Actinomicosis en el hueso temporal. Reporte de un caso pediátrico / Actinomycosis in temporal bone. A pediatric case report

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

Actinomycosis, a lurking threat: a report of 11 cases and literature review

Abstract Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.

Actinomicosis mamaria. presentación de dos casos / Mammary actinomycosis. presentation of two cases

La actinomicosis mamaria es una infección supurativa crónica que se caracteriza por la producción de "gránulos de azufre" a partir de fístulas externas en la piel de las mamas. Por ser una enfermedad rara en esta localización y al encontrarnos con dos casos similares decidimos realizar este estudio, siendo los aspectos antes mencionados la motivación principal del mismo. Además, pretendemos despertar el interés de los médicos al estudio de tal padecimiento para el diagnóstico y conocimiento del tratamiento el cual debe ser precoz y duradero para su cura. Se hizo énfasis en la importancia del diagnóstico y tratamiento tempranos(AU)

Mammary actinomycosis is a chronic suppurative infection that is characterized by the production of sulfur granules from external fistulas in the skin of the breasts. Due to, it is a rare disease in this location. Two similar cases, are carried out in this study, the mentioned aspects being the main motivation. In addition, we intend to awaken the interest of doctors to the study of such condition for the diagnosis and knowledge of the treatment which must be early and lasting for its cure. The importance in early diagnosis and treatment is emphasized(AU)

Actinomicosis torácica: presentación de un caso / Thoracic actinomycosis: report of a case

La actinomicosis es una enfermedad producida por bacterias del género Actinomyces. La forma torácica representa el 30% de los casos. La evolución es habitualmente crónica, con clínica variable. Se presenta una nina de 11 años de edad con tumefacción subescapular derecha de un mes de evolución, asociada a fiebre, hiporexia y pérdida de peso. Se diagnosticó actinomicosis torácica producida por Actinomyces meyeri. Recibió tratamiento antibiótico durante un año, con resolución completa. Aunque es poco frecuente, debe ser tenida en cuenta como diagnóstico diferencial en cuadros de tumoración torácica de larga evolución con compromiso del estado general. Debe informarse al microbiólogo la sospecha diagnóstica por lo difícil de su desarrollo en los medios de cultivo habitual.

Actinomycosis is a disease produced by bacteria of the genus Actinomyces. The thoracic form represents 30% of the cases. Signs and symptoms are generally unspecific. A previously healthy 11 year old girl was admitted with a chest mass of a month of evolution associated with fever, hyporexia and weight loss. Thoracic actinomycosis was diagnosed with the isolation of Actinomyces meyeri in the mass drainage. She received antibiotic treatment for a year with complete resolution. Although rare, it should be taken into account as a differential diagnosis in long evolution thoracic tumor affecting the general condition. The microbiologist must be warned about the suspected diagnosis because it is difficult to find it in routinely used culture media.

Actinomicosis pelviana: caso clínico / Pelvic actinomycosis: a case report

La actinomicosis pelviana es una enfermedad granulomatosa crónica muy infrecuente, causada por un bacilo Gram positivo, y que clínicamente suele confundirse con neoplasias pelvianas. Se presenta un caso clínico en que sospechó la infección en forma temprana, logrando resultados exitosos con tratamiento médico.

Pelvic actinomycosis is a chronic granulomatous disease quite uncommon; it is caused by positive Gram bacilli, and clinically it may appear as a pelvic neoplasia. We present a case report in which the infection was pursued actively, achieving excellent results with medical treatment.

Actinomycosis affecting the spinal cord: a case report / Actinomicose comprometendo a medula espinhal: um relato de caso

Actinomycosis is a rare, chronic, suppurative, granulomatous infection caused by a group of gram-positive anaerobic bacteria belonging to the natural flora of the oral cavity and gastrointestinal and urogenital tracts. It may involve several organs. This case study refers to pulmonary actinomycosis with chest wall involvement and cord compression in a 29-year-old male who presented with fever, cough, hemoptysis, neck pain, and paresis and plegia of the lower limbs of 5-month duration.

A actinomicose é uma infecção rara, crônica, supurativa e granulomatosa, causada por um grupo de bactérias anaeróbias Gram-positivas que pertencem à flora natural da cavidade oral, do aparelho gastrointestinal e urogenital. Pode envolver diversos órgãos. O estudo refere-se à actinomicose pulmonar com envolvimento da parede torácica e compressão medular em um paciente masculino com 29 anos que apresentava febre, tosse, hemoptise e cervicalgia, além de paresia e plegia em membros inferiores com cinco meses de evolução.

Actinomicosis pulmonar: Diagnóstico por punción-aspiración con aguja fina / Pulmonary actinomycosis: Fine needle aspiration diagnostic

Se presentan 4 casos de actinomicosis pulmonar en pacientes mayores de 40 años, 2 de ellos con enfermedad pulmonar obstructiva crónica (EPOC), que mostraron un aumento de la tos productiva, episodios de disnea, hemoptisis y fiebre de larga evolución. En las radiografías de tórax de rutina se observaban imágenes segmentarias de consolidación aérea, sugestivas de cuadros neumónicos no resueltos o neoplasia. La tomografía axial computarizada (TAC) mostró hallazgos similares a los anteriores. Los cultivos de esputo y las pruebas de Mantoux fueron repetidamente negativos. Debido a la mala evolución de los pacientes y a los hallazgos radiológicos, se practicó una punción-aspiración con aguja fina (PAAF) para descartar neoplasia. En la citología se observaron conglomerados tridimensionales, de bordes filamentosos y aspecto algodonoso compatibles con Actinomyces. El tratamiento antibiótico produjo la mejoría del cuadro clínico y el seguimiento demostró la desaparición de las opacidades radiológicas. Actualmente, la actinomicosis pulmonar es infrecuente y la sintomatología inespecífica, por lo que puede confundirse con procesos neoplásicos. Por tanto, en pacientes con factores de riesgo, síntomas de neumonía subaguda e imágenes radiológicas de consolidación del parénquima es aconsejable considerar la posibilidad de actinomicosis pulmonar. Es una enfermedad tratable y su correcto diagnóstico mediante la PAAF evita al paciente pruebas diagnósticas más agresivas, retrasos en el diagnóstico y le permite una cura completa con tratamiento antibiótico.

We present four cases of pulmonary actinomycosis in patients over 40 years of age, two of them with chronic obstructive pulmonary disease (COPD), showing an increase in productive cough, episodes of dyspnea, hemoptysis and long-term fever. Routine chest radiographs revealed segmental air-space consolidation, suggestive of unresolved pneumonia or neoplasm. Computed tomography (CT) scan showed similar findings to the ones previously described. Sputum cultures for mycobacteriae and Mantoux tests were constantly negative. Due to the poor clinical and radiodological outcome of the patients, a fine needle aspiration (FNA) was made to rule out a neoplasm. Tridimensional filamentous colonies of Actinomyces were observed in cytology. Antibiotic treatment resulted in an improvement of symptoms. The follow-up showed a decrease of the consolidation areas. Pulmonary actinomycosis is rare nowadays and clinical symptoms are unspecific and can be confused with a neoplasm process. Therefore, in patients with risk factors, symptoms of subacute pneumonia and radiologic findings of consolidation, it is advisable to consider pulmonary actinomycosis as a diagnostic possibility. It is a treatable disease and its correct diagnosis by FNA, avoids performing invasive diagnostic tests, delays in the diagnosis and allows for a complete cure by antibiotic therapy.

Tratamento da actinomicose pulmonar com levofloxacina / Treatment of pulmonary actinomycosis with levofloxacin

A actinomicose é uma infecção bacteriana supurativa crônica caracterizada por múltiplos abcessos, trajetos fistulosos e fibrose envolvendo a face, o pescoço, o tórax e o abdômen. É causada por uma bactéria anaeróbia, Gram-positiva e saprófita (Actinomyces). A actinomicose pulmonar primária é uma doença rara que resulta provavelmente da aspiração de secreções da orofaringe. Pode apresentar-se como uma doença respiratória crônica. O tratamento de escolha é a antibioticoterapia com penicilina. Os autores apresentam o caso clínico de uma mulher de 55 anos com diagnóstico de actinomicose pulmonar tratada com sucesso com levofloxacina.

Actinomycosis is a chronic suppurative bacterial infection characterized by multiple abscesses, fistulous pathways, and fibrosis involving the face, neck, chest, and abdomen. It is caused by an anaerobic Gram-positive saprophytic bacterium (Actinomyces). Primary actinomycosis of the lung is a rare disease that probably results from aspiration of oropharyngeal secretions. It can present as a chronic respiratory disease. The treatment of choice is antibiotic therapy with penicillin. The authors report the case of a 55-year-old female diagnosed with pulmonary actinomycosis and successfully treated with levofloxacin.

Actinomicose pulmonar com envolvimento da parede torácica / Lung actinomycosis with chest wall involvement

A Actinomicose é uma infecção rara, crônica, supurativa e granulomatosa que pode envolver diversos órgãos. A infecção pulmonar geralmente está relacionada à imunodepressão e à saúde bucal precária. O envolvimento torácico é incomum (10 - 20 por cento), a parede torácica é acometida em apenas 12 por cento destes casos. No presente trabalho, é descrito o caso de um paciente de 26 anos, não HIV e sem co-morbidades, assintomático respiratório, com massa infra-escapular, de crescimento progressivo, muito dolorosa, com sinais locais flogísticos, sem trauma local, apresentando febre persistente, com três meses de evolução. O diagnóstico inicial foi de neoplasia de partes moles de parede torácica. A biopsia incisional da referida massa, houve saída de secreção gelatinosa vinhosa com grânulos amarelados, sugestivos de actinomicose, sendo confirmado por exame anatomopatológico. Empiricamente foi instituída ciprofloxacina devido alergia à cefalosporina. Houve excelente resposta clínica à drenagem externa e à medicação prescrita. Não houve recaída da doença em 18 meses de seguimento.

Actinomycosis is an uncommon suppurative granulomatous chronic infection that may involve several organs. Lung infection is usually related to immunodepression and poor oral hygiene. Cases of thoracic involvement are rare (10 - 20 percent) and only 12 percent of such cases affect the chest wall. This report describes the case of a 26-year-old HIV-negative patient without comorbidities or respiratory complaints who presented a very painful, progressively growing infrascapular mass, with local phlogistic signs and no local trauma, and persistent fever. It had been progressing for three months. The initial diagnosis was neoplasia of chest wall soft tissue. However, incision biopsy in this mass produced a red wine-colored gelatinous secretion containing yellowish granules suggestive of actinomycosis, which was later confirmed by anatomopathological examination. Ciprofloxacin was instituted empirically because of cephalosporin allergy. There was an excellent clinical response to external drainage and the prescribed medication. Over the course of 18 months of follow-up, there was no disease recurrence.

Revisión de infección pelviana por actinomices: presentación de un caso clínico / Pelvic actinomycosis review: presentation of a clinical case

La infección por actinomices ha sido llamada "la gran imitadora" en la práctica clínica. La actinomicosis es una infección crónica supurativa debido a gérmenes gram positivos, anaerobios, no esporulados. Habita normalmente en las mucosa oral, gastrointestinal, genitales. Las infecciones oportunistas ocurren cuando se rompen las barreras mucosas, ocasionando la formación de abscesos, fístulas o masas. La actinomicosis tiene tres grandes presentaciones clínicas: cervicofacial, torácica y abdomino-pélvica. Se presenta un caso de actinomices abdomino-pélvica.

Actinomicosis colorrectal / Colorectal actinomycosis

Se presenta la experiencia en el diagnóstico y tratamiento de 4 casos de actinomicosis colorrectal (ACR) atendidos en un período de 9 años, excluídas las de origen apendicular. La forma clínica de presentación fue la masa tumoral estenosante de colon sigmoides en 3 casos y la estenosis rectal con trayecto fistuloso ciego en el restante. El diagnóstico se sospechó luego de repetidas biopsias negativas endoscópicas o quirúrgicas y en un caso se certificó por el hallazgo del Actimomices Israelli en un absceso tuboovárico que obligó a una resección de colon con coloetomía a lo Hartmann. La prueba terapéutica fue indicativa de esta infección crónica en el resto de los casos, lográndose la desaparición completa de la masa tumoral y de la estenosis respectivamente. Luego de un tratamiento antibiótico con penicilina sódica seguida de tetraciclina o amoxicilina que duró entre 6 y 12 meses, se logró reconstituir el tránsito intestinal en todos los casos

Artritis de rodilla por Streptomyces Somaliensis: un caso / Arthritis of knee for streptomyces somaliensis: a case

Se presenta un caso de artritis de rodilla por Streptomyces somaliensis, raro agente causal de micetomas, que predomina en el continente africano. Es el segundo caso encontrado en la Argentina, con aislamiento e identificación microbiológica del agente causal y el único donde se demostró compromiso intra-articular