Pulmonary Actinomycosis Research Articles

Endobronchial actinomycosis with broncholithiasis presenting with hemoptysis—A case report

ABSTRACT Pulmonary actinomycosis is a rare chronic pulmonary infection caused by actinomyces. Pulmonary involvement is uncommon and often leads to a misdiagnosis of pulmonary tuberculosis or lung cancer. Endobronchial involvement is very rare, and broncholithiasis has occasionally been reported in association with pulmonary actinomycosis. Herein, we report a case of a 50-year-old male patient, who presented with a history of cough and hemoptysis diagnosed to be endobronchial actinomycosis with broncholithiasis by transbronchial biopsy.

Pulmonary sequestration associated with pulmonary actinomycosis: A case report and literature review.

Pulmonary sequestration (PS), a rare pulmonary disease, arises from congenital pulmonary vascular dysplasia. Meanwhile, pulmonary actinomycosis is a purulent infection of lung lesions triggered by the inhalation of actinomycetes, which is also uncommon. Even rarer is the occurrence of pulmonary actinomycete infection secondary to PS. Herein, we present a case report of such a rare occurrence. The 21-year-old female patient had been erroneously diagnosed with pneumonia and tuberculosis, presenting symptoms of cough, sputum, and hemoptysis; however, the implemented anti-infection and antituberculosis treatments proved to be ineffective. The diagnosis of the sequestration in the right lower lung was confirmed through an enhanced chest CT scan and a 3-dimensional reconstruction of the pulmonary vessels. During the surgical video-assisted thoracoscopic resection of the right lower lobe lesion, it was discovered that the isolated lung tissue's blood supply vessel originated from the thoracic aorta. Additionally, the pathological examination revealed that the lung tissue of the right lower lobe lesion was infected with pulmonary actinomycetes. Following thorough evaluation, the patient received a final diagnosis of pulmonary actinomycete infection that occurred secondary to right lower lung sequestration. Consequently, they underwent treatment consisting of high-dose penicillin administered for a period of 6 months post-operation. Over the course of the subsequent 23-month follow-up, no recurrence of the infection or abnormal CT scan findings were observed. Pulmonary sequestration bears clinical resemblance to pulmonary actinomycetes. In cases where recurrent episodes of pneumonia occur at the same location, and chest imaging indicates persistent lesions in the basal segment of the lower lobe near the spine, the possibility of PS should be considered. Prompt chest-enhanced CT and 3-dimensional reconstruction of pulmonary vessels are crucial for a definitive diagnosis. Imaging findings such as mass-like consolidation, cystic lesions, liquefactive necrosis, and pneumonia-like changes, coupled with typical air suspension signs and sulfur-like particles visible under tracheoscopy, suggest a potential pulmonary actinomycete infection. Timely biopsy is essential to confirm the diagnosis and prevent missed or incorrect diagnoses.

Clinical Features of Actinomycosis in Older Adults: A 10-Year Experience of a Single Institute in Beijing, China.

Actinomycosis is a rare infectious disease with non-specific clinical presentations often resulting in delayed diagnosis, especially in older adults. Diagnosing and treating actinomycetal infections in this population can be particularly challenging due to the lack of comprehensive case series studies focusing specifically on actinomycosis in older adults. The existing literature mainly consists of case reports, highlighting the need for more extensive research in this area. This study aimed to provide a profile of actinomycosis in older adults to guide future research efforts. Elderly patients aged 60 years and older who satisfied the inclusion criteria for actinomycosis at Peking Union Medical College Hospital from January 2014 to May 2024 underwent a retrospective analysis. The research centered on describing the clinical features and diagnostic techniques, distinguishing between different conditions, and treating clinically important instances of actinomycosis within this specific age bracket. This study involved 22 patients, with a balanced gender distribution of 11 males and 11 females, aged between 60 and 84 years, and a median age of 67 years. The disease predominantly affected the thoracic region (n=17), followed by the abdominal-pelvic (n=2) and orocervicofacial (n=2) regions, along with one case involving soft tissue (n=1). Microbiological methods confirmed the diagnosis in 17 cases (77%), while histopathological examination was employed in the remaining five cases (23%). General symptoms, such as fever and weight loss, were reported by 64% of the patients, whereas 32% exhibited symptoms localized to the infection site. Only one patient (4%) did not present any symptoms. The median duration from the onset of initial symptoms to diagnosis was 120 days (IQR 34.5-240). Nine patients were successfully treated with antibiotics, with only one patient experiencing a relapse during the follow-up period. Infections caused by actinomycetes are infrequent among the elderly and often exhibit non-specific clinical symptoms and imaging results. Among the various types of actinomycetal infections in this demographic, pulmonary actinomycosis is the most prevalent. Recognizing the wide-ranging capacity of actinomycetes to induce infections beyond our present knowledge is essential. It is important for healthcare practitioners to deepen their knowledge of actinomycosis to prevent delays in both diagnosis and treatment.

Pulmonary Actinomycosis in a 65-Year-Old Female with Poor Oral Dentition.

Pulmonary actinomycosis is an uncommon clinical entity that can be challenging to diagnose due to its non-specific symptomatology. Misdiagnosis and delayed treatment may result in invasive procedures and extended antimicrobial treatment courses. We report a case involving a 65-year-old female with poor oral dentition admitted for acute respiratory failure subsequently found to have a left-sided pleural effusion and perihepatic abscess formation. Cytopathology examination and microbiology studies confirmed the diagnosis of pulmonary actinomycosis.

Pulmonary actinomycosis in a patient with systemic lupus erythematosus

La actinomicosis es una enfermedad infecciosa granulomatosa, rara, causada por bacterias de especies Actinomyces. Estas bacterias son colonizadores de la cavidad oral, del tracto gastrointestinal y del aparato genital femenino. La manifestación clínica más frecuente es la forma cervicofacial. Sin embargo, puede afectar cualquier órgano del cuerpo. El diagnóstico de la infección constituye un reto, ya que los cultivos o hallazgos de la bacteria son poco frecuentes. Presentamos el caso de un paciente varón con lupus eritematoso sistémico, en tratamiento inmunosupresor con corticoides y ciclofosfamida por reagudización de nefritis lúpica. El paciente manifiesta tos con expectoración purulenta, disnea, baja de peso y episodios de hemoptisis. Estudios de tomografía mostraron múltiples cavidades en ambos pulmones; el paciente fue sometido a bronscoscopia y lavado broncoalveeolar para realizar la toma de muestras. Los resultados de cultivos fueron positivos a Pseudomona aeruginosa. El estudio de citología mostró imágenes de gránulos de azufre compatible con actinomicosis. El paciente recibió tratamiento con cefepima, seguido con amoxicilina/ clavulánico, presentando una mejoría de los síntomas. La actinomicosis es una enfermedad infecciosa rara, con manifestaciones clínicas variadas. La actinomicosis pulmonar presenta manifestaciones clínicas y radiológicas inespecíficas, lo que constituye un reto diagnóstico. Se debe considerar esta enfermedad en pacientes con inmunosupresión para un diagnóstico precoz y mejorar el pronóstico.

Massive hemoptysis as a complication of pulmonary actinomycosis: a case report

Massive hemoptysis as a complication of pulmonary actinomycosis: a case report

Pulmonary actinomycosis mimicking lung cancer – a case report

We present a case of a 55-year-old female patient admitted to the Thoracic Surgery Center for the treatment of a solid left lung mass of unknown aetiology. The patient was transported from another hospital, and the main reason for the patient’s referral to the Thoracic Surgery Center was recurrent haemoptysis and pulmonary haemorrhages. A chest X-ray in the posteroanterior projection showed no changes that could indicate the cause of the patient’s symptoms. In the course of diagnosis, a positron emission tomography combined with computed tomography scan was performed, in which an area of pathological radiotracer uptake was detected in the X segment of the left lung, with transverse dimensions of 6 × 6.5 cm, suggesting left lung cancer. Lower left lung lobectomy was performed, along with mediastinal lymphadenectomy. Final diagnosis was reached by histopathological examination of the resected tissues – the image corresponded to pulmonary actinomycosis.

Pulmonary Actinomycosis, A Lesson Learned Story

The bacteria Actinomyces spp. a gram-positive bacteria responsible for the actinomycosis disease. Its 15–20% pulmonary presentation is generally chronic, progresses slowly, and might be misinterpreted as lung cancer or other long-term conditions. We describe a man in his 60s with weight loss and dyspnea. The presence of Actinomyces spp. was identified in a bronchial biopsy of the middle lobe, ruling out lung cancer as the initial diagnostic possibility. After a month of intravenously administered antibiotic treatment, the patient experienced bronchiectasis. Pulmonary actinomycosis should be considered since it is challenging to detect and sometimes mistaken for lung neoplasia or TB due to its comparable clinical and radiographic presentations. The prognosis of pulmonary actinomycosis (PA) is favorable, and it is feasible to avoid recurring complications with the correct antibiotic treatment.

Coexistence of pulmonary actinomycosis with diffuse panbronchiolitis: A case report

Abstract Pulmonary actinomycosis is difficult to diagnose, and many clinicians lack an understanding of the disease. Delayed diagnosis and misdiagnosis are common. Diffuse panbronchiolitis (DPB) is a rare clinical and pathologic syndrome that involves pulmonary bronchiolitis and chronic sinusitis. This report describes a case of DPB complicated with pulmonary actinomycosis. A 77-year-old Chinese male was admitted with complaints of chronic cough, expectoration, shortness of breath, and fever. He had a history of smoking, drinking, and dental caries. Chest examination revealed coarse crackles. Pulmonary function tests showed an obstructive defect. Computed tomography of the chest showed consolidation shadows, thickening and dilatation of bronchiolar walls, and diffuse central lobular nodules in both lungs. Histopathological examination of a surgical lung biopsy specimen confirmed DPB combined with actinomycosis. The patient’s symptoms and radiological findings were significantly improved after penicillin combined with azithromycin therapy. Actinomycosis should be considered in older men who have structural lung diseases with recurrent lung infections. Early histological diagnosis and combination antibiotic therapy are very important in such patients.

Pulmonary Actinomycosis by Actinomyces graevenitzii in Two Hematologic Patients.

Pulmonary Actinomycosis by Actinomyces graevenitzii in Two Hematologic Patients.

The Incidence and Risk Factors of Chronic Pulmonary Infection after Radiotherapy in Patients with Lung Cancer.

This study aimed to investigate cumulative incidence and risk factors associated with chronic pulmonary infection (CPI) development after radiotherapy for lung cancer. We retrospectively analyzed 1,872 patients with lung cancer who received radiotherapy for lung cancer from 2010-2014, had a follow-up period of ≥ 3 months after radiotherapy, and did not have CPI at the time of radiotherapy. CPI was defined as pulmonary tuberculosis, non-tuberculous mycobacterial pulmonary disease, chronic pulmonary aspergillosis, or pulmonary actinomycosis. The cumulative incidence of CPI and overall survival (OS) were estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards analysis was performed to identify risk factors associated with CPI development. The median follow-up period was 2.3 years with OS rates of 55.6% and 37.6% at 2 and 5 years, respectively. CPI developed in 59 patients at a median of 1.8 years after radiotherapy, with cumulative incidence rates of 1.1%, 3.4%, 5.0%, and 6.8% at 1, 3, 5, and 7 years, respectively. A lower body mass index, interstitial lung disease, prior pulmonary tuberculosis, larger clinical target volume, history of lung cancer surgery or radiation pneumonitis, and use of inhaled corticosteroids were independent risk factors for CPI development. The long-term survival rate of lung cancer patients receiving radiotherapy was not low, but the cumulative incidence of CPI gradually increased to 6.8% at 7 years after radiotherapy. Therefore, close monitoring of CPI development is required in surviving patients with risk factors.

Usefulness of Transbronchial Needle Aspiration Through a Guide Sheath Using the PeriView FLEX Device in Addition to Endobronchial Ultrasonography with a Guide Sheath Transbronchial Biopsy for the Diagnosis of Pulmonary Actinomycosis

Usefulness of Transbronchial Needle Aspiration Through a Guide Sheath Using the PeriView FLEX Device in Addition to Endobronchial Ultrasonography with a Guide Sheath Transbronchial Biopsy for the Diagnosis of Pulmonary Actinomycosis

December 2022 Medical Image of the Month: Bronchoesophageal fistula in the Setting of Pulmonary Actinomycosis

No abstract available. Article truncated after 150 words. A 65-year-old woman, never smoker with hypothyroidism, hypertension, anxiety, and depression disorders, initially presented to the emergency department with progressive nonspecific chest discomfort for two days. She had CT Angio, which was negative for PE but showed a 4.6 cm subcarinal centrally necrotic nodal mass (Figure 1A-B). She was subsequently advised to follow up with her primary care physician. A week later, she attended our emergency department again with a new intermittent cough and one episode of non-bloody emesis. She reported a sensation of drowning with the intake of liquids and subsequent intractable coughing. Otherwise, she did not have other associated symptoms such as shortness of breath, abdominal pain, fever, sweats, or chills. Vital signs and physical exam were unremarkable. A repeat chest CT was performed, which demonstrated internal cavitation of the subcarinal mass with fistulous communication between the lumen of the midthoracic esophagus and the proximal left mainstem bronchus …

An Unusual Cause of a Pulmonary Mass: Actinomycosis

We present the case of a 62-year-old male with chronic obstructive pulmonary disease and poorly controlled diabetes mellitus who presented with haemoptysis. A radiograph of the chest showed a right lower parahilar opacity which on the contrast enhanced computed tomography was seen to be an irregular, spiculated mass localised to the middle lobe. Considering malignancy as the most probable diagnosis, a bronchoscopic endobronchial biopsy was performed which surprisingly established pulmonary actinomycosis as the diagnosis. The patient was successfully managed with amoxicillin and clavulanic acid and glycaemic control.

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.

A RARE CASE OF ACTINOMYCES EMPYEMA

A RARE CASE OF ACTINOMYCES EMPYEMA

Pulmonary Actinomycosis and Multiple Cavitary Lung Lesions in a Patient Previously Reported with Pulmonary Candidiasis: A Case Report

This paper presents the case of a 43 years old patient admitted three times to the Pneumology Department with productive cough, asthenia,
 important weight loss, and fever. His chest CT showed multiple pulmonary cavities growing over time, ground-glass opacities, and pleural effusion. Clinical symptoms and radiological signs were highly suggestive of tuberculosis, but he tested negative multiple times. Candida spp. was diagnosed through bronchial washing and treated. After a few months, the patient comes back with worsened symptoms and is diagnosed with pulmonary actinomycosis.

Two cases of pulmonary actinomycosis diagnosed after surgical resection

Two cases of pulmonary actinomycosis diagnosed after surgical resection

Pulmonary actinomycosis mimicking lung cancer on 18F-fluorodeoxyglucose positron emission tomography: a case report

BackgroundPulmonary actinomycosis is a chronic disease characterized by abscess formation, draining sinuses, fistulae, and tissue fibrosis. It can mimic other conditions, particularly malignant and granulomatous diseases, and is perhaps extremely challenging to diagnose.Case presentationA 64-year-old Japanese man presented with 6-week history of a painful solid lump in the chest wall. Chest computed tomography scan revealed a mass-like consolidation in the left upper lobe, with rib erosion and direct extension into the anterior chest wall. 18F-fluorodeoxyglucose positron emission tomography scan showed increased metabolic activity in the mass, which is indicative of primary lung cancer. The bronchoscopy and computed tomography scan-guided transthoracic biopsy results were considered nondiagnostic. Finally, the patient was diagnosed with pulmonary actinomycosis via surgical resection. He completed an 8-week course of antibiotic therapy and experienced no recurrence.ConclusionsThere is no difference in positron emission tomography/computed tomography scan findings between actinomycosis and malignancy. Therefore, pulmonary actinomycosis should be considered in the differential diagnosis of cases involving intensive activity on 18F-fluorodeoxyglucose positron emission tomography scan.

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.