支气管扩张症并亚洲诺卡菌感染1例及文献回顾

诺卡菌病是由诺卡菌感染引起的局限性或播散性化脓性或肉芽肿性疾病,它主要涉及肺部、皮肤、中枢神经系统（central nervous system,CNS）,其中肺部受累最常见。常见于免疫功能抑制宿主,但也可发生在免疫功能正常宿主。免疫抑制宿主更容易患播散性疾病,预后更差。诺卡菌病临床发病率低,是一种罕见病,免疫功能正常宿主患病率更低。最近,暨南大学附属广州市红十字会医院呼吸内科收治了1例支气管扩张症并肺亚洲诺卡菌感染的免疫功能正常患者,以下结合文献回顾进行报道。     

Mandibular osteomyelitis in children mimicking juvenile recurrent parotitis

Objective

To describe pediatric cases with mandibular osteomyelitis initially diagnosed and treated as juvenile recurrent parotitis.

Methods

We reviewed the patient data of all our pediatric patients treated at Helsinki University Central Hospital, a tertiary care hospital, between 1998 and 2010 who had the initial diagnosis of recurrent parotitis which in fact was osteomyelitis.

Results

Over a period of 12 years, six children (aged 5-17 years, five girls) presented with mandibular osteomyelitis primarily diagnosed as recurrent parotitis. Diagnostic delay ranged from 1.5 months to 6.0 years before the final diagnosis of mandibular osteomyelitis confirmed in MRI. Of the six cases undergoing biopsies, bacterial culture showed Actinomyces or Streptococcus viridans in four cases. All patients received antimicrobial treatment. Two received hyperbaric oxygen therapy with no resolution of symptoms. Debridement was performed in these two cases as well, and in the second case persistent symptoms led to bisphosphonate treatment.

Conclusions

Juvenile parotitis is in most cases a clinical diagnosis, and treatment is symptomatic. In contrast, mandibular osteomyelitis is a severe disease requiring lengthy treatment. Because symptoms of these two entities may mimic each other, unclear cases require MRI.     

Actinomyces cardiffensis septicemia: a case report

Actinomyces cardiffensis is an anaerobic, Gram-positive, non-spore-forming rod that was first identified by Hall et al. (Hall V. et al. (2002) J Clin Microbiol 40:3427-31). Here we report a case of bacteremia with liver and lung abscesses associated with A. cardiffensis. A 67-year-old man was hospitalized with fever and headache for 20 days. Blood culture revealed an Actinomyces species, which was ultimately identified as A. cardiffensis by 16S rRNA gene sequencing. A computed tomography scan of his chest showed small abscesses in his lung and liver. After a 3-week course of intravenous ceftriaxone, the patient showed rapid improvement. The patient was transitioned to oral amoxicillin for the remainder of his antibiotic treatment.     

Actinomycosis of the colon with invasion of the abdominal wall: An uncommon presentation of a colonic tumour

Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. The most common type causing disease in humans is Actinomyces israelii. This organism is a commensal of the human mouth and is seldom pathogenic. When it does cause disease, however, three main clinical types of involvement are recognized including cervico-facial, thoracic and abdominal actinomycosis.Herein, we present the case of a 79-year-old male patient who underwent surgical exploration following presentation with abdominal pain and an abdominal mass, initially thought to be a malignancy. Pathologic examination confirmed this as a case of abdominal actinomycosis. This diagnosis should always be included in the differential diagnosis of patients who present with an infiltrative abdominal mass.     

放线菌病九例临床分析

目的探讨放线菌病的临床特点,提高临床医师对该病的认识。方法回顾性分析北京协和医院1990年1月至2006年6月确诊的9例放线菌病病例。结果（1）9例患者中7例女性,2例男性;年龄30～50岁;病程2～36个月;（2）9例患者中面颈部病变3例,妇科病变2例,肺部及胸腔病变2例,乳腺、肠道病变各1例。其中3例患者有累及多器官的播散性病变;（3）9例中6例通过手术获得病理诊断,2例依靠痰涂片或硫磺颗粒诊断,1例由临床及理化诊断;（4）9例均使用抗生素治疗,8例好转,1例死亡。结论放线菌病临床少见,多表现为慢性脓肿,易误诊为恶性肿瘤,应引起临床医师的重视,早期诊断、及时治疗,可改善预后。     

Plasma cell granuloma associated with pulmonary actinomycosis: a case report

Plasma cell granuloma (PCG) of the lung is a rare disease that usually presents as a pulmonary nodule or mass on incidental radiographic examination without symptoms. Although the etiology of PCG is still controversial, many findings have lent support to the lesion being a reactive inflammatory process rather than a neoplastic one. We describe a 53-yr-old male who presented with a hemoptysis and have a lung mass at the left upper lobe on chest radiograph. The lung mass was primarily diagnosed as PCG by percutaneous needle aspiration and biopsy, and the patient was treated with oral steroid because he and relatives refused the operation. However, the size of the lung mass did not change and open thoracotomy and lobectomy were done therefore. He was confirmed as having pulmonary actinomycosis with PCG after surgery. To our knowledge, this is the first report of PCG associated with actinomycosis in Korea.     

Clinical Features of Abdominopelvic Actinomycosis: Report of Twenty Cases and Literature Review

Purpose

Intrabdominal actinomycosis is difficult to diagnose preoperatively. This chronic infection has a propensity to mimic many other diseases and may present with a wide variety of symptoms. The aim of this study was to evaluate the characteristic clinical features with review of the literature.

Materials and Methods

We retrospectively analyzed 22 patients with intrabdominal actinomycosis between January 2000 and January 2006.

Results

There were two men and 20 women with a mean age of 42.8 years (range, 24 - 69). Twelve patients presented with masses or abdominal pain, whereas 3 patients presented with acute appendicitis. The rate of performing an emergency surgery was 50% due to symptoms of peritonitis. The mean size of tumor was 5.5 cm (range, 2.5 - 11.0). Sixty percent (n = 12) of female patients had intrauterine device (IUD). The average time to definite diagnosis was 10.6 days.

Conclusion

Intrabdominal abdominal actinomycosis must first be suspected in any women with a history of current or recent IUD use who presents abdominal pain. If recognized preoperatively, a limited surgical procedure, may spare the patient from an extensive operation.