Cutaneous actinomycosis: a rare case

Cutaneous actinomycosis is a rare presentation. Here we present a case of cutaneous actinomycosis with no history of trauma or systemic dissemination. The isolate was identified as Actinomyces viscosus by standard methods. The isolate was found to be penicillin resistant by Kirby Bauer disc diffusion method. Therefore, the patient was treated with cotrimoxazole and improved. Thus, this case highlights the importance of isolation and susceptibility testing in actinomycotic infection. The sinuses have healed, and the patient has recovered.     

Thoracic vertebral actinomycosis: Actinomyces israelii and Fusobacterium nucleatum

Actinomyces spp. are considered rare pathogens in today's medicine, especially with thoracic vertebral involvement. Classic actinomycosis (50%) presents as an oral-cervicofacial ("lumpy jaw") infection. This report describes a case of spinal cord compression caused by Actinomyces israelii with the coisolation of Fusobacterium nucleatum. There are limited numbers of similar cases.     

Abdominal actinomycosis

Intra-abdominal and extraperitoneal actinomycosis are rare infections, caused by different Actinomyces species. However, they have been diagnosed more frequently in the last ten years. We report three cases of abdominal actinomycosis and a literature review of the last eight years. All three patients were diagnosed by means of histopathologic examination only. In one case, an intrauterine device (IUD) was associated with the infection. Therapy consisted of surgical resection of the inflammatory, infected tissue, and long-term antibiotic therapy. All patients are free of recurrence. Abdominal actinomycosis should be included in the differential diagnosis of an abdominal pathology of insidious onset, especially when an IUD is in place. Even when infection had spread extensively, combined operative and antibiotic therapy cured most of the cases.     

背部皮肤软组织放线菌病一例并文献回顾

目的探讨皮肤软组织放线菌病的临床表现、诊断、鉴别诊断及治疗，提高创面外科医师对皮肤软组织放线菌病的认识。 方法报道1例背部皮肤软组织放线菌病的诊治经过，分别以"放线菌、放线菌感染、皮肤、软组织"及"actinomycosis，cutaneous，soft tissue"为检索词检索中国知网和PubMed的相关文献并进行分析。 结果与所检索20篇文献相比，本例皮肤放线菌病的临床表现、鉴别诊断及治疗既典型又具自身特点。本例患者入院时并未表现出明显皮肤肿物，但皮下感染组织内多个窦道，伴较多土褐色脓液流出较为典型。本例患者入院第9天才培养出放线菌，但无论是术中肉眼观察、细菌培养还是组织病理学检查均未见典型"硫磺颗粒"。本例患者查体、术中所见及辅助检查结果和气性坏疽的临床表现高度相似，因此最初曾高度怀疑产气荚膜梭菌感染，但多次细菌培养及涂片均未提示产气荚膜梭菌感染。治疗主要包括全身状态的调整、手术清创及抗生素的应用。 结论原发于皮肤软组织的放线菌病较少见，临床表现多样，即便有相对典型特征，也并无特异性，诊断需综合考虑并鉴别诊断。皮肤软组织放线菌感染发病率低，不易诊断，需引起创面外科医师的注意，及早对本病作出诊断及治疗。     

Actinomyces naeslundii as an agent of pelvic actinomycosis in the presence of an intrauterine device.

Actinomyces naeslundii is a saprophyte, sometimes a pathogen, of the human oral cavity. Very few extra-oral infections related to this agent have been described. We report the first instance of A. naeslundii as an etiological agent of pelvic actinomycosis in a user of an intrauterine device, an infection so far exclusively attributed to Actinomyces israelii.     

Hepatic actinomycosis. A case report

A case of hepatic actinomycosis contracted one year after removal of an intrauterine device during ongoing Actinomyces cervicitis is reported. During active disease, lymphocytes from the apparently fully immunocompetent patient were able to proliferate but not to produce the proinflammatory lymphokine gamma-interferon in response to Actinomyces antigen. This ability was only partly restored during antibiotic therapy.     

Disseminated coinfection with Actinomyces graevenitzii and Mycobacterium tuberculosis: case report and review of the literature

We report the first case of disseminated infection with both Actinomyces graevenitzii and Mycobacterium tuberculosis and review the medical literature. Concomitant actinomycosis and tuberculosis is very rare. The potential of the facultatively aerobic, newly described A. graevenitzii for disseminated invasive infection needs to be evaluated.     

Aktinomykose der haut bei HIV-infektion

Summary A 29-year-old woman with HIV-infection developed disseminated abscesses of the skin, identified as an infection with Actinomyces israelii. To our knowledge, actinomycosis associated with HIV-infection (AIDS-related complex) has been reported only once previously.

     

Endobronchial actinomycosis simulating endobronchial tuberculosis: a case report.

We report a case of a 70-year-old woman who presented with mild exertional dyspnea and cough. Fiberoptic bronchoscopic findings revealed an endobronchial polypoid lesion with stenotic bronchus. The lesion was very similar to endobronchial tuberculosis. Histologic examination of the biopsy specimen demonstrated Actinomyces infection. There was a clinical response to intravenous penicillin therapy. Primary endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial lesion, especially endobronchial tuberculosis in Korea.     

Malar mass due to Actinomyces odontolyticus.

Actinomyces odontolyticus was isolated from a patient with a soft tissue mass in the malar region. The organism was identified on the basis of morphological, cultural, and biochemical characteristics. On histological examination, the tissue mass contained several granulomatous foci with small, basophilic staining areas resembling microscopic sulfur granules. This is believed to be the first reported case of actinomycosis due to A. odontolyticus.     

Post-Traumatic Course Complicated by Cutaneous Infection with Absidia corymbifera

 Cutaneous mucormycosis is a rare but serious infection in trauma patients. Reported here is the case of a young patient with cutaneous mucormycosis due to Absidia corymbifera probably caused by a soil-contaminated wound. Despite daily surgical debridement and amphotericin B therapy, cure could be achieved only by amputation of the lower limb.     

Management of patients with huge pelvic actinomycosis complicated with hydronephrosis: a case report

Actinomycosis is an uncommon, chronic, granulomatous disease caused by several species of the genus Actinomyces, a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Actinomycosis can be mistaken for malignant tumors, and in most cases the diagnosis is delayed or missed entirely until surgery. Actinomycosis in the abdomen or pelvis mostly results from prolonged use of an intrauterine device. We report the case of a 40-year-old female who presented with decreased urine production, poor appetite, marked loss of body weight and intermittent lower abdominal pain for 3 months. Abdominal computed tomography indicated a large infiltrative pelvic mass that was complicated by bilateral hydronephrosis, bladder compression and small bowel adhesions. Despite the elevated levels of cancer antigen 125, we suspected pelvic actinomycosis because of a 15-year history of an intrauterine device. The diagnosis was confirmed by histopathological examination of soft tissue obtained from a laparotomy biopsy. We successfully treated the patient with prolonged antibiotics instead of surgical eradication. Abdominal computed tomography obtained 1 year later showed almost complete resolution of the pelvic inflammatory mass.     

Entz��ndliche Dermatitiden

The seven basic patterns of inflammatory dermatoses according to Ackerman can be applied to infectious dermatoses. However, it should be borne in mind that infection caused by one agent may induce differing patterns according to the stage of disease. Dermatophytosis and the arthropod reaction belong to perivascular dermatoses with spongiosis. Secondary syphilis and acrodermatitis chronica atrophicans regularly show a lichenoid infiltrate with interface dermatitis, whereas epidermal involvement is typically absent in erythema migrans, virus exanthema and bacillary angiomatosis. Lupus vulgaris, atypic mycobacteriosis, lepra, actinomycosis, cutaneous leishmaniosis and erysipelas belong to the nodular and diffuse dermatoses. In the group of vasculitides, septic vasculitis is induced by a biological agent, and the pattern of vesicular dermatitis is reflected by infections with herpes viruses, impetigo contagiosa and staphylococcal scalded-skin syndrome. Follicular dermatitis shows a pattern of furuncles and carbuncles which are mainly caused by bacteria or fungi.     

Identification by 16S rRNA Gene Sequencing of an Actinomyces hongkongensis Isolate Recovered from a Patient with Pelvic Actinomycosis

A case of Actinomyces hongkongensis pelvic actinomycosis in an adult woman is described. Conventional phenotypic tests failed to identify the Gram-positive bacillus isolated from a fluid aspirate of a pelvic abscess. The bacterium was identified by 16S rRNA gene sequencing and analysis using the SmartGene Integrated Database Network System software.     

Clinical evaluation of precipitin tests for genital actinomycosis

A precipitin test system for antibodies against Actinomyces israelii, comprising a combination of counterimmunoelectrophoretic and crossed immunoelectrophoretic gel techniques, was evaluated for its clinical usefulness in diagnosing genital actinomycosis. A total of 263 serum samples from healthy women and women with proven actinomycosis, A. israelii-associated salpingitis, other gynecological infections, or miscellaneous gynecological diseases were analyzed. Six different precipitins could be detected. Five precipitins were defined as specific for actinomycosis, whereas one was found to occur nonspecifically in women with gynecological infections. The specificity of the test system for the detection of cases of genital actinomycosis was 98%, and the sensitivity was 83%. The accuracy was 100% for negative prediction and 45% for positive prediction. Thus, the test was shown to be valuable for a noninvasive diagnosis of genital actinomycosis.     

Tubo-ovarian Actinomycosis: A case report with brief review of literature

Pelvic actinomycosis is an uncommon condition, often associated with the use of intrauterine contraceptive device (IUCD). Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. Ovarian actinomycosis is even rarer. Here, we present a 24-year-old woman using an IUCD for 3 1 / 2 years with right-sided adnexal mass, which was diagnosed postoperatively as tubo-ovarian actinomycosis. Many times, an appropriate management is overlooked or delayed due to its non-specific and variable clinical and radiological features. Sometimes, it can even mimic an advanced pelvic malignancy. Therefore, the gynecologist should consider the possibility of this infection to spare the patient from morbidity of radical surgical procedure.     

Subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans. Report of a case with a review of the literature.

A case of subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans is reported. The patient was successfully treated first by a combination of gentamicin and ampicillin and then, because of severe allergic reactions, ampicillin was replaced by co-trimoxazole; symptoms did not recur and blood cultures remained sterile. A synoptic table is presented of 19 reported cases of infection caused by A. actinomycetemcomitans not connected with actinomycosis, with particular regard to their clinical features, treatment, and outcome.     

Zygomycosis due to Apophysomyces elegans: report of 2 cases and review of the literature

OBJECTIVE: The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen. METHODS: Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A. elegans that have been reported in the literature were reviewed. RESULTS: Both patients developed infection due to A. elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A. elegans, was isolated from each case. CONCLUSION: Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. Infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin B. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy.     

Human actinomycosis. A study of 181 subjects

The clinical and pathologic features of 181 cases of human actinomycosis are reviewed. Actinomycosis is a chronic, sometimes fatal infection caused by species of Actinomyces and involves any part of the body. The abscesses produced contain soft tiny granules in thick pus. These granules contain gram-positive branching bacilli and a radiating eosinophilic fringe. Actinomycosis is not characterized by draining sinuses or hard yellow grains, and the organism is seldom identified by culture. The clinical diagnosis of actinomycosis is seldom made. The infection responds best to a combination of surgical and antibiotic treatment.     

Pulmonary actinomycosis. Fine needle aspiration diagnostic

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.