Clinical Features of Actinomycosis in Older Adults: A 10-Year Experience of a Single Institute in Beijing, China.

Abstract

Actinomycosis is a rare infectious disease with non-specific clinical presentations often resulting in delayed diagnosis, especially in older adults. Diagnosing and treating actinomycetal infections in this population can be particularly challenging due to the lack of comprehensive case series studies focusing specifically on actinomycosis in older adults. The existing literature mainly consists of case reports, highlighting the need for more extensive research in this area. This study aimed to provide a profile of actinomycosis in older adults to guide future research efforts. Elderly patients aged 60 years and older who satisfied the inclusion criteria for actinomycosis at Peking Union Medical College Hospital from January 2014 to May 2024 underwent a retrospective analysis. The research centered on describing the clinical features and diagnostic techniques, distinguishing between different conditions, and treating clinically important instances of actinomycosis within this specific age bracket. This study involved 22 patients, with a balanced gender distribution of 11 males and 11 females, aged between 60 and 84 years, and a median age of 67 years. The disease predominantly affected the thoracic region (n=17), followed by the abdominal-pelvic (n=2) and orocervicofacial (n=2) regions, along with one case involving soft tissue (n=1). Microbiological methods confirmed the diagnosis in 17 cases (77%), while histopathological examination was employed in the remaining five cases (23%). General symptoms, such as fever and weight loss, were reported by 64% of the patients, whereas 32% exhibited symptoms localized to the infection site. Only one patient (4%) did not present any symptoms. The median duration from the onset of initial symptoms to diagnosis was 120 days (IQR 34.5-240). Nine patients were successfully treated with antibiotics, with only one patient experiencing a relapse during the follow-up period. Infections caused by actinomycetes are infrequent among the elderly and often exhibit non-specific clinical symptoms and imaging results. Among the various types of actinomycetal infections in this demographic, pulmonary actinomycosis is the most prevalent. Recognizing the wide-ranging capacity of actinomycetes to induce infections beyond our present knowledge is essential. It is important for healthcare practitioners to deepen their knowledge of actinomycosis to prevent delays in both diagnosis and treatment.