Abstract
Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli. This paper reviews the etiology and clinical presentation associated with Actinomycosis that often presents as a pelvic mass that mimics a pelvic malignancy. A combination of patients treated by the authors in the recent past and a literature review of patients with pelvic Actinomycosis were assessed for demographic, clinical and predisposing co-factors. An analysis is made of age distribution, gender, diagnostic methods and treatment concepts. Thirty-three patients were included in the study that included 2 current patients and 31 obtained from literature review. There were 27 females (age range 16 - 69 years, mean 38 years) and 6 males (16 - 55 years, mean 36 years). Presenting signs and symptoms were lower abdominal mass in 28 (85%); lower abdominal pain in 21 (63%); vaginal discharge or hematuria in 7 (22%). Two patients developed fistulae (entero-vesico 1; vesico-cutaneous 1). Nineteen (70%) of the 27 female patients had intra-uterine contraceptive devices (IUD). Four patients (12.5%) (3 males and 1 female) had urachus or urachal remnants. Cystoscopy in 12 patients noted an extrinsic mass effect, bullous edema and in one patient " vegetative proliferation " proven to be a chronic inflammatory change. Exploratory laparotomy was performed in 32 of the 33 patients who had excision of mass and involved organs. Diagnosis was established by histologic examination of removed tissue. Penicillin (6 weeks) therapy was utilized to control infections. Pelvic actinomycosis mimics pelvic malignancy and may be associated with the long-term use of intra-uterine contraceptive devices, and persistent urachal remnants. Removal of infected mass and antibiotic therapy will eradicate the inflammatory process.
Highlights
Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli, which often occur in clusters of tangled filaments called sulfur granules
This paper presents an assessment of patient with pelvic Actinomycosis, and the associated risk factors
A literature review of 31 patients and 2 recent patients were evaluated to determine demographics, etiologic and clinical patterns of patients with pelvic infection caused by Actinomycosis
Summary
Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli, which often occur in clusters of tangled filaments called sulfur granules. Actinomyces is a natural inhabitant of the gastrointestinal tract. Clinical actinomycosis includes cervicofacial (60%), thoracic (15%), abdominal/ pelvic (25%) [1]. Actinomycosis is a chronic infection characterized by the presence of dense fibrous tissue and pus. This infection does not invade intact mucous membranes, and commonly requires tissue trauma or the presence of foreign body. Abdominal surgery, ruptured viscus, tubo-ovarian abscess and intrauterine contraceptive devices (IUD) are recognized risk factors for abdominal/pelvic Actinomycosis [2]. Actinomyces are thought to be induced by oro-genital contact [3]
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