Intracranial actinomycosis in juvenile patients. Case report and review of the literature

A case of actinomycotic brain infection in a juvenile patient is described. Cases of actinomycosis affecting the head and neck are rare, particularly in juvenile patients. In this case complete resolution of the infection was achieved by means of surgical treatment and prolonged antibiotic therapy. The authors emphasize the importance of a combined approach for treatment of this unusual brain infection and stress the difficulties involved in the diagnosis of this pathology.

Actinomycosis of the central nervous system: surgical treatment of three cases

Three cases of actinomycotic brain infection are described, 2 of which manifested as cerebral abscess, the third as epidural empyema. Complete resolution of the infection was always achieved by means of surgical treatment and prolonged antibiotic therapy. The cases reported emphasize the importance of a combined approach in the treatment of this unusual cause of brain infection.

Abdominal actinomycosis misdiagnosed as a secondary bladder tumor: a case report

A 46-year-old woman presented with a hypogastric mass. The preoperative diagnosis was a malignant ovarian tumor involving multiple organs, including the urinary bladder. Surgical exploration was performed with wide resection of the right ovary and uterus, including the affected ileum, sigmoid colon, and omentum. An intraoperative histopathological examination of the paravesical tissue revealed abdominal actinomycosis. Consequently, bladder resection was not done. The cause of abdominal actinomycosis in this patient was probably due to implantation of an intrauterine device 3 years previously.

The laboratory investigation of vaginal discharge

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Clinically inapparent tuboovarian actinomycosis in a woman with an IUD. A case report

BACKGROUND

The consequences and management of asymptomatic Actinomyces-like organisms detected on cervical cytologic smears continue to be controversial.

CASE

A unilateral tuboovarian actinomycotic abscess was discovered in a woman who had undergone a hysterectomy for uterine leiomyomas. She had had an intrauterine device in place for many years without any symptoms of pelvic inflammatory disease.

CONCLUSION

Ascending infection of the upper genital tract by Actinomyces may be clinically inapparent. When Actinomyces-like organisms aer detected on cervical cytologic smears, removal of an intrauterine device should be considered.

Chest pain with induration of the chest wall

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Actinomycotic thyroiditis in a child

The authors present a unique case of actinomycosis occurring in a 10-year-old girl who presented with a painless, noninflammatory left neck mass of 3 weeks duration. Physical examination findings showed a firm, nontender mass within the left thyroid lobe, and a presumptive diagnosis of thyroid neoplasm was made. Inflammatory changes subsequently occurred and surgical drainage was performed revealing sulphur granules. Histological examination confirmed actinomycosis of the thyroid gland.

[Actinomycosis of the tongue. Report of two cases and review of the literature]

Actinomycosis of the tongue is a rare form of infection whose initial clinical manifestation is a submucosal swelling that may mimic both benign and malignant neoplasias. Two cases are, presented and their clinical features and diagnostic criteria are discussed in the light of twelve cases drawn from the literature. Infection in the tongue is rare, though perhaps underestimated. It is generally located on the anterior two thirds laterally to the median sulcus, and presents as a moderately painful nodule set deep in the extrinsic and intrinsic muscles and poorly mobile on the adjacent planes. In a few weeks the lesion increases in size and painfulness with consequent loss of function in the absence of diagnosis and appropriate antibiotic management. Both our patients, in fact, presented with deep lesions and no apparent involvement of the mucosa, and were investigated by means of fine-needle aspiration biopsy (FNAB). The aspirated material was used to prepare both routine smears and cell blocks embedded in paraffin. The pathological material provided by this combination of methods proved quantitatively and qualitatively sufficient for the definitive diagnosis of actinomycosis in both cases.

Biochemical and ribotypic comparison of Actinomyces pyogenes and A pyogenes-like organisms from liver abscesses, ruminal wall, and ruminal contents of cattle

OBJECTIVE

To isolate Actinomyces pyogenes and A pyogenes-like (APL) organisms from the ruminal wall and ruminal contents of cattle and compare them with isolates from liver abscesses from the same animals, using ribosomal DNA restriction fragment length polymorphism analysis or ribotyping.

PROCEDURE

Specimens of liver abscesses, ruminal walls, and ruminal contents were collected from 59 cattle at slaughter. All beta-hemolytic, pinpoint colonies that were gram positive, pleomorphic rod-shaped, and catalase negative, and that hydrolyzed casein and gelatin were presumptively identified as A pyogenes and were characterized biochemically, using an identification kit. The isolates that resembled A pyogenes but fermented mannitol or raffinose, or both, were called APL organisms. Isolates from the ruminal wall and ruminal contents were compared with liver abscess isolates from the same animal by use of ribotyping.

RESULTS

Actinomyces pyogenes and APL organisms were isolated more frequently from the ruminal wall than from ruminal contents. Ruminal isolates of A pyogenes and APL had biochemical characteristics similar to those of the isolates from liver abscesses. Among 6 sets of isolates (4 A pyogenes and 2 APL), 2 isolates from liver abscesses had ribopatterns identical to the corresponding ruminal wall isolates. Also, the APL organisms isolated from the ruminal content matched with the corresponding liver abscess isolates for both sets of specimens tested.

CONCLUSIONS

The ruminal wall may be the niche for A pyogenes and APL organisms in the rumen. The genetic similarity, on the basis of ribotyping among isolates from liver abscesses, the ruminal wall, and ruminal contents of the same animal suggests that A pyogenes and APL organisms that cause liver abscesses originate from the rumen.

Spinal abscess and spondylitis due to actinomycosis

STUDY DESIGN

Report of a rare case of spinal actinomycosis in a young immunocompetent woman.

OBJECTIVE

To show the difficulties in diagnosing spinal actinomycosis.

SUMMARY OF BACKGROUND DATA

Spinal actinomycosis is rare and usually occurs as a result of a contiguous (abdominal, pelvic, or thoracic) spread of the infection. This localization represents less than 5% of the infectious sites and was mainly, before the penicillin era, a postmortem discovery.

METHODS

A case is reported of a 34-year-old Algerian woman who had fever, persistent cough, right-side thoracic pain, and progressive severe back pain. Radiographs, computed tomographic scan, and magnetic resonance imaging demonstrated lytic areas on the vertebral bodies of T11 and T12 and a paravertebral mass, without disk involvement. A surgical biopsy of T12 and the paravertebral abscess was performed.

RESULTS

Presence of characteristic sulfur granules and gram-positive filamentous bacteria in surgical biopsy tissues and isolation of Actinobacillus actinomycetemcomitans in cultures led to the diagnosis of vertebral actinomycosis. The patient was virtually free of pain and fever after a 3-month regimen of ofloxacin and rifampicin (Rifadine, Marion-Merell, France) and was without recurrence after 18 months of follow-up.

CONCLUSIONS

Actinomycosis of the spine, caused by the spread of a paraspinal abscess, is extremely rare. The previously poor prognosis has been transformed by antibiotics.

[The first description of infection by Actinomyces radingae]

BACKGROUND

To communicate at clinical value of an isolation of Actinomyces radingae from an ulcerated lesion the external supra-malleolus region.

MATERIAL AND METHODS

We proceed to study the clinical and bacteriological value of an isolated aerobic gram positive rod in pure culture obtained from an ulcerated lesion ocated at the external supra-malleolus region of a 92 years old woman in whom there was later evidence of an epidermoid carcinoma. Surgical and antibiotic treatment were needed. The biochemistry characterization of the isolated was carried out according to the schemes of Weaver-Hollis and Funke et al, as well as the characterization of the fat acids of their cellular wall by gas-liquid chromatography.

RESULTS

The isolated was identified as Actinomyces radingae. The patient follow-up was satisfactory after the treatment.

CONCLUSION

The first infection description by Actinomyces radingae is reported wherein its pathological value is evident as it is isolated in pure culture.

Actinomycotic osteomyelitis of the mandible: review of 15 cases

The authors have analysed 15 cases of actinomycotic osteomyelitis of the mandible. Primary actinomycotic inflammation of the mandible was diagnosed in nine patients, secondary in six patients (following fracture or resection of the mandible). The diagnosis was established on the basis of the clinical examination confirmed by bacteriological and/or histopathological tests. The basic method of treatment was antibiotic therapy of long duration. Surgical treatment was performed in all patients. Twelve of fifteen patients who had received the therapy and proved asymptomatic for 1 year to 23 years were recognized to be cured of the disease. In three patients, a single recurrence of the disease was observed after 1.5-2 months.

Intrauterine device--associated pelvic actinomycosis: a rare disease mimicking advanced ovarian cancer: a case report

A case report of intrauterine device (IUD)-associated tubo-ovarian actinomycosis is presented. The patient was a 37-year-old nulliparous woman with IUD usage for the last four years. She presented anemia and weight lost of 8 kg. Ultrasound and computed tomography showed an unilateral large mass in the right adnexum adherent to the uterus and compressing the urinary bladder. Preoperative diagnosis of ovarian cancer with liver metastases was made. Bilateral salpingoophorectomy and total abdominal hysterectomy were performed. After pathological and biological analyses, actinomycosis was diagnosed and the patient was treated postoperatively with penicillin. The purpose of this article is to add to the literature a new case of this rare disease which clinically mimics ovarian cancer.

Seasonal fluctuations in the cervical smear detection rates for (pre)malignant changes and for infections

The detection of diseases can exhibit seasonal fluctuations. This can be studied in cervical smears. Over a 9-year observation span (January 1983-January 1992) a series of 504,093 cervical smears obtained from a routine cytology laboratory in The Netherlands were examined for infections (monilia, trichomonas, actinomyces, human papilloma virus [HPV], chlamydia, and herpes) as well as for mild, moderate, and severe dysplasias, carcinoma in situ, and squamous carcinoma. Statistical analysis (principal component analysis) demonstrates clear seasonal rhythms in the detection of infections as well as in precursor lesions. These findings suggest that we are dealing with "true" detection rhythms. For the detection of (pre)malignancy and HPV, yearly fluctuations in women being screened might be the explanation for our observations.

Advanced actinomycosis involving urogenital organs simulating malignancy: a case report

A long-standing and widely used intrauterine contraceptive device has been associated with actinomycotic pelvic inflammation. The stealthy and chronic nature of the disease progresses and occasionally infiltrates adjacent organs. The non-specific symptoms of the disease, solid invasive mass and lack of marked leukocytosis, often suggest a malignancy. We present a case of advanced pelvic actinomycosis involving urogenital organs which has not been reported before. The behaviors of the disease, which mimic malignancy and urogenital manifestation, pose difficulties in diagnosis and management.

Thoracic actinomycosis and human immunodeficiency virus infection

Despite the impairments of cellular and humoral immunity that accompany the acquired immunodeficiency syndrome, there has not been increased evidence of thoracic actinomycosis. We report on a patient with the human immunodeficiency virus (HIV) infection who had pulmonary actinomycosis. We review the current ideas regarding this unusual pulmonary pathogen and offer possible explanations for its rare appearance in the HIV population.