Thoracic Actinomycosis With Infiltration of the Spine: An Oncological Pitfall.

Thoracic actinomycosis with involvement of the vertebral column and chest wall is rare in children and may resemble malignant tumors. A 12-year-old girl was admitted to our clinic having B-symptoms, cachexia, and painful scoliosis (Karnofsky index 20%). Imaging showed a large thoracic left-sided paravertebral tumor with infiltration of the vertebrae, destruction of the chest wall and multiple intrapulmonary nodules. Initially, Ewing sarcoma was suspected and chemotherapy started without previous biopsies. Definite diagnosis of actinomycosis was established later upon histopathologic examination and successfully treated by ß-lactam antibiotics. Collectively, this case illustrates that actinomycosis can be an oncological pitfall and possible differential diagnosis.

Isolation of Trueperella pyogenes in a case of thoracic and abdominal abscess in a galago (Otolemur garnettii).

BACKGROUND: An adult male galago (Otolemur garnettii) presented for fight wounds following pairing for breeding. Treatment was symptomatic with recovery. Following resolution, the animal re-presented and died, despite additional treatment. METHODS: Necropsy, histopathology, bacterial cultures, and 16S RNA sequencing. RESULTS: A large intrathoracic/intra-abdominal abscess due to Trueperella pyogenes was found at necropsy. CONCLUSIONS: T. pyogenes should be considered in abscesses/wounds of galagos.

Rare case of subcutaneous mycosis with intrathoracic extension due to Chaetomium strumarium.

A 47-year-old man presented with a 10-year history of multiple lumps over his left upper arm and shoulder and the adjoining left side of his chest and upper back. His medical history included diabetes mellitus type 2. The patient was a farmer and used to lift sacks of grains and fertilizers onto his shoulders as part of his work, although he did not recollect any history of specific trauma. Skin biopsy revealed granulomatous reaction with Splendore-Hoeppli phenomenon, while periodic-acid-Schiff and Grocott-Gomori stains confirmed fungal elements. Sabouraud agar grew Chaetomium species, and lactophenol blue mount confirmed the fungus as Chaetomium strumarium. Radiography and computed tomography of the chest revealed intrathoracic extension of the mycetoma. The patient responded well to treatment with oral Itraconazole. Subcutaneous mycosis due to C. strumarium is rarely reported in the literature, and the intrathoracic extension makes it an even rarer entity.

Bacterial etiology of empyema thoracis and parapneumonic pleural effusion in Thai children aged less than 16 years.

This study aimed to identify the bacterial etiology of empyema thoracis or parapneumonic pleural effusions in Thai children, with a focus on pneumococcus. This hospital-based, descriptive study included children aged < or = 16 years, diagnosed with empyema thoracis or parapneumonic pleural effusion, from whom a pleural fluid (PF) sample was taken between January 2008 and November 2009. PF and blood samples were cultured and PF samples were also tested by polymerase chain reaction (PCR) to assess whether evidence of an infection might be identified among culture-negative samples. Serotyping of Streptococcus pneumoniae-positive samples was performed by molecular techniques and Quellung reaction. In this study, 29 children with empyema thoracis and 42 children with parapneumonic pleural effusion were enrolled. Potentially pathogenic bacteria were cultured in 13/71 samples at local or central laboratories; the most common bacteria were Staphylococcus aureus (8 children) and S. pneumoniae (2 children). Molecular techniques detected one or more targeted respiratory pathogens in 18/71 PF samples. S. pneumoniae and Haemophilus influenzae were identified by PCR in 13 and 6 children, respectively; PCR for S. aureus was not performed. The pneumococcal serotypes identified were 1, 3, 5, 6A/B, 9A/V, 14, 15A, 19F and 23A. This study shows that among Thai children with empyema thoracis and parapneumonic pleural effusions, S. aureus and S. pneumoniae were the most common pathogens identified by culture and PCR, respectively. These findings confirmed that molecular techniques are more sensitive for identification of S. pneumoniae and H. influenzae and enhance detection of important bacterial causes of empyema.

A thoracic mass infiltrating the chest wall.

A case of thoracic mass infiltrating the chest wall mimicking a pulmonary invasive neoplasm is reported. Differential diagnosis and characteristic radiological and histological imaging had a decisive role in the case management. Actinomycosis is caused by a gram-positive, filamentous, microaerophilic bacteria. About 15% of the infections caused by Actinomyces involve the thorax. If not promptly diagnosed and treated thoracic actinomycosis may determine contiguous and systemic involvement. Actinomycosis is an anaerobic-to-microaerophilic bacteria and direct identification and isolation are difficult to obtain. In depth discussion diagnostic and therapeutic features are described in this report.

Craniocervical necrotizing fasciitis of odontogenic origin with thoracic extension.

Craniocervical necrotizing fasciitis is an uncommon but aggressive infection with high morbidity and mortality. We present a case of craniocervical necrotizing fasciitis with thoracic extension caused by a dental infection in a 56-year-old man, with a successful outcome involving broad-spectrum intravenous antibiotics and an aggressive surgical debridement.

A rare case of thoracic brucellosis misdiagnosed as malignant tumor and literature review.

Brucellosis remains a major public health problem worldwide. It is commonly found in most developed and developing countries, such as the Mediterranean region, the Middle East, and Latin America. In China, brucellosis is mainly distributed in some of the northern provinces and is relatively rare in Shandong province. Brucellosis has a variety of clinical manifestations, with fever, sweating, fatigue, and migratory joint pain being the most common. Because of the non-specific clinical symptoms, brucellosis is often misdiagnosed as other diseases. Here, we report a rare case of brucellosis of thoracic vertebrae misdiagnosed as thoracic malignant tumor and present a review of related literature.

Surgical resection of chest wall tuberculosis.

BACKGROUND: Chest wall tuberculosis is a rare disease. After reviewing cases previously treated by surgical resection, the methods of resection, results, perioperative complications, and recurrence of the disease were analyzed. METHODS: The clinical and radiological data of 21 patients with chest wall tuberculosis treated between March 1998 and May 2007 were reviewed retrospectively. RESULTS: Symptoms included growing chest wall mass, with the time intervals of surgical resection from symptoms ranging from one to eight months (mean 2.3 months). Fourteen patients had a past history of tuberculosis. Preoperative needle aspiration was performed in 10 patients. The lesion was confined to the chest wall without a pleural lesion in 4 patients; 14 patients had a chest wall lesion with a pleural space. Resection of the abscess without rib resection was performed in nine patients. Complete resection of the abscess together with soft tissue and the involved rib was performed in 12 patients. Recurrence occurred in two patients (9.5 %): one underwent complete resection with rib resection while the other had resection without rib resection. CONCLUSION: Chest wall tuberculosis requires surgical resection in most cases and complete surgical resection may be needed to keep the recurrence rate low.

Chest wall abscess due to Prevotella bivia.

Prevotella bivia is associated with pelvic inflammatory disease. A 77-year-old man developed a rapidly growing chest wall abscess due to P. bivia within days. He underwent surgical resection of the infected area; his postoperative course was uneventful. This is the first case of chest wall abscess due to P. bivia infection. Its correct diagnosis cannot be underestimated because fulminant infections can occur in aged or immunocompromised patients if treated incorrectly. Prompt, appropriate surgical management, and antibiotic therapy affect treatment outcome.

Don't Let Its Name Fool You: Relapsing Thoracic Actinomycosis Caused by Pseudopropionibacterium propionicum (Formerly Propionibacterium propionicum).

BACKGROUND Pseudopropionibacterium propionicum was called Propionibacterium propionicum until a recent taxonomy change in 2016. Diseases caused by P. propionicum resemble actinomycosis and thus differ dramatically from the infectious syndromes caused by common cutaneous Propionibacterium spp. However, if treating physicians are not familiar with P. propionicum and its clinical presentations, it is possible for them to regard it as a skin contaminant such as Cutibacterium acnes (formerly Propionibacterium acnes). CASE REPORT A 71-year-old man with past surgical history of right pneumonectomy was admitted with right chest wall abscess and right empyema. The chest wall abscess was drained surgically, and the empyema was drained via a chest tube. The abscess culture took 5 days to grow beaded branching Gram-positive rods, and 15 days to identify them as P. propionicum. The patient received 17 days of ceftriaxone and 4 weeks of doxycycline. However, he experienced a relapse of the chest wall abscess and right empyema 4 months after discontinuation of doxycycline. Cultures from the chest wall abscess and empyema grew P. propionicum again. We treated him with ceftriaxone for 6 months followed by minocycline for 7 months along with adequate drainage. CONCLUSIONS It is important to recognize that P. propionicum can cause thoracic actinomycosis and will likely require the prolonged treatment course typical for actinomycotic disease, which is 2 to 8 weeks of intravenous antibiotic therapy followed by 6 to 12 months of oral antibiotic therapy.

Spontaneous subscapular abscess: a rare surgical condition.

Subscapular abscess is a rare clinical problem. Herein we describe a young male patient who presented with a subscapular abscess and was managed successfully with surgical drainage and debridement of the cavity.

Pott's disease in a young child.

A 16-month-old emaciated, immunized child presented with low-grade fever and progressive kyphosis with a right sided para-vertebral abscess for 9 months. During this period of illness the child had marked loss of appetite and progressive weight loss. There was history of contact with sputum smear positive father. A gibbus was present at thoraco-lumbar region with a cold abscess at the right side of the gibbus and signs of upper motor neuron lesion were found on lower limb examination. Diagnosis was supported by relevant investigations including MRI of dorsolumbar spine and treatment was started beforehand with anti-tubercular drugs. The paravertebral abscess was drained several times and antibiotics were used depending upon the results of microbiological study. At the same time the patient was advised to wear a modified chest brace for immobilization and the management for severe malnutrition was also started accordingly. There was significant clinical improvement observed within one month of starting treatment.

[Tuberculosis Abscess of the Chest Wall on an Immunocompetent Patient in the Teaching Hospital of Dakar (Senegal)]. / Abcès tuberculeux de la paroi thoracique chez une patiente immunocompétente au centre hospitalier universitaire de Dakar (Sénégal).

Tuberculosis remains a problem of public health, in spite of the numerous significant advances noted in the diagnosis in recent years. The involvement of the thoracic wall is a rare extra lung shape. Its clinical presentation is not specific and a collected thoracic tumefaction is the main clinical demonstration. The diagnosis is improved by the use of non-invasive tools such as the Xpert MTB/Rif® test with a good sensibility on the pus. Medical care is based on medical treatment and sometimes associated with surgical treatment.

La tuberculose demeure un problème de santé publique, malgré les nombreuses avancées significatives notées dans le diagnostic ces dernières années. L'atteinte de la paroi thoracique est une forme extrapulmonaire rare. Sa présentation clinique est non spécifique, et une tuméfaction thoracique collectée en est la principale manifestation clinique. Le diagnostic est amélioré par l'utilisation d'outils non invasifs tels que le test Xpert MTB/Rif® avec une bonne sensibilité sur le pus. La prise en charge repose sur le traitement médical quelquefois associé à un traitement chirurgical.

Relevance of group Milleri streptococci in thoracic surgery: a clinical update.

Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all beta-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.

Invasive pulmonary aspergillosis presenting as thoracic mass causing obstruction of the superior and inferior vena cava in an immunocompetent patient: a diagnostic dilemma.

Invasive pulmonary aspergillosis (IPA) is a disease of immunocompromised patients, but its prevalence is increasing in immunocompetent persons. Patients usually present with non-specific symptoms, sometimes consistent with bronchopneumonia. We discuss the case of a 19-year-old boy who presented with constitutional respiratory symptoms along with signs of obstruction of the superior and inferior vena cava. A chest radiograph was suggestive of a thoracic mass raising suspicion of bronchogenic carcinoma/ benign mass, sarcoidosis and tuberculosis, but a diagnosis of invasive aspergillosis was established. The patient showed excellent clinico-radiological improvement with administration of voriconazole. Invasive pulmonary aspergillosis may also present with atypical findings and should be considered in differentials when investigating a case even if the patient does not have a risk factor.

The oral cavity as a reservoir of bacterial pathogens for focal infections.

Dental procedures, but more importantly, oral infections and poor oral health can provoke the introduction of oral microorganisms into the bloodstream or the lymphatic system. The subsequent attachment and multiplication of these bacteria on tissues or organs can lead to focal oral infections. Pathogenic agents may also remain at their primary oral site but the toxins liberated can reach an organ or tissue via the bloodstream and cause metastatic injury. Finally, metastatic inflammation may result from an immunological injury caused by oral bacteria or their soluble products that enter the bloodstream and react with circulating specific antibodies to form macromolecular complexes.