Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis.

Charlotte Vaysse,Fabien Vidal,Blandine Hervy,Gregoire Miailhe,Claire Illac,Julie Carrara,Yohann Dabi,Cyril Touboul,Bassam Haddad,Dounia Skalli

doi:10.3390/jcm9030821

Abstract

The particularity of pelvic actinomycosis lies in the difficulty of establishing the diagnosis prior to treatment. The objective of this retrospective bicentric study was to evaluate the pertinence and efficacy of the different diagnostic tools used pre- and post-treatment in a cohort of patients with pelvic actinomycosis. The following data were collected: clinical, paraclinical, type of treatment, and the outcome and pertinence of the two diagnostic methods, bacteriological or histopathological, were evaluated. Twenty-seven women were included, with a pre-treatment diagnosis proposed for 66.7% (n = 18) of them. The diagnosis was established in 13.6% (n = 3) of cases through bacteriological samples, and in 93.8% (n = 15) of cases through histopathological samples, with endometrial biopsy positive in 100% of cases. The treatment was surgical with antibiotics for 55.6% (n = 15) of patients, medical with antibiotic therapy for 40.7% (n = 11) of patients, and surgical without antibiotics for one patient. All patients achieved recovery without recurrence, with a median follow-up of 96 days (4–4339 days). Our study suggested an excellent performance of histopathological analysis, and in particular endometrial biopsy, in the diagnosis of pelvic actinomycosis. This tool allowed early diagnosis and, in some cases, the use of antibiotic therapy alone, making it possible to avoid surgery.

Highlights

Actinomycosis is a chronic bacterial infection of which the causative agent belongs to the large family of Actinomyces [1,2]
Our study suggested a very good performance of endometrial biopsy to diagnose pelvic actinomycosis (PA), which could avoid surgical diagnosis
No duration threshold had been established; a mean of 7 years [10] or 8 years was suggested in the meta-analysis of Fiorino [20], who looked into the association of intra-uterine device (IUD) use and development of the disease

Summary

Introduction

Actinomycosis is a chronic bacterial infection of which the causative agent belongs to the large family of Actinomyces [1,2]. This saprophytic bacterium can be found on the human body in the gastrointestinal, oropharyngeal, and urogenital tracts [1]. The use of a copper IUD and the duration of its use (7 years on average) [9,10], gynecological and digestive surgeries [11], and a state of immunodepression [12] have been incriminated in the process of pathological development of the bacterium

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