Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.

Actinomycosis--an unusual case of an uncommon disease

Actinomycosis is an uncommon disease caused by organisms of the Actinomyces genus. These organisms are commonly found in the mucous membranes but do not cause infection unless there is disruption of the membranes, as occurs, for example, during dental trauma or abdominal surgery. Use of an IUD is also a risk factor for pelvic actinomycosis. The disease is usually insidious and is often mistaken for other conditions. Treatment of the infection, once diagnosed, is a regimen of long-term antibiotics such as penicillin, clindamycin, and others. Our patient had pelvic and sacral actinomycosis without any of the traditional risk factors for infection.

Isolation of Corynebacterium pilosum and Actinomyces pyogenes from cystitis and vulvovaginitis infection in a 2-month-old female calf

Cystitis and vulvovaginitits, due to Corynebacterium pilosum and Actinomyces pyogenes infection in a 2-month-old female calf, is described. The prominent clinical signs were urinary incontinence, adherence of triple phosphate crystals to the vulvar hair and ulceration on the vulva, the ventral side of the tail skin and the perineum. Only a mild inflammation of the bladder mucosa and submucosa was seen on histological examination.

Pulmonary actinomycosis in Korea

Pulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces, a Gram-positive, microaerophilic bacterium. Pulmonary involvement, other than cervicofacially or abdominopelvically, is uncommon and often leads to a misdiagnosis of pulmonary tuberculosis or lung cancer. In order to investigate the clinical, radiological, diagnostic and therapeutic characteristics of pulmonary actinomycosis, we reviewed a total of 25 cases reported in Korea. Thirteen were diagnosed at our hospital between 1985 and 1997 and 12 were reported in Korean publications. The condition occurred most frequently in middle-aged males, the most common symptom being haemoptysis, followed by cough and sputum. The main radiological features were peripherally located mass or nodule and consolidation, with central low attenuation. Complications such as empyema, sinus fistula or mediastinitis did not occur. Diagnosis was confirmed by percutaneous needle aspiration (n = 8), bronchoscopic biopsy (n = 3) or thoracotomy (n = 13). Eleven of 25 cases were treated medically and in nine others, surgical resection was followed by treatment with antibiotics. In conclusion, when a middle-aged male patient presents with haemoptysis and cough, together with radiologic findings of a peripheral mass or nodule with/without central low attenuation, pulmonary actinomycosis should be suspected.

[Pelvic tumoral actinomycosis: a difficult diagnosis. Two case reports]

Two cases of intra-uterine device-associated occlusive pelvic pseudo-tumoural actinomycosis are presented. A pre-operative diagnosis of ovarian carcinoma was considered in both cases and lead to a wide and difficult surgery. Actinomycosis was confirmed by the postoperative histopathologic examination, and the patients were successfully treated with penicillin. The difficulties and limits of the clinical and histopathological diagnosis are exposed. The interest of the pre and intra-operative diagnosis which can avoid an extensive surgery with high morbidity is highlighted.

Actinomyces and nocardia infections in immunocompromised and nonimmunocompromised patients

A retrospective survey of nocardia and actinomyces infections in five local hospitals was conducted over a 3-year period in El Paso, Texas, a border city, in the southwestern United States. The medical records of 42 patients with suspected nocardiosis or actinomycosis were reviewed. One patient was diagnosed with actinomyces and 12 patients with nocardia. Microbiological data included morphologic characteristics, biochemical profile, and susceptibility testing. Predisposing factors included leukemia, renal insufficiency, renal transplant, and lymphoma. No predisposing factors were found in 67% (n = 8) of patients (including the patient with actinomycosis). Twenty-three percent (n = 3) of patients had disseminated disease without evidence of underlying disease or immunosuppression. The mortality and morbidity of these infections appeared to be low.

[Pelvic actinomycosis]

Actinomycosis is an uncommon inflammatory disease of the female genital tract predominantly affecting the upper sections. Its appearance is in close connection with expended use of different IUDs. Its histological demonstration needs the detection of the specific sulphur granules. Because they often are rare it is recommended working of 8-12 paraffin blocks from suspected cases. The exact diagnosis is of high significance for preventing possible recivides after surgical intervention.

Systemic antibiotic therapy on multiple intracerebral abscesses of unknown origin

A 68-year old patient presented with increasing right-sided weakness, dysarthria, pyrexia and a deteriorating general condition. CT and MRI showed about 20 round hyperdense lesions with peripheral enhancement of contrast material up to 1.5 cm in diameter. Antibiotic triple-therapy using ceftriaxone, gentamycin and metronidazole for 39 days and followed by antibiotic double-therapy using ceftriaxone and metronidazole for a further 22 days resulted in a radiologically proven reduction of the abscesses to very small remnants which disappeared completely during the follow-up period of two years. Simultaneously the general condition of the patient improved significantly. Repeated attempts at isolation of bacteria, fungi, protozoa and parasites from a subdural empyema failed. The histological examination of an abscess, which was entirely removed on occipital craniotomy, showed a structure resembling actinomycosis.

Thoracic actinomycosis

OBJECTIVE

Thoracic actinomycosis is a disease that is difficult to diagnose because its appearance varies from similarities with bronchogenic carcinoma to pneumonitis-like tuberculosis infections. Therefore the majority of patients undergo operations for diagnosis. We had seven patients with thoracic actinomycosis which were not diagnosed before operation.

METHODS

Between July 1990 and November 1997, seven patients with thoracic actinomycosis were diagnosed after thoracotomy in our centre. They all had non-specific symptoms and radiographic findings, so we failed to diagnose the disease during preoperative examinations. Therefore they all underwent thoracotomy for diagnosis. Four patients were operated because of suspicion of malignancy, two patients were operated because of pulmonary infiltration and abscess formation and one patient because of undiagnosed pulmonary infiltration. Lobectomy was performed in five of them because of destroyed lobes, and wedge resection was performed in two patients. In two patients the disease was diagnosed by fresh smears obtained from specimens in the course of operation and confirmed histopathologically and in the others histopathologically in the postoperative period.

RESULTS

Three major complications, acute renal failure, empyema and persistent air leakage developed in three cases after the operations. Bronchopleural fistula was found in only one of them and the patient died because of uncontrolled infection and sepsis on the 26th postoperative day. All of the other six cases are still alive. We did not observe any other problem in their long-term follow-up. All patients regularly took 20 million units/day of intravenous crystalline penicillin G when they were in the hospital. After that, antibiotic treatment was completed up to 2 months with procaine penicillin.

CONCLUSIONS

Sometimes diagnosis of the actinomycosis of the lung is very difficult although it is an infection. In that case thoracotomy is needed for the diagnosis and sometimes for the treatment. In some cases because of the irreversible parenchymal change resective surgery may be needed. Actinomyces israelii infections should be suspected of in chronic infiltrative, nodular, cavitary process and tumour-like mass lesions besides other most probable causes. After diagnosed, it is treated using penicillin chemotherapy at least for 2 months.

[Maxillary actinomycosis and maxillary candidiasis in the immunocompetent patient]

Two distinct cases of maxillary actinomycosis and maxillary candidosis in immunocompetent hosts are reported; These infections are rare and similar to mycotic extramucosal non allergic sinusitis. Microbiology and microscopic examination are mandatory to prompt and successful management. Endoscopic endonasal surgery by middle meatotomy seems to be an adequate treatment for these particular entities.

[Chronic inflammatory changes in the lung of an 8-year old boy]

A case of pulmonary actinomycosis in the child is described. Firstly, tumor of lung was suspected. Correct diagnosis was made after thoracotomy and histological examination of material.

Cranial actinomycosis

A 67-year-old man presented with actinomycotic osteomyelitis of the skull and underlying central nervous system (CNS) involvement. The computed tomography (CT) and magnetic resonance imaging (MRI) findings are discussed and the radiological literature is reviewed.

[Appendicular pseudo-tumors: unusual diagnosis]

The discovery of a tumour mass of the appendix, in an acute or chronic context, raises the problem of its benign or malignant, inflammatory or infectious nature. We report five cases of patients operated by the same surgical team between June 1991 and September 1996, who presented macroscopically and histologically with unusual appendicular pseudotumours: appendicular diverticulosis (n = 1), Crohn's disease localized to the appendix (n = 2), yersiniosis (n = 1), actinomycosis (n = 1). The preoperative diagnosis was acute appendicitis (n = 2) or tumour (n = 3). The postoperative course was uneventful in every case, and specific medical treatment was prescribed in two cases (yersiniosis and actinomycosis). These differential diagnoses must be considered in all appendicular diseases, but they are extremely difficult to confirm preoperatively.