Actinomyces Infections Research Articles

#5521 TENCKHOFF CATHETER EXIT-SITE INFECTION BY ACTINOMYCES ODONTOLYTICUS: A RARE CASE

Abstract Background and Aims Actinomyces odontolyticus is an anaerobic Gram-positive bacteria, which can be found among the commensal flora of the mouth and oropharynx. Diagnosis of infections due to this microorganism can be difficult because of its rarity, indolent course and lack of specific symptoms. Only one case of exit-site infection (ESI) due to Actinomyces odontolyticus in a patient on continuous ambulatory peritoneal dialysis (CAPD) has been reported. This work aims to report a case of ESI due to this rare agent. Method We present a case of Tenckhoff catheter ESI due to Actinomyces odontolyticus in a patient on CAPD. Results Case report: We report the case of a 26-year-old woman with a personal history of dyslipidemia, arterial hypertension and end-stage chronic kidney disease caused by Alport Syndrome in a CAPD program since April 2016. In June 2020, the patient presented an episode of refractory ESI due to methicillin-sensitive Staphylococcus aureus and was submitted to a shaving of the external cuff of the Tenckhoff catheter, with good subsequent evolution. The patient had no complications related to the catheter until April 2021, when she presented purulent drainage through the exit-site associated with erythema of the surrounding area. The consecutive exit-site swabs were negative. She underwent antibiotic therapy with cotrimoxazole for 2 weeks with apparent resolution. However, in May 2021, the patient presents again erythema and purulent drainage and, at that time, a rare agent was isolated in the swab: Actinomyces odontolyticus with resistance to penicillin, amoxicillin, ceftriaxone and cotrimoxazole. Given this isolation, the patient was treated with doxycycline 100mg every 12 hours for 4 weeks. The evolution was favorable with resolution of the infection and absence of recurrence for a 6-month follow-up. At the end of this follow-up time, the patient was transplanted. Conclusion Actinomyces odontolyticus is a bacteria of the commensal flora of the oral cavity and upper gastrointestinal tract, which can acquire pathogenicity in situations of impaired mucosal integrity and in immunosuppressed patients. Infections caused by this agent are rare and represent a diagnostic challenge due to its growth in an anaerobic environment and prolonged isolation time (5 days to 4 weeks). The immunosuppression conferred by chronic kidney disease and the history of external cuff shaving may have propitiated the infection by this rare opportunistic agent in our patient. The ESI presented for the patient in the previous month, which did not have an identified agent, was possibly caused by Actinomyces odontolyticus, but it was not isolated probably due to culture difficulties. The treatment of Actinomyces infections is generally conservative with 2 to 4 weeks of high-dose of intravenous penicillin, followed by 2 to 6 months of oral antibiotic therapy. In case of allergy, regimens with ceftriaxone, doxycycline, clindamycin or carbapenems are recommended. There is no consensus on the duration of treatment, with some authors recommending a minimum of 2 to 6 weeks. The mentioned patient was treated with 4 weeks of doxycycline according to the sensitivity test and the result was favorable, without the need to remove the catheter.

714 Actinomyces Necrotizing Soft Tissue Infections: A Case Series from a Single Institution

Abstract Introduction Necrotizing soft tissue infections (NSTI) are rare, severe infections that can lead to septic shock. NSTI have a mortality rate of 20-50% in patients who require intensive care. Management includes surgical debridement and broad-spectrum antibiotics until definitive culture results. Actinomyces is a slow-growing bacterium found in the mouth, skin, genitourinary, and gastrointestinal tracts, with several case reports of actinomyces related NSTI. At this single institution, NSTI are managed by burn surgeons. The goal of this study is to quantify patients with actinomyces-related infections, identify modifiable risk factors, and demonstrate the pharmacology of effective antibiotic treatment. Methods All patients with actinomyces-related infections admitted to a single institution’s burn center from January 2020 to September 2022 were included. Patients were identified via the institution’s data warehouse. Patient demographics, infection location, associated injuries or illnesses, antibiotic exposure, and treatments required were obtained. Results were recorded and compared using descriptive statistical analysis. Results A total of 22 patients with actinomyces infections were identified, 18 with NSTI and 4 with non-NSTI infections (1 hidradenitis suppurativa, 1 Job’s syndrome, and 2 burn-related). Average age was 50.3 years old, and 68% of patients were male. Seventy-four percent of patients were obese, and average BMI for obese patients was 40.3 kg/m2. Fourteen NSTI patients had diabetes or pre-diabetes (mean A1c 9.4%), and two were taking a sodium-glucose co-transporter 2 inhibitor. All NSTI patients underwent surgical debridement and broad-spectrum antibiotic treatment. The groin was the most common site of infection. Time from collection of sample to culture resulting with Actinomyces was 44 to 185 hours (mean 111 hours). Species isolated were A. europaeus, A. radingae, A. turicensis, A. odontolyticus, and A. funkei. Three of the NSTI patients died. Among NSTI survivors, average length of stay was 34 days, duration of antibiotics was 10.7 days (6 to 16 days), and 50% of patients were de-escalated to either ampicillin/sulbactam, or ertapenem. Conclusions To our knowledge this is the largest single institutional series to date for patients affected by Actinomyces related NSTI. The high percentage of patients with diabetes, 73% of NSTI patients, suggests an increased susceptibility to infection for these patients. A variety of Actinomyces isolates are present in NSTI. The mortality rate (17%) of these ICU admitted NSTI patients agrees with prior studies. Applicability of Research to Practice Novel findings of actinomyces infection in NSTI patients

A RARE CASE OF ACTINOMYCES EMPYEMA

A RARE CASE OF ACTINOMYCES EMPYEMA

Actinomycosis mimicking a pancreatic head neoplasm: A case report

IntroductionActinomycosis is a chronic suppurative disease caused by a filamentous, Gram-positive, facultative anaerobic bacterium Actinomyces. Abdominal actinomycosis accounts for 10 to 20% of reported Actinomyces infections and pancreatic involvement is extremely rare.Presentation of caseWe report the case of a 64-year-old man who presented with a 3-week history of abdominal pain, nausea, weight loss, and icterus. Abdominal CT scan revealed a 3.5 cm heterogeneously enhanced mass of the pancreatic head, associated with mild dilation of the main bile duct and the Wirsung duct. The diagnosis of pancreatic head malignancy was highly suspected and surgical management was decided. Intraoperatively, a 3 cm indurated mass of the pancreatic head was found. Whipple's procedure was performed. Histopathological examination revealed pancreatic actinomycosis.DiscussionPancreatic actinomycosis is extremely rare. To our knowledge, only 18 cases have been reported in the English literature to date. It commonly presents as a slow-growing mass with bile and pancreatic ducts obstruction, which can mimic malignancy. Therefore, it has often been misdiagnosed and over-treated with futile surgery, when medical treatment based on antibiotherapy is the only required treatment.ConclusionWe reported a rare observation of surgical management of actinomycosis mimicking a pancreatic head neoplasm. As clinical and radiological findings are nonspecific, the accurate diagnosis can only be made by histology. Through our case, we aim to highlight the importance of preoperative suspicion of pancreatic actinomycosis, given the still relevant morbidity of pancreatic resections.

Disseminated Nocardia in an Immunocompetent Host

A 44-year-old man with no medical comorbidities presented with recurrent inferior vena cava thrombosis and several months of fever, headache, and weight loss. Positron emission tomography–computed tomography was performed, which revealed a 1.5-cm fluorodeoxyglucose avid left lung mass and hypermetabolic soft tissue masses in bilateral inguinal regions (Figure 1). He underwent computed tomography–guided biopsy of the lung and left inguinal masses. Histopathology found clumps of filamentous branching bacilli, consistent with Nocardia (Supplemental Figure, available online at http://www.mayoclinicproceedings.org). Broad-range bacterial polymerase chain reaction (16s rRNA detection) returned positive for Nocardia paucivorans. Subsequent brain magnetic resonance imaging exhibited innumerable brain abscesses (Figure 2). Immunodeficiency work-up was performed and was unremarkable. He began therapy with intravenous trimethoprim-sulfamethoxazole, amikacin, and imipenem.Figure 2Abscesses with surrounding vasogenic edema on T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Nocardia is a filamentous, Gram-positive, partially acid-fast bacterium that is ubiquitous in the environment.1Lerner P.I. Nocardiosis.Clin Infect Dis. 1996; 22: 891-903Crossref PubMed Scopus (499) Google Scholar It is capable of disseminating to almost any organ, but it has a predilection for the lungs and brain. It also has a tendency to recur. Disseminated infection is more common in immunocompromised hosts, but approximately one-third of infections occur in patients who are immunocompetent.2Corti M.E. Villafañe-Fioti M.F. Nocardiosis: a review.Int J Infect Dis. 2003; 7: 243-250Abstract Full Text PDF PubMed Scopus (170) Google Scholar, 3Dominguez D.C. Antony S.J. Actinomyces and Nocardia infections in immunocompromised and nonimmunocompromised patients.J Natl Med Assoc. 1999; 91: 35-39PubMed Google Scholar, 4Sorrell T.C. Mitchell D.H. Iredell J.R. Chen S.C.-A. Nocardia species.in: Bennett J.E. Dolin R. Blaser M.J. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Elsevier, Philadelphia, PA2015: 2853-2863Crossref Scopus (16) Google Scholar Treatment for disseminated disease requires induction with intravenous multidrug therapy. Trimethoprim-sulfamethoxazole forms the backbone of induction therapy and is combined with one or both of amikacin and imipenem. Imipenem is required if there is central nervous system involvement. Treatment should be tailored based on susceptibilities, if available. After induction, patients may be transitioned to dual oral therapy with trimethoprim-sulfamethoxazole and either minocycline or amoxicillin-clavulanate. A total of 12 months of therapy is typical for immunocompromised patients and those with central nervous system involvement.4Sorrell T.C. Mitchell D.H. Iredell J.R. Chen S.C.-A. Nocardia species.in: Bennett J.E. Dolin R. Blaser M.J. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Elsevier, Philadelphia, PA2015: 2853-2863Crossref Scopus (16) Google Scholar We acknowledge and thank Julie Guerin, MD, and Ayse Tuba Kendi, MD, for interpreting and providing the images of the brain magnetic resonance imaging and positron emission tomography–computed tomography, respectively.

A cervicofaciális actinomycosisok jellemzői és korszerű diagnosztikája: összefoglaló az irodalmi adatok alapján

Members of the Actinomyces genus are saprophytic components of the normal microbiota of humans. Actinomyces spp.infections are considered to be rare, with cervicofacial infections (frequently called as ‘lumpy jaw syndrome’) describedas the most prevalent type in the clinical practice. Actinomycoses may resemble other pathologies, such as solid tumorsor other infectious processes. These infections are characterized by a slowly progressing infection, with non-specificsymptoms. The clinical diagnosis of actinomycosis may be difficult and it requires a plethora of clinical, microbiologicaland histopathological examination methods. The aim of this review is to summarize current advances on the clinical features,diagnostics and therapy of cervicofacial Actinomyces infections for dental specialists.

CERVICOFACIAL ACTINOMYCOSIS CAUSING PNEUMONIA AND EMPYEMA

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Actinomyces are non-spore-forming, anaerobic bacteria with variable morphology found as part of normal oral flora. Active infections are seen in patients with a history of poor dental hygiene, diabetes, alcoholism, and immunosupression. Although actinomyces is a known cause of cervicofacial and lung infections separately, we present a case of a patient diagnosed with cervicofacial actinomycosis with extension into the pleural cavity causing empyema. CASE PRESENTATION: A 38 year old male with an only known history of alcohol abuse was admitted to the hospital for evaluation of an enlarging anterior neck mass. He stated that he had intermittent chills and night sweats. The patient was complaining of no shortness of breath or chest pain. Physical exam was unremarkable other than poor dentition, a large anterior neck mass, and decreased breath sounds in the right lung base. On presentation, the patient was febrile to 102.3F with a leukocytosis of 30,000 cells/mcL.The patient was initially started on broad spectrum antibiotics. CT of the chest showed posterior and medial right sided pleural thickening, dense consolidation of posterior and medial aspects of the right upper and lower lobes, likely right sided empyema with split pleura sign, and a 10cm by 6cm phlegmonous neck mass with likely extension into the apex of the right pleural cavity.There was associated mediastinal lymphadenopathy. The patient underwent surgical incision and drainage of the neck mass. Surgical pathology revealed granulation tissue with lymphohistiocytic infiltrate and focal abscess formation. Pathology also identified actinomyces species and sulfur granules. A chest tube was placed to drain the effusion and the patient's antibiotics were switched to ampicillin/sulbactam and eventually to oral penicillin. DISCUSSION: Actinomyces are non-spore-forming, strict or facultative anaerobes with a variable cellular morphology. They are only found in normal oral flora of humans and usually only cause infections in patient with poor dentician, diabetes, chronic alcoholism, and immunosupression. There is a male predominance. Disease is usually caused by direct, not hematogenous, spread and has the capability to cross fascial planes, form multiple abscesses, fistulae, and draining sinus tracts. Infections typical present in two forms as either slow indolent none painful infections or acute suppurative infection with significant pain and symptoms. Given that our patient was relatively asymptomatic, he most likely presented with the slow indolent form and had likely been infected for weeks before his neck mass was noted. CONCLUSIONS: Actinomyces infections are a well known cause of cervicofacial infections and can spread by direct extension. We present an unusually case of a patient with cervicofacial actinomycosis that formed a direct tract to the pleural cavity causing pneumonia and emypema. Reference #1: Moturi K, Kaila V. Cervicofacial Actinomycosis and its Management. Ann Maxillofac Surg . 2018;8(2):361-364. DISCLOSURES: No relevant relationships by Cory Bolinger, source=Web Response No relevant relationships by Jeffrey Williams, source=Web Response

Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview.

Similarly to other non-spore-forming Gram-positive anaerobes, members of the Actinomyces genus are important saprophytic constituents of the normal microbiota of humans. Actinomyces infections are considered to be rare, with cervicofacial infections (also known as ‘lumpy jaw syndrome’) being the most prevalent type in the clinical practice. Actinomycoses are characterized by a slowly progressing (indolent) infection, with non-specific symptoms, and additionally, the clinical presentation of the signs/symptoms can mimic other pathologies, such as solid tumors, active Mycobacterium tuberculosis infections, nocardiosis, fungal infections, infarctions, and so on. The clinical diagnosis of actinomycosis may be difficult due to its non-specific symptoms and the fastidious, slow-growing nature of the pathogens, requiring an anaerobic atmosphere for primary isolation. Based on 111 references, the aim of this review is to summarize current advances regarding the clinical features, diagnostics, and therapy of cervicofacial Actinomyces infections and act as a paper for dentistry specialists, other physicians, and clinical microbiologists.

Synchronous multifocal necrotizing soft tissue infections: a case report and literature review

Necrotizing soft tissue infections are a group of conditions with a common pathophysiological basis, affecting any or all layers of the soft tissue compartment. They are rare, life-threatening diseases that require a high index of suspicion for early detection as well as urgent surgical debridement. Rarely, they can occur in more than one non-contiguous site of the body (‘multifocal’ disease), and this is associated with a much higher mortality than monofocal disease. Here, we present the case of a 46-year-old male with bilateral upper limb necrotizing soft tissue infection following an unclear history of trauma. The patient developed septic shock necessitating transfer to the intensive care unit following emergency surgery. Microbiological tests yielded Streptococcus pyogenes, Staphylococcus aureus and opportunistic Candida spp. and Actinomyces infections. A total of seven surgical debridements were performed; fortunately, the patient survived. We discuss the presentation, diagnosis and management of this case including primary reconstruction of the soft tissue defects, and review the literature on necrotizing soft tissue infections as a clinical entity, incorporating clinical updates from the latest guidelines worldwide. Level of Evidence: Level V, therapeutic study.

Premature labor and neonatal sepsis caused by Actinomyces neuii

Actinomycosis is a rare infection in patients younger than 10years of age. It mainly affects the cervicofacial region, but many other sites of infection have been recognized. About 70% of infections are due to either Actinomyces israelii or Actinomyces gerencseriae.Actinomyces neuii was first described in 1985 in two patients with post cataract endophthalmitis, A. neuii represents 17% of clinical Actinomyces isolates. Several reports indicated a well-known association between Actinomyces infections and Intrauterine devices (IUD).We are reporting a case of neonatal sepsis due to A. neuii as a first case reported from Saudi Arabia. It was thought to be the cause of the premature labor and neonatal sepsis.The prevalence of Actinomyces infection is likely underestimated and additional premature labors and abortions could have been caused by Actinomyces infections that were never detected. More studies are needed to confirm the association of maternal Actinomyces infections with preterm labor.

Actinomyces neuii infection following ovarian cystectomy

Background: Abdominal Actinomyces infections are rare complications of surgery. A case of Actinomyces neuii presenting as a severe postoperative pelvic infection is described.Case: A 30 year-old nulligravid female was transferred from an outside hospital for a postoperative fluid collection, fever, leukocytosis, and abdominal pain following exploratory laparotomy and bilateral ovarian cystectomy. She rapidly decompensated requiring emergent exploratory laparotomy, bilateral salpingooophorectomy, and abdominal washout. Cultures isolated A. neuii. Following a prolonged ICU admission, she was treated with prolonged antibiotics and made a complete recovery.Conclusions: Rare pathogens, such as A. neuii, may cause severe infections following gynecologic surgery. Multidisciplinary care at tertiary care facilities is critical.

Metastatic Crohnʼs Disease Without Gastrointestinal Manifestations of Crohnʼs Disease

Introduction: Crohn's disease(CD) is a chronic granulomatous inflammatory disease that typically affects the terminal ileum but can involve any part of the gastrointestinal(GI) tract. Rarely it causes cutaneous, non caseating granulomas anatomically distinct from the GI tract called Metastatic Crohn's Disease(MCD). Most patients with MCD either have concomitant classic manifestations of CD or develop them within a few months to years. We present a case of MCD without involvement of the GI tract, recalcitrant to treatment. Case presentation: A 19-year-old female presented with pain and purulence of lesions on her vulva. On examination, the entire vulva and perineum appeared indurated, erythematous, edematous, with warmth and purulence. The patient had been diagnosed with MCD at the age of ten, after biopsy of perianal lesions showed florid epithelioid granulomatous reaction consistent with MCD. She has had no GI symptoms and multiple esophagogastroduodenoscopies and colonoscopies have been normal. She received Infliximab periodically for 6 years, with only mild improvement of MCD. She had also been given Adalimumab, prednisolone, and mesalamine with no response. In the hospital, she was treated with antibiotics for cellulitis due to superinfection of her genital lesions and was referred to a CD specialist. Discussion: MCD is the least common skin manifestation of CD. Genitalia are the most common site in children. MCD starts between the ages of 10-14 in children, with 50% having concurrent CD. In others, GI manifestations start from 9 months to 14 years after MCD diagnosis. In adults, it starts in the third decade with the majority already been diagnosed with CD. The differential diagnosis of MCD include cutaneous sarcoid, mycobacterial, fungal and actinomyces infections, hydradenitis suppurativa, pyoderma gangrenosum, foreign body reactions etc. Biopsy is needed to make a definitive diagnosis. There are no standard treatment guidelines as there are no clinical trials on treatment of MCD. Therapy with steroids, immunosuppressive agents, biological agents and oral antibiotics have been used with varying success. Surgical debridement with hyperbaric oxygen has also been reported to be effective. Though there are reports of spontaneous remission, MCD is mostly persistent and causes significant morbidity. MCD should be considered in the differential diagnosis of non healing skin lesions and biopsy should be done for early diagnosis and treatment.

The cytopathology of Actinomyces, Nocardia, and their mimickers.

Nocardia species and Actinomyces species are 2 of the most commonly diagnosed filamentous bacteria in routine cytopathology practice. These genera share many overlapping cytomorphologic features, including their thin, beaded, branching, Gram-positive, GMS-positive filamentous structures that fragment at their peripheries into bacillary- and coccoid-appearing forms. Features that help distinguish between these 2 microorganisms include the width of their filamentous structures, the angles at which they branch, and their ability or lack thereof to retain a modified acid-fast stain. In addition to cytomorphologic overlap, overlap in clinical presentation is frequent with pulmonary and mucocutaneous presentations seen in both. Differentiating between Nocardia and Actinomyces is essential because patients with these infections require different approaches to medical management. Both antibiotic susceptibilities and the need for early surgical intervention as part of the treatment plan vary greatly among these 2 groups. This review focuses on the clinical presentation, cytomorphology and staining characteristics that can be useful in identifying and distinguishing between Nocardia and Actinomyces infections, as well as their mimickers.

Actinomyces radicidentis and Actinomyces haliotis, coccoid Actinomyces species isolated from the human oral cavity

There are few reports on the bacterial species Actinomyces radicidentis in the literature. In this study, putative A. radicidentis isolates were collected from 16 root canal samples from 601 examined patients. The isolates were examined by biochemical tests, 16S rRNA gene sequencing, Arbitrarily-primed (AP-) PCR, antibiotic susceptibility testing, and MALDI-TOF analyses. In parallel, two A. radicidentis reference strains and two putative A. radicidentis isolates from United Kingdom were tested. Sixteen of the 18 isolates were confirmed as A. radicidentis. The remaining two isolates, both of which were isolated from root canals (one from Sweden and the other from the UK), but were identified as Actinomyces haliotis by sequencing ∼ 1300 base pairs of the 16S rRNA-gene. This isolates had a divergent, but between them similar, AP-PCR pattern, and a common distribution of sequence signatures in the 16S rRNA gene, but were not identified by MALDI-TOF. A. haliotis is a close relative to A. radicidentis, hitherto only been described from a sea-snail. The identity of A. haliotis was confirmed by a phylogenetic tree based on 16S rRNA gene sequences with species specific sequences included, and by additional biochemical tests.The examined bacteria exhibited similar antibiotic susceptibility patterns when tested for 10 separate antibiotic classes with E-tests (bioMérieux). The MIC90 for β-lactams (benzylpenicillin and cefuroxime) and vancomycin was 0.5 mg/L, for colistin and ciprofloxacin 8 mg/mL and for the other antibiotic classes ≤ 25 mg/mL The isolation of A. haliotis from infected dental root canals cast doubt on the accepted opinion that all Actinomyces infections have an endogenous source.

Actinomyces in Pregnancy: A Review of the Literature.

Actinomyces is commonly found in many areas of the body where it derives a benefit without harming the host. When it does infect the host during pregnancy, is that infection a threat to the obstetric patient and does that infection cause adverse pregnancy outcomes? The aim of this study was to review what is known about Actinomyces infections and the impact of an Actinomyces infection on pregnancy outcomes. A PubMed search was undertaken with the search years unlimited to April 1, 2016, and restricted to articles in English. The search terms included "actinomyces," "pregnancy," "prenatal," "maternal," "actinomyces infection," "pregnancy," "chorioamnionitis," "preterm labor," "premature birth," or "postpartum actinomyces." Eighteen of the 154 identified articles are the basis of this review. Actinomyces is a rod-like positive bacterium. The diagnosis of an Actinomyces infection can be by culture or Gram stain. Actinomyces is commensal and typically only infects after a mucosal break or lesion. Seventeen cases were identified in pregnancy. Ten cases were complicated by chorioamnionitis and a preterm delivery. A nidus leading to infection was identified in 12 of the cases including women with a cervical cerclage, dental abscesses, appendicitis, renal actinomycosis, and ovarian abscesses. Adverse pregnancy outcomes have been linked with periodontal disease, but treatment did not prevent preterm delivery in a randomized, blinded, controlled trial. Actinomyces infections in pregnancy are rare but, if they occur, have been linked primarily with preterm deliveries. Obstetricians and gynecologists, family physicians. After completing this activity, the learner should be better able to identify the areas of the body where Actinomyces infections occur and how the infections typically occur, identify the pathophysiologic changes that occur during pregnancy that might lead to an Actinomyces infection and how that infection may affect pregnancy outcomes, and describe the treatment for mild and severe Actinomyces infections.

Pulmonary actinomycosis presenting as post-obstructive pneumonia

Actinomycosis is a chronic suppurative infection caused by filamentous Gram-positive bacilli,leading to a purulent discharge due to sulfur granule formation. Thoracic actinomycosis represents around 20% of Actinomyces infections, with endobronchial involvement being fairly uncommon. Pulmonary actinomycosis should be considered in the differential diagnosis of non-resolving lobar pneumonia or a lobar mass suspicious for malignancy on endobronchial biopsy. A case of endobronchial actinomycosis presenting as post-obstructive pneumonia and mimicking right upper lobe endobronchial carcinoma, which was associated with foreign body aspiration, is reported here.

Actinomyces and Nocardia infections in chronic granulomatous disease

Objective:Chronic granulomatous disease (CGD) is an inherited disorder of the Nicotinamide adenine dinucleotide phosphate reduced oxidase complex characterized by recurrent bacterial and fungal infections. Disseminated infection by combination of opportunistic agents is being increasingly reported in CGD patients. We presented in the retrospective review of medical records, the etiology, presentation, clinical characteristics the infections detected, predisposing condition and outcome of nocardiosis and actinomycosis involved in a group of pediatric patients diagnosed with CGD.Materials and Methods:The clinical presentation of CGD-related infections was reviewed retrospectively from the medical records of all 12 patients with CGD. We studied respectively 12 patients between 2001 and 2008, and we analyzed two pediatric patients with CGD who acquired Nocardia and Actinomyces infections, and their clinical and microbiological characteristics were described. The material for investigations was collected from scrapings, crusts, pus from subcutaneous abscesses or exudation from sinus tracts, surgical debridement, and biopsy specimens. The microbiological diagnosis was determined by biochemical tests, histology, microscopy, and culture of clinical samples.Results:The medical records of 12 diagnosed CGD patients with suspected nocardiosis or actinomycosis were reviewed. One patient was diagnosed with actinomycosis and one patient with nocardiosis. Patients consisted of seven males and five females with ranging ages of 3 to 18 years. Nocardiosis and actinomycosis isolated in the two patients were confirmed by histology and culture methods. Neutrophil oxidative burst were absent (NBT=0) in both patients. The most common manifestations of CGD due to fungal infections, actinomycosis, and nocardiosis were osteomyelitis (42.8%), pulmonary infections (28.6%), lymphadenopathy (14.3%), and skin involvement (14.3%) during their illness.Conclusion:Nocardiosis and actinomycosis in children indicate the need for evaluation for an underlying immunological deficiency. Early diagnosis remains critical for decreased morbidity and occasional mortality. Physicians caring for patients with CGD should maintain a high index of suspicion for nocardiosis and actinomycosis especially if work up for TB and fungal infections are negative.

Septic Arthritis of the Knee in a Patient With Actinomyces meyeri Bacteremia

Actinomyces are filamentous, gram-positive, anaerobic commensals in the oropharyngeal and intestinal tracts in humans. Invasion of breached or necrotic tissue results in infection with this organism. Dental procedures are a well-documented risk factor for local and systemic Actinomyces infections. Actinomyces meyeri can cause serious systemic infections including brain abscesses, endocarditis, osteomyelitis, and empyema, but there are no previous reports of joint involvement with A. meyeri. Skeletal involvement in actinomycosis is usually secondary to local spread from the soft tissues. Hematogenous seeding of bones and joints is extremely rare. We report the first case of A. meyeri bacteremia with septic arthritis of the knee joint in a woman on chronic corticosteroids who underwent a recent dental extraction. We also review the medical literature for the last 30 years of joint involvement as a result of Actinomyces species.

Actinomycotic Infection of the Abdominal Wall Mimicking a Malignant Neoplasm

Actinomyces infections can create diagnostic dilemmas and be mistaken for malignant tumors. Case report and review of the pertinent English-language literature. A 44-year-old man who had undergone an appendectomy for perforated appendicitis presented three years later with an abdominal wall mass. He had been treated postoperatively for an abdominal wall infection with Actinomyces. Given his poor response to antibiotics and a diagnostic work-up that could not definitively rule out a malignant tumor, a wide local excision was performed. Microscopic examination revealed sulfur granules consistent with Actinomyces. Although the current recommendation is to treat Actinomyces infections with antibiotics, there may be a role for surgical intervention if the response to antibiotics has been suboptimal or a malignant process cannot be ruled out.

Multiple Panniculitis Caused by Actinobacillus and Actinomyces Infections

Multiple Panniculitis Caused by Actinobacillus and Actinomyces Infections