Diagnosis Of Actinomycosis Research Articles

Role of MRI in the diagnosis of Actinomycosis: A Case Report

Actinomycosis is caused by non-spore-forming, anaerobic, gram-positive bacteria called actinomyces. Its wide range of manifestations and non-specific symptoms cause complications by delaying diagnosis. We here present a case of a 34-year-old female with a history of recurrent discharging sinus and skin rashes in the posterior chest wall for 1 year and 6 months. Initially, it was suspected of malignancy with secondary infection. The patient was advised for MRI which shows suspicion of actinomyces. Later on, it was confirmed with a biopsy of the posterior chest wall. Here we present a case to describe the role of MRI in the diagnosis of actinomycosis.

Actinomycosis Simulating Malignancy on CT: A Case of A Long-Forgotten IUD

Actinomyces Israelii is known to be commensal, particularly in the gums and tonsils, sometimes in the vagina. The diagnosis of actinomycosis is challenging owing to nonspecific clinical findings. First instance imaging often resembles inflammatory and infective pathologies like Crohn’s or intestinal tuberculosis, and in this case, abdominal malignancies [1]. Actinomycosis infectionsare complicated by their tendency to extend into surrounding structures and develop fistulae [2]. Our case report specifically looks at a fit-and-well female patient who had been referred under a suspected gastrointestinal cancer pathway after a recent change in bowel habit for CT imaging which was subsequently thought to be disseminative malignant growths. Our 56-year-old lady had an indurating mass in her abdomen draining pus which prompted her GP to discuss this case with the surgeons. On further MRI imaging and lab cultures, it was revealed that the sinister mass is found to be an Actinomyces Israelii colonised long-forgotten IUD placed 12 years ago. The unfortunate patient suffered widespread abdominal involvement which required extensive surgery involving major bowel resection, salpingo-oopherectomy, bilateral ureteric stents for hydronephrosis and a partial cystectomy.

Clinical features and treatment outcomes of pulmonary actinomycosis.

Pulmonary actinomycosis is a rare and chronic infectious disease that mimics malignancy and is frequently misdiagnosed. There are few reports that address the clinical characteristics of pulmonary actinomycosis. The objective of this research is to evaluate the clinical features, radiological findings, diagnostic approaches and treatment outcomes of pulmonary actinomycosis. Thirty-seven patients with pulmonary actinomycosis histopathologically diagnosed from 2009 to 2021 were analyzed retrospectively. The mean age at presentation was 53.7 (±13.3) years. Frequent symptoms were cough and hemoptysis. The median diagnosis time from the first symptoms was 60 days (interquartile range 18-195). Pulmonary comorbidity was found in 59.5% of cases. The most common thorax computed tomography finding was mass or nodule. The low-attenuation center within the mass or consolidation was observed in 40% of the lesions. The median maximal standardized uptake value of lesions on positron emission tomography (PET) was 6.5 (interquartile range 2.7-10.3). In the majority of cases (97.3%), the diagnosis of pulmonary actinomycosis was not suspected at admission, and 56.8% of patients were misdiagnosed with lung cancer. The mean duration of antibiotic therapy was 9.4 days (range 3-22) with intravenous antibiotics and 64.7 days (range 5-270) with oral antibiotics. Four patients died due to concomitant comorbidities. Eight cases were lost to follow-up. All other cases were fully cured. Pulmonary actinomycosis mimics other diseases, often lung cancer. Clinicians should consider the diagnosis of actinomycosis when they detect a mass or consolidation, especially with a low-attenuation center. PET/CT appears not to be useful for differential diagnosis. A shorter course of antibiotic therapy than traditionally recommended appears to be sufficient.

Cervicofacial Actinomycosis: A Case Report of a Mandibular Localization

Actinomycosis is a rare disease. The cervicofacial region is the most frequent localization. A chronic pus discharge, sometimes tumor-like, suggests the diagnosis, which is often confirmed by anatomopathological study. The treatment is surgical debridement and antibiotic therapy, frequently long-term. We report in the present work a case of a rare type of mandibular tumor about a 10-year-old girl who presented, to our maxillofacial surgery department of the university hospital center of Rabat, with a left fistulized mandibular swelling and normal mouth opening range. In her case, the diagnosis of actinomycosis was made by histology. The clinical outcome was good following an enucleation and a strong curettage and an antibiotic therapy. The lesions of this pathology, if untreated, may evolve to osteitis and sequestration which makes early diagnosis crucial.

Actinomycosis in head-and-neck region – A review

Actinomycosis is an uncommon chronic disease caused by filamentous Actinomyces, a Gram-positive anaerobic bacterium that usually colonizes in the human oral cavity, digestive tract, and genital area. Actinomycosis is rarely seen chronic infectious disease in the head-and-neck region. The clinical presentations are often nonspecific and mimic several diseases of the head-and-neck area such as malignancy and tuberculosis. Moreover, investigations such as imaging, fine-needle aspiration, and biopsy are often nonspecific. The diagnosis of actinomycosis is still difficult for the diagnosis at present time. Bacterial culture and histopathological study are the cornerstones of the diagnosis but a particular situation is needed to get the exact diagnosis. The prolonged bacterial cultures in anaerobic conditions are required to confirm the bacterium and classical microscopic findings like necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. The surgical excision of the lesion/mass along with appropriate antibiotic therapy is important treatment options. Clinicians must be aware of the typical clinical presentations of actinomycosis in the head-and-neck region as it may mimic the malignant process in the head-and-neck area. Actinomycosis patients need prolonged high doses of penicillin G or amoxicillin and the period of antimicrobial treatment can be shortened to a minimum of 3 months in patients in whom optimum surgical resection of the infected tissues has been useful.

More on search for causes of sensitization to tuberculin PPD for mammals in cattle

Despite the large number of papers dealing with the description of proposed methods for bovine tuberculosis diagnosis and mechanisms of non-specific reaction development in diseased and healthy animals, various aspects require further study. Many specialists are still of the view, formulated when studying causes of pseudoallergic reactions, that the agents of actinomycosis, trematode infections etc. can cause sensitization of the animal body to tuberculin PPD for mammals. The possibility of sensitization of cattle body to Аctinomyces bovis tuberculin was studied in 240 animals identified as actinomycosis diseased among 3,473 tested animals. Only 11 (4.6%) of the total number of diseased animals were reactors to tuberculin PPD for mammals. During bacteriological tests of material from animals euthanized for diagnostic purposes (tuberculin reactors and nonreactors with a confirmed postmortem diagnosis of actinomycosis), acid-tolerant nontuberculous mycobacterium (NTM) cultures were isolated. The results of the experiment conducted in 628 cows of a dairy holding confirmed that Actinomyces bovis lacks tuberculin-associated allergenicity: actinomycosis was detected only in one of 96 (15.2%) tuberculin reactors. The conducted clinical tests with high significance level (Р < 0.005) showed that there is no association between allergic reaction to tuberculin PPD for mammals and actinomycosis infection. The obtained results are indicative of imperfections in differential diagnosis, and further studies in this field should significantly contribute to gaining a better insight into non-specific sensitization of cattle body to tuberculin.

Actinomycotic Osteomyelitis of Maxilla in a Diabetic Patient- “A Rare Case Report & Review of Literature”

Actinomycosis may be a relatively rare infection caused by saprophytic bacteria of the mouth and alimentary canal which will become pathogenic. The chronic hyperglycemia in Diabetes Mellitus induces events that promote structural changes in various tissues and are related to problems in wound healing. This infection remains largely unknown to most clinicians due to its different presentations, and palatal involvement is extremely rare. This report describes the case of a 50-year-old man who was diagnosed with actinomycosis involving mucosal surface. The main clinical, histopathologic, and therapeutic characteristics and diagnosis of actinomycosis are reviewed. Till date, 4 cases of actinomycosis involving the palatal surface are reported.

When a rare simultaneous infection simulates a local extension of a rectal cancer: a case report

BackgroundActinomycosis is a rare chronic infection caused by Actinomyces. The abdominopelvic localization of this pathology makes preoperative diagnosis extremely exceptional. The following report is the case of a patient treated for adenocarcinoma of the middle rectum associated with mesorectal actinomycosis. The diagnosis of actinomycosis was made postoperatively.Case presentationA 69-year-old Caucasian male patient was admitted for rectal bleeding. Clinical and paraclinical assessment revealed a middle rectum adenocarcinoma with local extension in the mesorectum. The patient underwent an anterior resection of the rectum by laparotomy after neoadjuvant chemoradiotherapy. Postoperative follow-up was simple. Pathological study of the specimen noted complete sterilization of the rectal adenocarcinoma and the presence of large foci of suppurative necrosis containing actinomycotic grains in the mesorectum.ConclusionAbdominopelvic actinomycosis is a rare pathology and has therefore rarely been dealt with. This issue can lead to unnecessary and mutilating surgery. We report an exceptional coincidence of rectal adenocarcinoma and mesorectal actinomycosis mistaken for mesorectal extension of the cancer.

Actinomycosis Hard Palate: A Rare Presentation

ABSTRACT Actinomycosis is a gradually evolving infection caused by bacteria of genus Actinomyces. Cervicofacial involvement is the most common presentation and palatal involvement is very rare. Presented below is the case report of a 79-year-old diabetic and hypertensive female who presented with nonhealing ulcer over the hard palate for 10 months, which enlarged and formed a large oroantral fistula within 4 months. Following the diagnosis of actinomycosis by histology, complete debridement and removal of necrotic tissue was done. She was treated with intravenous crystalline penicillin 6th hourly for 4 weeks and was discharged on oral amoxicillin for 12 months with regular follow-up. Only four cases of actinomycosis hard palate have been reported in English literature so far. How to cite this article: Dahiya V, George BR, Ramachandran K, et al. Actinomycosis Hard Palate: A Rare Presentation. Int J Otorhinolaryngol Clin 2019;11(3):73–75.

Hepatobiliary Actinomycosis, a Rare Presentation of a Rare Disease!

Actinomycosis is a chronic granulomatous infection caused by opportunistic bacteria, Actinomyces. These bacteria lack virulence and cause disease when there is a breach in the integrity of the mucosa. Diagnosis of Actinomycosis is challenging and less than 10% of abdominopelvic cases are diagnosed preoperatively. The treatment involves prolonged course of antibiotics with or without removal of tissue. In this case report we will present a case of hepatobiliary actinomycosis which was managed by a combination of both surgical and medical treatment.

ACTINOMYCOSIS MIMICKING LUNG CANCER: A CASE REPORT

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary actinomycosis is a rare disease that can be challenging to diagnose and is associated with multiple risk factors such as poor oral hygiene, alcoholism, and chronic underlying lung diseases. Actinomycosis can often be misdiagnosed as lung abscess, tuberculosis, or malignancy with radiologic findings that might be misleading. Here we present a case with initial chest CT finding concerning neoplasm but diagnosed as pulmonary actinomycosis on further evaluation. CASE PRESENTATION: 55-year-old male with past medical history of HTN presented with right sided upper back pain and 6 pounds of unintentional weight for 4 weeks. He did not report any symptoms of cough, hemoptysis, shortness of breath, or chest pain. He was a heavy smoker with 45 pack years of smoking and a history of chronic alcoholism with 30 ml of 3-4 vodka shots twice a week for the last 30 years. Patient’s laboratory studies were pertinent for WBC count of 19.6 X 10 3. CT of the chest showed 4.6 x 3.4 cm thick-walled cavitary mass in the right lower lobe concerning for neoplasm with the extension of mass to the right paravertebral region and diffuse right pleural metastases, pathologic lymphadenopathy, and trace right pleural effusion. He underwent BAL with bronchial brushing which showed significant endobronchial inflammation. Microbiological examination of samples obtained from BAL showed Gram-positive filamentous bacteria. Treatment was given with IV clindamycin and he was discharged home on PO Clindamycin for 4 weeks with a repeat chest X-ray in 2 weeks. He was readmitted after 2 weeks with worsening shortness of breath, was found to be hypoxic with SpO2 of 65% on RA and RR of 40/min, he was intubated. Repeat CT chest showed diffuse right pleural thickening and ground-glass opacity of the right upper and middle lung. He was started on broad-spectrum antibiotics with IV vancomycin, IV Zosyn and IV Penicillin but he remained critically ill and a decision was made by the family to withdraw care. The patient was terminally extubated. DISCUSSION: Actinomycosis is a chronic, granulomatous disease mostly caused by A. israelii which is a normal commensal of human oropharynx, GI tract, and female genitalia. Pulmonary actinomycosis accounts for 15% of total disease burden and is usually caused by aspiration of the oropharyngeal or gastrointestinal secretion especially in patients with chronic alcoholism and poor dentition, facial or dental trauma1. CONCLUSIONS: Diagnosis of actinomycosis can be challenging given that presentation and radiologic findings might resemble various other conditions. Pulmonary actinomycosis if diagnosed and treated early has an excellent prognosis, the clinician should have high levels of suspicion in patients with risk factors such as chronic alcoholism, poor dental hygiene, prompting further evaluation with radiology and confirmation of diagnosis with histology and microbiology. Reference #1: 1. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J. 2003;21(3):545-551. doi:10.1183/09031936.03.00089103 DISCLOSURES: No relevant relationships by Sotirios Doukas, source=Web Response No relevant relationships by Leena Kavali, source=Web Response No relevant relationships by Shashank Nuguru, source=Web Response

Large-extension osteosarcoma with involvement of multiple maxillofacial structures: a rare case report

Background: Osteosarcoma is a malignant neoplasm that occurs most often in long bones, with the head and neck region being rarely affected, accounting for less than 1% of all cancers in this region. Objective: To report a rare case of a large-extension osteosarcoma with emphasis on its clinical and diagnostic aspects. Case presentation: A 43-year-old woman presenting an intraoral exophytic lesion with involvement of other maxillofacial structures, such as nostril, zygoma and orbit. Despite the initial clinical diagnosis of actinomycosis, an incisional biopsy confirmed the histopathological diagnosis of osteosarcoma, showing a wide morphological variety. Conclusion: This case highlights the importance of clinical and histopathological findings for the correct diagnosis of osteosarcoma. Moreover, it shows that, although surgical resection is the primary treatment for this neoplasia, depending on the extent of the tumor and its proximity to vital anatomical structures, the most appropriate conduct is not always feasible.

ACTINOMYCOSIS IN THE MAXILLA OF A YOUNG ASYMPTOMATIC PATIENT: A CASE REPORT

A 21-year-old white man was referred for the analysis of panoramic radiography and cone beam computed tomography, where the presence of a hypodense lesion was observed on the left side of the maxilla, which extended from the 21 to 25 tooth region. On intraoral examination, a depression was observed in the hard palate mucosa as well as a fistula in the alveolar mucosa close to tooth 21. An incisional biopsy was performed for diagnostic purposes. The histopathologic examination revealed the presence of a microorganism colony with filamentous pattern of radiated rosette, whose central portions were basophilic and the peripheral areas were eosinophils, surrounded by polymorphonuclear inflammatory cells. Based on the morphologic features, the diagnosis of actinomycosis was established. The treatment was based on antibiotic therapy. The patient has been under follow-up for 10 months, and no lesion exacerbation was observed.

ACTINOMYCES OF THE JAW: CASE REPORT

Actinomycosis is a rare chronic granulomatous infection that requires a correlation of histopathologic and microbiologic findings for diagnosis. The case refers to a 52-year-old patient with a lesion in the anterior mandibular region after oral surgery. Clinical examination showed pain symptoms unresponsive to pain killers, prostration and numbness in the lip and chin regions, and a chest x-ray that revealed multiple nodules in the lung. The lesion presented erythema, edema, and granulomatous aspect that extended from tooth 32 to 45. The consistency was fibrous and without suppuration. Radiographic examination revealed extensive radiolucent area with poorly defined boundaries and destruction of the buccal and lingual cortical. The histologic report of incisional biopsy revealed granulomatous tissue after cell culture. The diagnosis of actinomycosis was defined as a disease that has an excellent prognosis and a low mortality rate if diagnosed early.

ORAL AND MAXILLOFACIAL OSTEOSARCOMA: CASE REPORT

A 43-year-old female patient attended the oral maxillofacial and traumatology service presenting volume increase in the right hemiface with painful symptomatology. At the intraoral examination, an exophytic lesion involving the alveolar ridge and palate region was observed, extending to the right nostril. The lesion showed a partially ulcerated surface, with purulent secretion, firm consistency, and normal mucosal color. Computed tomography revealed a mixed appearance of hyperdensity and ill-defined hypodensity in the maxillary region with extension to the zygoma and the right orbit. Because of poor oral hygiene and a history of regression with antibiotic therapy, a clinical diagnosis of actinomycosis was issued, and incisional biopsy of the lesion was subsequently performed. In the microscopic analysis, proliferation of pleomorphic and atypical malignant mesenchymal cells was associated with deposition of osteoid matrix, thus confirming the histopathologic diagnosis of osteosarcoma. The patient was referred to the State Reference Center for appropriate treatment.

Disseminated actinomycosis in an immunocompetent patient: a case report

This case report describes a 58-year-old patient who visited the hospital after an 8-month disease period characterized by multiple skin and soft tissue abscesses associated with an approximately 20-kg weight loss, severe hypoalbuminemia, moderate anemia and polyserositis. Several imaging tests revealed abscesses on the left thigh muscle. Additionally, abdomen, pelvis and thorax ultrasounds showed bilateral interstitial nephropathy, ascites and bilateral pleural effusion. The histopathological examination confirmed the diagnosis of actinomycosis. Given the systemic manifestations and diffuse distribution of the abscesses, the case was clinically consistent with disseminated actinomycosis. Therefore, the patient received IV antibiotic treatment with penicillin G sodium for 4 weeks and then with amoxicillin p.o. The patient evolved favorably and exhibited abscess remission.

Actinomyces and Alimentary Tract Diseases: A Review of Its Biological Functions and Pathology.

Actinomyces are nonmotile, filamentous, Gram-positive bacteria that cause actinomycosis in immunodeficiency patients. Although the prognosis of actinomycosis is good, the diagnosis of actinomycosis is quite difficult. Recent studies on actinomycosis have shown that Actinomyces play an important role in various biological and clinical processes, such as the formation of dental plaque and the degradation of organics in the gastrointestinal tract. Here, the distribution of Actinomyces in the digestive tract, and different biological effects of actinomycosis, and its clinical association with inflammatory diseases are discussed. Furthermore, an overview of the most commonly used treatment methods and drugs used to treat Actinomyces infected alimentary canal diseases is presented.

Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations.

Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60–180), whereas the median follow-up time was 12 months (interquartile range 5.25–18). Two patients died.This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.

Gastric inflammatory pseudotumour secondary to Actinomyces hordeovulneris infection in a cat.

BackgroundThe authors report the first case of feline gastric actinomycosis associated with infection by Actinomyces hordeovulneris.Case presentationA 4-year-old, neutered male, semi-feral European cat, with a 1 year history of chronic vomiting, was referred to the clinic. Abdominal ultrasound examination identified a hypoechoic focal transmural thickening with loss of normal wall layering and hyperechoic speckles at the gastric body. Initial gastroscopic examination showed a tumour-like gastric mass with an ulcerated depression at the level of the greater curvature. Histologic examination of endoscopic biopsy specimens was consistent with a severe lymphoplasmacytic gastritis. After 2 months, due to persistence of abdominal discomfort, surgical exploration and intraoperative sampling of gross abnormalities was recommended. Full thickness gastric wall biopsies, and fine needle aspiration of the gastric thickening and gastric lymph node, were performed. Histopathological examination identified a transmural pyogranulomatous gastritis. Aspirate samples of the gastric wall cultured positive, with colony morphology, biochemical testing and PCR of the 16 s rRNA gene compatible with Actinomyces hordeovulneris. After 4 months of treatment with cefovecin (8 mg/kg subcutaneously every 14 days), the vomiting completely resolved, as well as the ultrasonographic gastric alteration.ConclusionThis case report of feline gastric actinomycosis, caused by Actinomyces hordeovulneris, suggests that gastric bacterial infection should be considered in cases of focal gastric wall thickening associated with chronic vomiting in the cat, which may otherwise closely resemble neoplastic disease. Once a diagnosis of actinomycosis was obtained, a correct treatment with antibiotic therapy can resolve it.

Pelvic Actinomycosis Simulating a Malignant Neoplasm: Case Report and Review of the Literature

Pelvic actinomycosis is rare. It has an insidious onset, and the clinical features may mimic tuboovarian abscess, pelvic malignancies or retroperitoneal tumors. We report the case of a 35-year-old woman with right adnexal mass, right hydroureter and hydronephrosis. She was explored elsewhere for ovarian tumor, declared inoperable and referred to our institute for further management. Ultrasound guided true-cut biopsy showed spindle cell tumor; hence, decision for re-exploration was taken. The final diagnosis of actinomycosis was made on histopathological examination of the specimen. The case is reported because of its rarity and the diagnostic dilemma it presented.