Diagnosis Of Pulmonary Actinomycosis Research Articles

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.

Een bacterie vermomd als schimmel: pulmonale actinomycose bij een geriatrische patiënte

A bacteria masked as a fungus: a case of pulmonary actinomycosis in a geriatric patient Pulmonary actinomycosis is a relatively rare diagnosis which probably results from the aspiration of oropharyngeal or gastrointestinal secretions. Individuals with aspiration, alcoholism, poor oral hygiene, chronic obstructive lung disease and a decreased immune response are at risk. The most common symptoms are nonspecific and often present late. The imaging of pulmonary actinomycosis is not specific. Therefore, the disease is frequently confused with a malignancy or tuberculosis. The gold standard for the diagnosis is a histological examination and bacterial culture of a lung biopsy. Its treatment requires high doses of penicillin during at least 3 months. In this article, the case of an 82-year-old patient with malaise but without any respiratory complaints is presented. Further examination revealed inflammatory blood signs, as well as infiltration of the right upper lobe on a CT scan of the thorax. To exclude an underlying malignancy, a bronchoscopy was performed. Gram staining of the bronchoalveolar washing showed gram-positive branching rods suspicious for Actinomyces species. Histological examination confirmed the diagnosis of pulmonary actinomycosis. By means of an antibiotic treatment with amoxicillin the patient recovered both clinically and biochemically.

Pulmonary Actinomycosis in South Australian Koalas (Phascolarctos cinereus).

Pneumonia has been reported in both free-ranging and captive koalas and a number of causative agents have been described. Between 2016 and 2019, 16 free-ranging and 1 captive koala (Phascolarctos cinereus) from the Mount Lofty Ranges of South Australia were identified with pyogranulomatous lobar pneumonia, which involved the left caudal lobe in 14/17 (82%) cases. Within lesions, numerous gram-positive or gram-variable, non-acid-fast filamentous bacteria were observed in association with Splendore-Hoeppli phenomenon. Culture yielded growth of anaerobic bacteria, which were unidentifiable by MALDI-TOF-MS (matrix-assisted laser desorption ionization-time of flight mass spectrometry) analysis in 5/5 cases. Sequencing of the bacterial 16S rRNA gene identified a novel Actinomyces species in 4 samples, confirming a diagnosis of pulmonary actinomycosis. Concurrent examination of resin lung casts from healthy koalas suggested greater laminar flow of air to the left caudal lung lobe in koalas. Actinomyces spp. have been reported as commensals of the oral microbiome in other species, and an association with similar pulmonary lesions in other species. Considering the predilection for involvement of the left caudal lung lobe, aspiration is suggested as the likely cause in some cases of pulmonary actinomycosis in koalas. Pulmonary actinomycosis has not been previously described in koalas and further work needs to be undertaken in order to classify this organism within the Actinomyces genus.

Insufficient initial treatment but good recovery after diagnosis of pulmonary actinomycosis

Actinomycosis is an infrequent invasive bacterial disease. Although multiple different clinical features of actinomycosis have been described, pulmonary actinomycosis (PA) is a rare but challenging diagnosis and complete cure to make. Here we report the case of a 41-year-old Asian woman who had a mass-like consolidation in the right middle lung field. The lung lesion was exacerbated after initial treatment. After diagnosis of PA, thoracoscopic resection combined with intravenous and oral penicillin made a good recovery.

Pulmonary lesions associated with sputum culture-positive actinomycetes: report of one case

Pulmonary actinomycosis (PA) is a rare subacute or chronic infectious disease. As simple culture of Actinomyces in BAL, as with sputum, may represent colonization, the diagnosis of PA relies on pathological examination. The preferred treatment is long-term, high-dose penicillin. A 6-12-month-course of antibacterial treatment is the rule in extended PA, although the optimal duration of treatment has not been investigated through randomized trial. In this article, we report a case presented with slowly-progressing pulmonary cavitary lesions. Actinomyces odontolyticus was detected in sputum specimen harvested by tracheoscopy. The clinical diagnosis was PA, which gradually improved with prolonged treatment of penicillin and ornidazole. This is followed by a discussion of diagnosis and treatment, especially in terms of treatment.

ACTINOMYCOSIS

SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Actinomycosis is a rarely encountered infection and technically difficult to culture, hence may pose a challenge for the clinician. Awareness regarding this uncommon infection, when dealing with susceptible patients, can lead to early diagnosis and optimal treatment. CASE PRESENTATION: 37 M with history of chronic alcohol abuse, presented complaining of hemoptysis, SOB, subjective fever and generalized myalgias for 2 weeks. PE revealed tachypnea, fever and left lung crackles. Labs showed acute hypoxic respiratory failure and lactate elevation. CT revealed 9 x 6 cm inflammatory-appearing cavitary lung mass in the left lower lobe most likely representing a lung abscess, along with large left sided loculated pleural effusion. Patient was intubated and empiric antibiotic therapy was started.2 left CT were placed for loculated pleural effusion. Sputum and pleural fluid AFB were negative. Pleural fluid was exudative and revealed Gram positive cocci and Gram positive rods, with identification of sulfur granules which was highly suggestive of Actinomyces. Intrapleural fibrinolytic agents were given with optimal drainage of empyema. Patient was extubated and improved clinically DISCUSSION: Diagnosis of Pulmonary Actinomycosis, solely based on clinical presentation is not possible. Imaging studies commonly show air-space consolidation and/or cavitary or mass-like lesions. Parenchymal disease can also extend to pleural cavity and chest wall. BAL for culture is inappropriate since it may only represent colonization. Acceptable specimen include lung biopsy or pleural fluid. Gold-standard for diagnosing Actinomycosis is growth of the bacteria in culture, but is technically difficult and occurs only in a minority of cases. If the suspicion is high, the clinician should indicate this to the microbiologist to ensure appropriate processing specimen measures. Identification of sulfur granules from pleural fluid is strongly supportive of Actinomycosis and may be enough to lead the clinician into the diagnosis and appropriate management. Carbapenems or combination of a beta-lactam with beta-lactamase inhibitor in the setting of lung abscess, is a proper empiric approach.Therapy should be targeted once Actinomycosis has been diagnosed. Intravenous therapy should be given for 2 to 6 weeks, followed by oral route.Length of the oral antibiotic depends on clinical and radiological response. Resolution of radiographic findings may take several months, with 6 months to 1 yr. of oral antibiotics being recommended. CONCLUSIONS: Actinomycosis should be suspected in patients with history of aspiration or at risk for it and individuals with chronic alcohol abuse. A high clinical index of suspicion could lead to the proper usage of diagnostic tools and facilitate the rare growth of the causative pathogen in culture. Proper diagnosis should guide to targeted treatment and follow up, along with optimal duration of antibiotics. Reference #1: Choi J, Koh WJ, Kim TS, et al. Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. Chest. 2005 Oct. 128(4):2211-7. Reference #2: De Montpreville VT, Nashashibi N, Dulmet EM. Actinomycosis and other bronchopulmonary infections with bacterial granules. Ann Diagn Pathol. 1999 Apr. 3(2):67-74. Reference #3: Kim TS, Han J, Koh WJ, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. AJR Am J Roentgenol. 2006 Jan. 186(1):225-31. DISCLOSURES: No relevant relationships by Jonathan Arnedo, source=Web Response No relevant relationships by Yesika Garcia, source=Web Response No relevant relationships by Seyedmohammad Pourshahid, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response

Pulmonary actinomycosis mimicking a lung metastasis from esophageal cancer; a case report

BackgroundActinomycosis is a rare bacterial infection caused by Actinomyces. The symptom of actinomycosis is nonspecific and radiological images present as a slow-progressive mass lesion similarly to malignancies. Thus, it is difficult to distinguish pulmonary actinomycosis from malignancies.Case presentationA 74-year-old male who had esophageal cancer and a pulmonary mass that was positive for 18F–fluorodeoxyglucose positron emission tomography/computed tomography was initially diagnosed with esophageal cancer with a lung metastasis because he was asymptomatic. However, aspiration of pleural effusion revealed that the pulmonary lesion was actinomycosis.ConclusionWe present a case of pulmonary actinomycosis mimicking a lung metastasis from esophageal cancer. Diagnosis of asymptomatic pulmonary actinomycosis is difficult, and needle aspiration could be useful for a definitive diagnosis of pulmonary actinomycosis.

Pathologically confirmed pulmonary Actinomycosis in 11 cases: clinical features and misdiagnosis analysis

Objective To analyze the pathologically confirmed pulmonary Actinomycosis in the 11 patients in focusing on clinical features and mis-diagnostic reasons so as to improve physicians' awareness of this rare disease and reduce the misdiagnosis. Methods We retrospectively reviewed the medical records of 11 cases with pathologically confirmed pulmonary Actinomycosis during January 2003-August 2015.The clinical data and main causes of misdiagnosis in these cases were collected and analyzed. Results The study included 11 patients with a mean age of(53.0±11.6.0)years.Among the 11 cases, 8(72.7%)patients had complications, 6(54.5%)were current or ex-smokers.Main clinical manifestations of 11 cases were cough(11/11, 100.0%), sputum(11/11, 100.0%), hemoptysis(7/11, 63.6%), chest pain(6/11, 54.5%)and fever(3/11, 27.3%). Ten patients presented with one lobe of lung lesions, including 4 patients in the lower lobe and 3 in the upper lobe of the left lung, 2 in the upper lobe and 1 in the lower lobe of the right lung.While, the remained one case presented with lesion locating in right main bronchus.Iconography often presented as pulmonary mass shadow, consolidation shadow, spicule sign, lobulation sign, hilar and/or mediastinal lymphadenopathy and pleural effusion.Vacuolar lesions were observed in some of the focuses.Flexible bronchoscopy was performed in 8(72.7%)patients.Among them, 7 patients showed mucosal swelling and congestion, luminal occlusion with purulence secretion, 2 cases with polypoid neoplasm.Initial misdiagnosis rate were 100%(11/11), among which 7 cases were misdiagnosed as lung cancer, 2 cases as fungus infection, and 1 case as pulmonary tuberculosis and 1 case as pneumonia, respectively.All patients were definitely diagnosed by biopsy finding an evidence of hyphae of Actinomycosis in lung tissue specimens.The definitive diagnosis was made by CT-guided percutaneous lung biopsy in 4 cases, by transbronchial lung biopsy(TBLB)in 5 cases and by thoracotomy or video-assisted thoracoscopic surgery(VATS)in 1 case respectively.Actinomycosis in most patients was cured with high-dose penicillin administration over a prolonged period. Conclusions The diagnosis of pulmonary Actinomycosis remains challenging via its non-specific clinical symptoms and iconography features, and the presence of comorbidity may further increase the difficulty and complexity of diagnosis, leading to delaying-or mistaking-diagnosis.Obtaining positively pathological specimens is diagnostic key.Transbronchial lung biopsy through a bronchoscope and CT-guided percutaneous needle biopsy are the priority methods. Key words: Actinomycosis; Diagnostic errors

Bronchoscopic View of a Tuberculosis Cavity With Actinomyces

Coexistence of pulmonary actinomycosis with tuberculosis has rarely been reported. The presence of Actinomyces in sputum and bronchoalveolar lavage is inadequate for diagnosis, as it may represent mere colonization. Traditionally, excisional biopsy is considered to be the gold standard for histologic diagnosis. There are multiple case reports in which the diagnosis of pulmonary actinomycosis was based on bronchial biopsy and Wang needle aspiration. We describe an incidental finding of a bronchial communication with passage of a flexible bronchoscope into the tuberculosis cavity. The images reveal a 5-cm cavity with a whitish, stone-like structure noticed to move back and forth with respiration. Colonies of Actinomyces were seen on transbronchial brushing cytology. Bronchoalveolar lavage cultures were negative. To our knowledge such a detailed pictorial description of a tuberculosis cavity with Actinomyces has not been reported in the past.

Lesion Mimicking Lung Tumor

A 75 year old woman was admitted for evaluation of right lung mass. She was not a smoker. She had been diagnosed as uterine prolapse and during preoperative assessment a lung mass was found incidentally on simple chest X-ray. On chest CT scan, 3.5×2 cm sized homogeneous mass was located in the anterior segment of right upper lobe and there were multiple calcified lymph nodes in both hilum and mediastinal area. We performed diagnostic bronchoscopy, but no definite endobronchial mass was found. Next we did CT guided percutaneous fine needle aspiration biopsy. On microscopy, sulfur granules consisting of multiple granular basophilic centers with hyaline projection of branching filaments were noted. From this finding we made a diagnosis of pulmonary actinomycosis. (Tuberc Respir Dis 2004; 57:1-4)

A case of pulmonary actinomycosis.

Actinomycosis is a chronic suppurative infection characterized by extensive necrosis, fibrosis and sinus formation without regard to normal tissue planes. The causative organism in human infection is Actinomyces israelii. Thoracic actinomycosis is diagnosed in the presence of poor oral hygiene, pulmonary infiltrate, empyema, sinus tract and osteomyelitis of ribs. However, in the absence of chest wall involvement, the diagnosis of pulmonary actinomycosis is difficult and its initial clinical manifestations may lead physicians to suspect tuberculosis or neoplasm. It could not be distinguished from tuberculosis or neoplasm radiologically. We report a case of pulmonary actinomycosis in a 64 year old woman with a review of the literature.

Endobronchial Actinomycosis Simulating Bronchogenic Carcinoma: Diagnosis by Bronchial Biopsy

Five cases of actinomycosis of the main bronchi or trachea which were suggestive clinically of bronchogenic carcinoma are described. In four patients the correct diagnosis was made by a bronchial biopsy or wash, or both. Three of them recovered following antibiotic treatment, and one died a few days after bronchoscopy. In one case the Actinomyces were found in the bronchial wash retrospectively following diagnosis of pulmonary actinomycosis in the lobectomy specimen. A concomitant endobronchial lipoma was found in one of the patients. The diagnosis of pulmonary actinomycosis by bronchial biopsy may save the patient major surgical intervention.

Pulmonary Actinomycosis Treated By Lung Resection

Two cases of pulmonary actinomycosis treated by upper lobectomy are presented. Both patients had uncomplicated postoperative courses and were well at the time of this writing. There have been 26 other cases of pulmonary resection for actinomycosis reported in the English literature. A correct preoperative diagnosis was made in only one instance. Penicillin administered in the postoperative period makes pulmonary resection for actinomycosis safe. The diagnosis of pulmonary actinomycosis should be considered prior to thoracotomy in the patient who has an undiagnosed chronic lung infiltrate without evidence of tuberculosis or carcinoma.