Een bacterie vermomd als schimmel: pulmonale actinomycose bij een geriatrische patiënte

Abstract

A bacteria masked as a fungus: a case of pulmonary actinomycosis in a geriatric patient Pulmonary actinomycosis is a relatively rare diagnosis which probably results from the aspiration of oropharyngeal or gastrointestinal secretions. Individuals with aspiration, alcoholism, poor oral hygiene, chronic obstructive lung disease and a decreased immune response are at risk. The most common symptoms are nonspecific and often present late. The imaging of pulmonary actinomycosis is not specific. Therefore, the disease is frequently confused with a malignancy or tuberculosis. The gold standard for the diagnosis is a histological examination and bacterial culture of a lung biopsy. Its treatment requires high doses of penicillin during at least 3 months. In this article, the case of an 82-year-old patient with malaise but without any respiratory complaints is presented. Further examination revealed inflammatory blood signs, as well as infiltration of the right upper lobe on a CT scan of the thorax. To exclude an underlying malignancy, a bronchoscopy was performed. Gram staining of the bronchoalveolar washing showed gram-positive branching rods suspicious for Actinomyces species. Histological examination confirmed the diagnosis of pulmonary actinomycosis. By means of an antibiotic treatment with amoxicillin the patient recovered both clinically and biochemically.