manifestations. Pericardial involvement of actinomycosis is particularly rare. Here, we present a case of a 79-year-old man who initially complained of exertional dyspnea, orthopnea, and decreased urine amount. There was no fever, chest pain, or productive cough. Physical examination was remarkable for decreased breath sounds at the left lower lung field. Poor dental hygiene and a firm, well-defined mass without discharge over the hard palate were noted. Echocardiography revealed reduced ejection fraction of the left ventricle, global hypokinesia, and thickened pericardium (> 5 mm) with a small amount of pericardial effusion. On admission, the patient underwent diagnostic thoracentesis, and the results suggested an exudate. However, bacterial and fungal cultures were all negative. There was no malignant cell by cytology. Computed tomography revealed contrast-enhanced pericardial nodular masses. Video-assisted thoracoscopic pericardial biopsy was performed. Histopathology confirmed actinomycosis with chronic abscess formation, and a tissue culture yielded Aggregatibacter actinomycetemcomitans. The symptoms resolved with administration of clindamycin for 6 months. This case highlights the challenge in the diagnosis of cardiac actinomycosis, the potential role of concomitant microorganisms as diagnostic clues, and the favorable clinical response achieved with appropriate antibiotic treatment.