Digestive actinomycosis: three cases and review

Actinomycosis is a chronic suppurative disease. It is caused by an anaerobic bacterium, generally Actinomyces israelii. Cervical and thoracic localizations are most frequent. Digestive actinomycosis is rare and can simulate cancer leading to resection. We report 3 cases of surgical abdominal actinomycosis. Localization was colic in 2 cases and hepatic in 1 case. The diagnosis of actinomycosis was made after resection in the 3 cases. The evolution was favourable under medical treatment. These observations illustrate the difficulty of diagnosing this rare and unrecognised disease which can be cured by long term penicillin therapy.     

A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man

Actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.     

Primary hepatic actinomycosis

A case of primary hepatic actinomycosis is reported. Multiple liver abscesses were diagnosed in a febrile 60-year-old-man by means of non-invasive techniques such as ultrasonography, CT and radioisotope scans. The aetiology was confirmed by the unusual finding of Actinomyces israelii in anaerobic blood cultures. Other sites were not involved. Early penicillin therapy enabled surgery to be avoided.     

Pericarditis with effusion casued by Actinomyces israelii.

Actinomyces israelii is a rare cause of pericarditis. Infection spreads to pericardium from an intrathoracic focus. Branching gram-positive filaments are seen on microscopic examination of clinical specimens. Cultures should be performed under anaerobic conditions. Both surgical drainage and antibiotics (penicillin) are required for treatment. Nocardiosis may resemble actinomycosis in many respects.     

Pseudo-colonic carcinoma caused by abdominal actinomycosis: report of two cases

Background Abdominal actinomycosis is an infrequent chronic, suppurative infection caused by the aerobic gram-positive bands Actinomyces israelii. Patient presentation We report two cases of abdominal actinomycosis, simulating colon cancer. Before operation, both patients presented with abdominal pain and a palpable mass. Abdominal computed tomography (CT) revealed an infiltrating irregular mass in the cecum and transverse colon, respectively. Surgical intervention was then performed under the impression of colonic malignancy.Conclusion Postoperatively, pathologic examination confirmed the diagnosis of abdominal actinomycosis in which the characteristic finding of sulfur granules in the resected specimen was demonstrated. After surgery, the patients continued antibiotic treatment with ampicillin for 2 months at our OPD and had no signs of recurrence 1 year after surgery.     

Primary actinomycosis of an extremity: a case report and review

Primary infection of an extremity is an uncommon feature of actinomycosis and can readily be confused with actinomycetoma caused by aerobic actinomycetes such as Nocardia and Streptomyces. A case of primary actinomycosis of the leg is reported, and 35 cases published in the English-language literature are reviewed. There were 14 cases of upper extremity infections and 22 cases of lower extremity infections. Antecedent trauma had occurred in 21 cases. Lesions began in the skin, subcutaneous tissue, muscle, bone, and joint space. Spread to contiguous structures was characteristic, and most lesions eventually involved all of the aforementioned structures. The lesions were typical of actinomycosis with sinus formation and granules in the pus. Cultures were positive in 17 cases. Surgical therapy was necessary in most instances; penicillin remains the drug of choice. Pending results of culturing, a lesion with granules of branching gram-positive bacteria would best be treated empirically with penicillin and a sulfonamide. Prognosis is excellent.     

Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device.

Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Asymptomatic colonization of the cervix with this organism has been noted in users of an intrauterine device (IUD), and its prevalence ranges between 1.6% and 36%. Rarely, symptomatic infection may occur, with the potential for extensive morbidity and even death. Herein we report a patient who survived severe disseminated actinomycosis yet presented with the clinical picture of a metastasized malignancy. This is the first report of disseminated pelvic actinomycosis presenting as an external lesion of the abdominal wall and in which a Progestasert IUD (Alza, Palo Alto, CA) was present. The common difficulty, and thus delay, in diagnosing this disease led to considerable morbidity due to an infection considered curable with penicillin. We recommend that all patients with an IUD or a history of IUD use have such information made known to those responsible for interpreting the Papanicolaou smear. Such knowledge may heighten suspicion and focus attention on the identification of these organisms before onset of clinical disease. It is important to consider this disease when caring for patients with an IUD or when counseling those contemplating its use as a contraceptive.     

Primary combined intra- and extra- abdominal actinomycosis. A case report

Actinomycosis is an infrequent chronic progressive granulomatous and suppurative disease. This infection is caused by Actinomyces israelii, normally present in healthy individuals. We present a rare case of a combined intra- and extra- abdominal actinomycosis in a 50 year old female patient, with no underlying predisposing factors. The patient complained of a right lower quadrant pain. Although we first diagnosed a peri-appendiceal abscess, the CT scan suggested a right colon tumor. The patient underwent segmental colectomy and the histological examination of the specimen revealed colon actinomycosis. A review of the possible pathogenesis and therapeutic modalities is also presented.     

Severe Actinomyces israelii infection involving the entire spinal cord

A case of severe spinal infection with Actinomyces israelii is presented. A 38-y-old male was admitted with symptoms of infection and neurological symptoms. Magnetic resonance imaging showed extensive affection involving the entire spinal cord. Cultures of the cerebrospinal fluid revealed Actinomyces israelii. The patient was treated with long term penicillin G followed by amoxicillin. The patient recovered with severe neurological sequelae.     

Actinomycosis of the pelvis with an indwelling IUD

Infection with actinomycosis israeli (an anaerobic, gram-positive bacterium) presents as chronic inflammation with tendency to fibrosis and suppuration with formation of external sinuses. Cervicofacial, thoracic and abdominal forms of the disease made up 95% of cases of actinomycosis. A 53-year-old woman was admitted to the hospital because of a pelvic mass which was thought to be malignant. A laparotomy was performed and the histologic examination showed actinomycosis. The patient first received penicillin followed by tetracyclin and the pelvic mass shrunk. One year later no more mass was detectable. We think that the IUP in place over years is the source for this infection.     

Ileo-caecal actinomycosis: report of a case simulating complicated inflammatory bowel disease

Abdominal actinomycosis is a rare infectious disease caused by Actinomyces israelii, a gram-positive anaerobic saprophyte germ that is a normal inhabitant of the upper intestinal tract in humans. Actinomyces israelii rarely cause abdominal infections or actinomycosis. Abdominal actinomysosis is characterised by fistulae and abscesses and may mimic cancer or inflammatory bowel disease. Abdominal actinomycosis is difficult to diagnose preoperatively, and often require surgical removal of the diseased tissue, allowing pathologists for giving the definitive diagnosis, revealed by characteristic "sulfur granules". The authors report herein the case of a 47-year-old man who presented with diarrhoea and abdominal pain. Abdominal computed tomography evoked complicated inflammatory bowel disease and surgical procedure was decided. Laparoscopic exploration did not provide further significant information, and laparotomy with diseased bowel resection was performed. Pathology demonstrated "sulfur granules" and allowed the diagnosis of abdominal actinomycosis. This case demonstrated that abdominal actinomycosis should be included in the differential diagnosis when computed tomography shows an infiltrative and inflammatory mass.     

Primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade

Cardiac tamponade constitutes an exceptional form of actinomycosis. We describe a case of primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade in a 20-year-old patient with previous esophagectomy and colonic interposition, successfully managed by computed tomography-guided percutaneous drainage and a prolonged course of antibiotic treatment. Actinomyces israelii was identified in the pericardial fluid by 16S rRNA gene sequencing. The literature on the simultaneous presentation of cardiac and hepatic actinomycosis is reviewed.     

Foreign body-induced bronchial actinomycosis with severe stenosis that must be distinguished from lung cancer

A 59-year-old woman who accidentally swallowed a foreign body (fish bone) 9 months ago was admitted to our hospital because of cough, hemosputum and sleep wheezing for two months. Chest roentgenograms and chest CT scanning revealed severe stenosis of the right lower lobe bronchus and truncus intermedius, suggesting lung cancer. Bronchoscopic examination revealed an intrabronchial foreign body. The biopsy specimen from granulation tissue revealed bronchial actinomycosis. The foreign body was removed bronchoscopically after an extensive chemotherapy with penicillin G (for actinomycosis) and prednisolone (for granulation tissue of the bronchus). This was considered to be a rare case of bronchial actinomycosis without a pulmonary lesion produced by a foreign body.     

Therapeutische Erfolge bei Aktinomykose der Lunge und der Pleura

This is a report on 7 cases of pleuro-pulmonary actinomycosis. 4 cases were treated successfully with conservative methods. On 3 cases, all suspect of suffering from tumor, surgery was performed with good results. It is stressed that at present the good results of the therapy of actinomycosis, also with regard to pulmonary function, depend on long-term antibiotic treatment in high dosage, especially with penicillin.     

Primary actinomycosis of the urinary bladder

Actinomycosis is caused by bacilli of the Actinomyces sp. They are Gram-positive, anaerobic or microaerophilic non-spore-forming bacilli. Actinomyces israelii is the most common aetiological agent. A case is reported of primary actinomycosis in the urinary bladder successfully treated with ceftriaxone.     

Actinomycosis as a rare cause of vertebral osteolysis

Actinomycosis is an uncommon entity caused by an anaerobic bacterium, Actinomyces species, most often Actinomyces israelii. We present a patient who suffered from progressive lumbar pain and high fever. Actinomycosis infection was diagnosed after extensive radiological and pathological evaluation. Treatment with i.v. ampicillin was started, followed by oral antibiotics for one year. This paper gives an overview of the different clinical presentations of actinomycosis infection, with special attention to the skeletal involvement. We also discuss diagnosis and treatment. The clinical picture can mimic several other conditions, such as lymphomas. Delay in diagnosis and treatment can significantly worsen the condition of the patient.     

Esophageal Actinomycosis: A Case Report and Review of the Literature

Abstract A 37-year-old African–American male with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. An upper gastrointestinal endoscopy had been performed two months previously and esophageal biopsy revealed extensive candidal infection with ulceration. He temporarily responded to fluconazole. Repeat biopsy revealed actinomyces and continued candidal infection. Review of the original biopsy also demonstrated actinomyces in addition to candida. After initial response to therapy with penicillin, he worsened on outpatient therapy and subsequently expired from progression of disease. Lack of compliance may have been contributary. To date, 8 patients with esophageal actinomycosis have been reported, five of whom had AIDS. Of the remaining three, none was otherwise immunocompromised. This is the first report of esophageal actinomycosis occurring as a superinfection of candidal ulceration. We also describe the findings and utility of thoracic CT in this condition and review the literature.     

Hepatic involvement of disseminated actinomycosis

A 35-year-old woman was admitted for weight loss, fatigue, and epigastric and back pain. She had undergone uterine myomectomy 6 weeks previously, and light microscopic examination revealed actinomycosis. Radiologic examination showed 5×4×4 cm and 2×2×2 cm solid lesions in the left liver lobe. Ultrasound-guided fine-needle aspiration biopsy could not exclude the possibility of malignancy. We decided to perform an explorative laparotomy. Frozen sections indicatedEchinococcus alveolaris infection or granulomatous inflammatory disease, and left hepatic lobectomy was performed. Histologic examination revealed hepatic actinomycosis. After 6 months' penicillin treatment, there was no sign of recurrence. This case of hepatic actinomycosis following uterine infection without gross involvement of any other abdominal organ raises questions on the dissemination pathway. The other interesting feature of this case is the short interval from the presumed initiatory event to the presence of the hepatic deposits.     

Phalengeal actinomycosis: a rare disease

INTRODUCTION: Bone involvement in actinomycosis is rare. EXEGESIS: We report a case of a 38 year-old woman with foot bone actinomycosis. The clinical symptoms were non-specific and the diagnosis was difficult. An X-ray revealed an osteolysis and a sclerosis of the proximal phalanx of the big toe. A phalengiectomy was carried out after the failure of antistaphylococcic antibiotherapy. The diagnosis of actinomycosis was substantiated by a histological examination. The clinical outcome was good after six-month treatment by penicillin G substitutes for cotrimoxazol. The patient completely recovered and was feeling well. The mean follow up was fifteen months. CONCLUSION: Clinical and therapeutic aspects of this rare localization are reviewed.     

Spontaneous peritonitis attributed to actinomyces species

Abdominal actinomycosis is a rare condition caused by actinomyces species found in the normal flora of the oral cavity, gastrointestinal and genital tract. All cases reported describe localized forms demonstrating masses, pseudotumors or abscess during surgery or radiology studies and there are no reports about spontaneous peritonitis caused by actinomycetes. We report a case in which this disease present as symptomatic ascitic fluid infection refractory to antimicrobial therapy for intra- abdominal sepsis and detected during unsuspected cytology test. The case was successfully treated with a penicillin regimen. As a spontaneous peritonitis variety, the microbiology diagnosis remains difficult as we don't think in this form of abdominal actinomycosis not described previously in the literature. The present illustrative case strength the usefulness of cytology test in patients with suspected ascitic fluid infection refractory to a medical therapy.