Pulmonary actinomycosis during the first decade of 21st century: cases of 94 patients

So Ri Kim,Jin Young Kwak,Eu-Gene Choi,Min Ki Lee,Woo Jin Kim,Young-Chul Kim,Seungsoo Kim,Lae Young Jung,In-Jae Oh,Hee Sun Park,Sei-Hoon Yang,Mi-Kyung Kim,Seung Won Ra,Yong Chul Lee,Soo-Jung Um,Kyeong-Cheol Shin

doi:10.1186/1471-2334-13-216

Abstract

BackgroundPulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces. Both improving oral hygiene and early application of antibiotics to the case of suspicious pulmonary infections result in changes in incidences and presentations of pulmonary actinomycosis. However, there are little reports dealt with the recent clinical characteristics of pulmonary actinomycosis. This study aimed to review the characteristics of pulmonary actinomycosis occurred during the first decade of 21st century.MethodsThis retrospective study was performed on 94 subjects with pulmonary actinomycosis diagnosed pathologically from January 2000 to December 2010 in 13 hospitals in Korea.ResultsThe data of the study showed that pulmonary actinomycosis occurs frequently in middle to old-aged males (mean age; 57.7 years old) and that the most common symptoms are cough, hemoptysis, and sputum production. Various radiologic features such as the consolidation with central low attenuation (74.5%) and no regional predominance were also observed. Most of patients recovered completely with medical and/or surgical treatment, reaching approximately 98% cure rate.ConclusionsThe results demonstrate that pulmonary actinomycosis is one of the cautious pulmonary diseases. More importantly, in cases of persistent hemoptysis or for differential diagnosis from lung malignancy, our data have revealed that surgical resection appears to be a useful intervention and that radiologic diagnosis may not provide decisive information. These findings indicate that it is important for the clinicians to include pulmonary actinomycosis as one of differential diagnoses for refractory pulmonary abnormal lesions to the current usual management.

Highlights

Pulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces
Even among experienced physicians, delayed diagnosis or misdiagnosis as tuberculosis, lung abscess or lung cancer is common [3]. Both improvement of oral hygiene and early application of antibiotics to the case of suspicious pulmonary infections result in changes in an incidence and presentations of pulmonary actinomycosis, i.e., the incidence is decreased and the clinical features are less aggressive compared with pre-antibiotic era [3]
All patients were diagnosed as pulmonary actinomycosis based on the histopathologic identification of organisms from the tissues obtained by percutaneous transthoracic needle biopsy/aspiration (PTNB/A), resection by video-assisted thoracic surgery, wedge resection of lung, lobectomy, or bronchoscopic biopsy

Summary

Introduction

Pulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces. The most common symptoms are chest pain, productive cough, and dyspnea [6] These non-specific clinical and radiologic presentations make pulmonary actinomycosis difficult to be diagnosed and often lead to misinterpretation as malignancy rather than an infective process [2,3]. Even among experienced physicians, delayed diagnosis or misdiagnosis as tuberculosis, lung abscess or lung cancer is common [3] Both improvement of oral hygiene and early application of antibiotics to the case of suspicious pulmonary infections result in changes in an incidence and presentations of pulmonary actinomycosis, i.e., the incidence is decreased and the clinical features are less aggressive compared with pre-antibiotic era [3]. As for the treatment, pulmonary actinomycosis has been known to well respond to penicillin and cure without further therapeutic modality such as surgery [3,9]

Objectives

Methods

Results

Discussion

Conclusion