Actinomycosis Research Articles

Actinomycosis of the Nasopharynx Causing Carotid Occlusion

Actinomycosis is a chronic, fibrotic infection caused by gram-positive bacteria that can mimic destructive processes such as malignancy or tuberculosis. Cervicofacial actinomycosis is the most common clinical form of actinomycosis and should be considered in the differential diagnosis of aggressive lesions of the nasopharynx. A case of actinomycosis of the nasopharynx extending to the skull base and resulting in occlusion of the internal carotid artery is presented. The presence of vascular occlusion by an infiltrative process, disproportionate bony destruction relative to the soft tissue involvement and lack of adenopathy should raise the suspicion of an inflammatory process as the etiology and not a tumor.

An Unusual Case of Abdominal Actinomycosis Mimicking Inflammatory Bowel Disease

Purpose: Introduction: Actinomycosis (AMC) is a chronic granulomatous disease manifesting in a number of ways, including fistula, sinus, mass or abscess. This disease very typically subscribes to an indolent course with non-specific signs and symptoms, often leading to delayed diagnosis. Abdominal AMC accounts for only approximately 20% of clinical presentations, with the majority of cases localized to the cervical and thoracic regions. However, within this 20%, the appendiceal site is by far the most common. AMC is sensitive to penicillin, and adequate treatment will almost always result in a full and permanent recovery. Case Presentation: A 23-year-old male without significant prior medical history who was referred to gastroenterology for evaluation of suspected Crohn's Disease. The patient endorsed progressively worsening abdominal pain, diarrhea and hematochezia of one month duration and had undergone abdominal imaging with an abdominal CT revealing diffuse thickening of the distal ileum with dilation of the proximal small bowel, suggestive of “ileitis secondary to Crohn's disease.” Prior to gastroenterologic evaluation, the patient developed acute small bowel obstruction with perforation and feculent pelvic peritonitis. He underwent emergent surgery requiring ileocectomy, appendectomy and resection of approximately 27 cm of distal ileum. The resected portion of bowel demonstrated chronic and focal active ileitis with architectural disarray and rare noncaseating submucosal granulomas in the appendiceal portion with focal ulceration. The patient was treated with intravenous steroids, which seemingly worsened his condition. Culture of the resected bowel subsequently grew Actinomyces israelii, at which time the patient was placed on intravenous clindamycin, given his anaphylactic allergy to penicillin. Patient noted marked improvement of his symptoms. Inflammatory markers returned to normal. He completed therapy with a 12 month course of oral doxycycline, and continues to remain asymptomatic without further complication. Repeat colonoscopy with multiple biopsies revealed no evidence of crypt architectural distortion, granuloma or dysplasia to indicate IBD. Discussion: Abdominal AMC is an exceedingly rare cause of abdominal pain in males, with only a few known case reports. However, given its propensity to form abscess and fistulize, it should be considered in the differential for all patients presenting in this manner, particularly if imaging localizes abnormalities to the distal ileum and appendiceal area. Early recognition of this process may prevent extensive surgical procedures and expensive, ineffective therapies.

Actinomycosis: report of a case with a persistent extraoral sinus tract

Cervicofacial actinomycosis is a chronic suppurative and granulomatous infection that may reside for years and recur with sudden onset. It is the second most common type of actinomycosis and could be caused by trauma or infection. We report a draining actinomycotic sinus tract with extraordinary thickness that occurred owing to a long-standing chronic periapical infection of an extracted upper left second premolar 3 years before.

Cervicofacial Actinomycosis and Tuberculosis Coinfection in a Patient Presenting With a Neck Mass

Cervicofacial Actinomycosis and Tuberculosis Coinfection in a Patient Presenting With a Neck Mass

Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report

BackgroundApart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon.Case PresentationWe report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible.ConclusionsClinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

Actinomicosis cervicofacial tras cirugía ortognática. A propósito de un caso

Objectives Presentation of a case of cervicofacial actinomycosis after orthognathic surgery. Material and methods A 32-year-old male underwent bimaxillary orthognathic surgery at another clinic. Several weeks after surgery, the patient developed a right lateral mass in the neck with intermittent signs of local inflammation. Cervical imaging suggested a solid or vascular tumor. The cytology revealed lymphocytosis. Results Two years after the index intervention, surgery performed through a Risdontype cervical incision revealed a granuloma in the lower right submaxillary cell with a fistula to the mandibular angle. The pathology report was consistent with chronic abscess with actinomyces colonization. Conclusions Early diagnosis of cervicofacial actinomycosis is difficult and only 10% of cases are detected at onset. Although uncommon, cervicofacial actinomycosis should be considered in patients with orthognathic surgery who develop a cervical mass in the weeks after surgery.

Bisphosphonate-related osteonecrosis of jaws and the relationship with actinomyces organisms

<h3>Background</h3> Actinomyces species are part of the normal oral flora. They may also be found in association with non-vital bony sequestra in suppurative osteomyelitis, osteoradionecrosis and bisphosphonate-related osteonecrosis of jaws (BRONJ). <h3>Methods</h3> Sixty-two cases of histologically diagnosed chronic suppurative osteomyelitis affecting the jawbones were retrieved from the archives at the ICPMR, Westmead Hospital. The haematoxylin and eosin-stained slides and the available clinical notes were reviewed. <h3>Results</h3> In 23 cases, a history of bisphosphonate use was established. Most cases presented in elderly females and the mandible was the most commonly affected site. Bacterial colonies with the morphological appearance of Actinomyces species were identified in 12 cases diagnosed as BRONJ (12 of 23 cases) while only four cases of non-specific suppurative osteomyelitis demonstrated these organisms (4 of 34 cases). The remaining five cases were diagnosed as osteoradionecrosis. <h3>Discussion</h3> Cervico-facial actinomycosis is a chronic bacterial infection of the soft tissue and jaws caused by the saprophytic Gram-positive, anaerobic bacteria Actinomyces species. In this study, Actinomyces species were frequently associated with BRONJ. As in cervico-facial actinomycosis, long-term use of an appropriate antibiotic, such as penicillin, may play a role in improving the outcome for these patients.

ステロイド内服患者に生じた頬部放線菌症の１例

76歳，女性。関節リウマチに対して，プレドニゾロンを数年間内服していた。左内眼角部に角化性結節が出現したため，皮膚科を受診した。最初，日光角化症が疑われたが，6週後に同様の皮疹が腫脹を伴って左頬部に出現した。細菌感染症を疑いセフジニルを投与したが改善はみられなかった。また，膿の一般細菌培養を行ったが，起因菌と考えられる細菌は検出されなかった。左頬部より皮膚生検を行ったところ，硫黄顆粒（sulfur granule）が認められ放線菌症と診断した。セファゾリンの投与と頬部のデブリードマンを行った。さらに左上顎臼歯に根尖性歯周炎がみつかり歯根除去を行ったところ，症状は徐々に改善した。放線菌症では細菌培養で菌を検出しえない場合もあり，病理組織学的に硫黄顆粒を認めることが診断の決め手になることが少なくない。顔面が好発部位なので，免疫が低下している場合など顔面に感染症を考えさせる皮疹がある場合，硫黄顆粒の有無を病理組織学的に検討することを検討するべきと考えた。

A Case of Pancreas Actinomycosis Mimicking Lower Bile Duct Cancer

症例は60歳の男性で，黄疸と腹痛を主訴に来院した．腹部造影CTで胆管と膵管の著明な拡張と膵内胆管の造影効果を伴う壁肥厚を認めた．膵頭部に線上石灰化以外に病変を指摘できず，下部胆管癌の膵内浸潤を疑った．ERCPで乳頭の発赤と胆管十二指腸瘻を認めたが，瘻孔と乳頭部からの生検で悪性所見は認めなかった．MRCPでは胆管と膵管の著明な拡張と総胆管結石を認めた．腫瘍マーカーの上昇はなかったが，FDG-PETでも膵頭部に一致して強い集積を認めたため下部胆管もしくは膵頭部の悪性疾患を否定できず，幽門輪温存膵頭十二指腸切除術を施行した．病理組織学的検索で膵頭部の放線菌感染による膵膿瘍と診断された．膵における放線菌感染症は極めてまれで，本症例の原因の一つとして総胆管結石による胆管十二指腸瘻が考えられた．

Tubo-ovarian Actinomycosis Complicated with Hepatic Abscess

Actinomycosis is a chronic, suppurative, granulomatous diseases characterized by extensive necrosis and abscess formation. Both hepatic and pelvic actinomycosis are rare diseases. Tubo-ovarian actinomycosis complicated with hepatic abscess is rarely reported. We present a 47 year old woman with a history of an intrauterine device (IUD) implantation for about 18 years, who presented with epigastric pain for one month. A computed tomography (CT) scan of abdomen revealed a mass (13×10×9.6 cm) over the left lobe of the liver and a right-sided tubo-ovarian lesion (6.6×5.9 cm). Exploratory laparotomy confirmed liver and tubo-ovarian abscesses. Pathology of the liver and the tubo-ovarian lesions both revealed actinomycosis infection. The patient received a 4-week intravenous ampicillin treatment, followed by oral amoxicillin for 6 months. No recurrence was noted in the follow-up. Actinomycosis should be considered in concomitant liver and ovary abscesses. Detailed history taking, such as IUD implantation, along with radiological examinations and pathological findings are important for diagnosing actinomycosis infection.

A case report of cervicofacial actinomycosis

Actinomycosis is a rare chronic granulomatous disease. Here we reported a 23-year-old male presented with a neck mass in the antero-inferior part for 35 days, with increasing in size and appearing some new masses in various sizes on left side of neck. The masses improved to some extent, with an empirical therapy but relapsed after discontinuation of treatment. After further investigations in second admission, long-term treatment with penicillin was started with a diagnosis of cervicofacial actinomycosis. Bronchial cleft actinomycosis was proved in this patient, which is one of rare cases of actinomyces involvement.

Aktinomykose im Bereich von Pharynx und Larynx

Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.

Streptomyces bacteremia in a patient with actinomycotic mycetoma

A 29-year-old woman presented with multiple painful swelling with discharging sinuses over the scalp. Histopathological examination of the biopsy tissue was suggestive of actinomycotic mycetoma. Streptomyces spp. was isolated from blood culture. The patient was successfully treated with trimethoprim-sulfamethoxazole and crystalline penicillin. This case is reported because of the rare occurrence of bacteremia by Streptomyces spp. secondary to subcutaneous actinomycotic mycetoma. Moreover, an interesting association between successive two pregnancies and occurrence of mycetoma of the scalp was observed in this case.

Cervicofacial actinomycosis possibly caused by a deciduous molar

Cervicofacial actinomycosis possibly caused by a deciduous molar

A case of perithyroidal actinomycosis in a child with pyriform sinus fistula

Although actinomycosis may occur anywhere in the body, the most common site of this infection is the head and neck region. Actinomyces, the usual cause of actinomycosis, is a commensal bacterium with low pathogenicity that is a normal resident in the oral cavity, thus odontogenic injury is a common antecedent event. Therefore, cervicofacial actinomycosis commonly occurs in the mandibular area, submandibular gland, and tongue in order of decreasing frequency. The authors encountered a case of a child with a history of slowly progressing swelling in the left side of the lower neck and no history of oral or odontogenic trauma. A pyriform sinus fistula found in this patient could be the unusual root of the cervicofacial actinomycosis occurring in the perithyroidal region, via a direct connection between the site of infection and the upper aerodigestive tract.

CT findings and rolated literature review of thoracic actinomycosis

Objective To characterize computed tomographic(CT) findings of thoracic actinomycosis. Meth-ods Chest CT scans obtained in 4 patients with histopathologically proved thoracic actinomycosis in the Guangdong Provincial People's Hospital from January 1995 to March 2008 were retrospectively analyzed and the related literatures were reviewed. Results Four cases was confirmed by CT-guided fine needle aspiration(2 cases) and biopsy with bronchoscope (2 cases). According to clinical data and imaging features, one was diagnosed as bronchial actinomycosis, three were diagnosed as pulmonary actinomycosis. The CT features of those three cases demonstrated the existence of common characteristics: soft tissue density mass, multiple lesions (three cases); visible bronchiectasis (two cases); contrast-enhanced CT image shows segmental consolidation containing central areas; cases), mediastinal and hilar lymphadenectasis (3 cases). Conclusion The typical CT feature of parenchymal aetinomycosis is chronic segmental air-space consolidation containing necrotic low-attenuation areas with frequent cavity formation, adjacent pleural thickening, mediastinal and hilar lymphadenectasis. Thoracic actinomycosis is a kind of relative infrequent disease and easily misdiagnosed. Key words: Thoracic actinomycosis; CT; Endobronchial actinomycosis

A RARE CASE REPORT OF ENDOBRONCHIAL ACTINOMYCOSIS WITH SEVERE HEMOPTYSIS

A RARE CASE REPORT OF ENDOBRONCHIAL ACTINOMYCOSIS WITH SEVERE HEMOPTYSIS

A case of Actinomycotic mycetoma involving the right foot

A 45-year-old male presented with history of multiple swellings over the foot with sinuses discharging seropurulent pus. Actinomadura madurae was demonstrated and identified by microbiological culture from the pus obtained directly of the lesion. This case is reported to emphasize the importance of laboratory diagnosis in the management and assessment of the prognosis of such cases.

Aktinomykose der Niere: Ein Fallbericht

Actinomycosis is a rare infection mainly of the head and neck region (cervicofacial actinomycosis). The cause of this infection is bacterial invasion of the host's mucosal barrier with consecutive infiltration of the surrounding tissues. The treatment of choice after diagnosis is a prolonged course of high-dose antibiotics. The presence of abdominal actinomycosis is at a maximum of 25%, whereas renal involvement appears only sporadically. Aggravating causes for early diagnosis are the appearance of abscesses, fistulae and a debilitating illness resembling carcinoma and leading to surgery as the treatment of choice. Renal actinomycosis is a diagnostic challenge because it is included in the differential diagnosis of renal masses with coexisting B-symptoms. The suspicion requires surgical treatment--nephrectomy. We report on a patient who was transferred to our department for nephrectomy because of radiologically diagnosed renal and perirenal abscesses. The histological result showed renal actinomycosis.

Huge Pelvic Mass, Cutaneous and Vaginal Fistulas, and Bilateral Hydronephrosis: A Rare Presentation of Actinomycosis with a Good Response to Conservative Treatment and with Long-Term Sequelae of Renal

Objective: Actinomycosis with an extended pelvic abscess is an uncommon condition, which usually occurs coincident with the presence of an intrauterine contraceptive device (IUD) in the uterine cavity. The clinical picture of pelvic actinomycosis may vary between individuals, is often accompanied by complications, and is frequently misdiagnosed. Here, we report a case of pelvic actinomycosis, presenting as a huge pelvic mass and complicated by a vaginal fistula, a cutaneous fistula, and bilateral hydronephrosis, and we discuss the diagnosis and management of this patient. Case Report: A 35-year-old woman was referred to our hospital with a huge pelvic complex mass and progressively worsening low abdominal pain. The tumor workup, which included a computed tomography (CT) scan, revealed an extended pelvic abscess and bilateral hydronephrosis. Both cutaneous and vaginal fistulas were also noted. Endometrial curettage and biopsies of the skin and vaginal lesions confirmed the diagnosis of actinomycosis. The patient underwent conservative treatment and recovered well, although the skin lesion only healed after 12 weeks of oral antibiotic treatment. At the 1-year follow-up, a CT scan showed sequelae including a mildly atrophic left kidney and left hydronephrosis. Conclusion: In patients presenting with a pelvic mass and an IUD in the uterine cavity, the diagnosis of actinomycosis should be seriously considered. A detailed workup, including a CT scan, endometrial curettage and biopsies where possible, should be performed before surgery. Once diagnosis has been confirmed, conservative medical treatment should be attempted before considering laparotomy, to reduce the risk of complications. Despite successful treatment with antibiotics, long-term sequelae such as hydronephrosis and renal atrophy are possible in cases of extended pelvic actinomycosis.