Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: A case report and brief literature review

Pulmonary actinomycosis (PA) is an uncommon pulmonary infectious disease that often is misdiagnosed. Metagenomic next-generation sequencing (mNGS) is a highly sensitive and culture-independent new molecular technology for precise infectious disease diagnosis. Here we report a PA case diagnosed by the combination of a radial endobronchial-ultrasonography guide sheath (R-EBUS-GS) and mNGS, along with a brief review of the literature.

Primary actinomycosis of the breast in postmenopausal women

INTRODUCTION

Actinomycosis is a chronic infection caused by actinomyces species characterized by an abscess formation, tissue fibrosis, and draining sinuses. Primary actinomycosis of the breast is rare.

PATIENTS AND METHODS

In this paper we present a 64-year-old postmenopausal woman. For the diagnosis of primary actinomycosis of the breast, mammography, ultrasonography, MRI, and histopathologic examinations are required. Microbiological culture and histopathology are of the most importance during the process of diagnosis. In our case, at the intersection of the sternum and the lower inner quadrant of the right breast, there was a 1 cm wide fistula opening, and an abscess. A. israelii has been isolated from the microbiological culture taken from the lesion RESULTS: An optimal surgical resection of infected tissues has been performed as the treatment with the wound left open for tertiary healing The patient was given sulbactam 4*1 gr/day intravenously for 4 weeks post-op.. Recurrence was not detected during the yearly follow up procedures CONCLUSIONS: Actinomycosis should be considered when differentially diagnosing clinical instances of suppurative or granulomatous infections of the breast and mass regions that can't be ruled out as malignancies. Early diagnosis will save the patient from unnecessary surgical operations and ineffective antibiotic treatments.

KEY WORDS

Actinomycosis, Breast abscess, Breast diseases.

[Thoracal actinomycosis - a diagnostic challenge]

Actinomycotic infection of the chest structures is rare but can be serious. Diagnosis is difficult, since both culture of the bacterium and pathological investigation require special methods. Investigations therefore usually take many months before the correct treatment can be started. The most common differential diagnosis is a chest malignancy. Treatment is long-term antibiotics. We here present three cases which illustrate the clinical and radiological findings and the diagnostic difficulties.

[Actinomycosis]

Actinomycosis is a chronic bacterial infection, caused by the genus Actinomyces, commensal of the digestive and genital tract. The most common presentation of the disease affects the cervicofacial region, but other anatomical sites in the abdomen, thorax and central nervous system may be involved. Differential diagnosis includes neoplasia. Prolonged culture of deep samples in an anaerobic environment is the gold standard of the diagnosis. The treatment of choice is intravenous penicillin G followed by oral amoxicillin for a total duration of 6 to 12 months. However, depending on the location and response to antibiotics, shorter therapy may be considered.

Lung abscess by Actinomyces odontolyticus and Parvimonas micra co-infection presenting as acute respiratory failure: A case report

RATIONALE

Actinomyces odontolyticus and Parvimonas micra are very rare causative organisms of lung abscess and acute respiratory failure.

PATIENT CONCERNS

A 49-year-old male patient visited the emergency room with a complaint of sudden onset of shortness of breath, and he developed acute respiratory failure rapidly.

DIAGNOSIS

An abscess in the left lower lung field was diagnosed on the computed tomography scan of chest.

INTERVENTIONS

Immediate treatment with intravenous antibiotics was initiated along with a pigtail catheter insertion for pus drainage.

OUTCOMES

A odontolyticus was cultured on the drained pus and P micra was identified by a blood culture. The patient was successfully weaned from the mechanical ventilator and the lung abscess was completely resolved.

LESSONS

To the best of our knowledge, this is the first case report of mixed infection with A odontolyticus and P micra, which caused acute respiratory failure in an immune-competent patient. Therefore, physicians should consider the possibility of these organisms as causative pathogens of a fulminant pulmonary infection even in an immune-competent patient.

A case report of esophageal actinomycosis in an immunocompetent patient and review of the literature

Actinomycosis is a rare, chronic and slowly progressive granulomatous disease caused by Actinomyces spp., a Gram-positive anaerobic bacterium that rarely affects the esophagus. Although this infection is uncommon, it has been reported in both immunocompromised and immunocompetent individuals. The infection is often misdiagnosed because it can mimic other pathological conditions (like neoplasms and candidiasis), and Actinomyces is difficult to isolate because it requires specific growth conditions. However, actinomycosis has a favorable course if the microbiological diagnosis is timely. We report a case of esophageal actinomycosis in an immunocompetent 23-year-old man. The patient was admitted with symptoms of gastro-esophageal reflux disease (GERD), that had subsequently worsened. Histological and microbiological investigations revealed the presence of Actinomyces spp. A review of the literature regarding the clinical features, diagnosis, and management of this infection is also discussed.

[Pulmonary actinomycosis. Diagnostic and therapeutic features]

INTRODUCTION

Actinomycosis is a rare suppurative infection, subacute or chronic caused by bacteria of the genus Actinomyces.

OBSERVATIONS

A case study of 4 patients with prolonged respiratory symptoms. The clinical examination was poor in all cases. The CT-scan showed, in all cases, a suspicious tissue mass. The bronchoscopy diagnosis showed, in 2 cases, a tumor budding and was normal for the 2 other cases. Bronchial biopsies were negative in all cases. Before the prolonged symptomatology, the poor general condition, the endoscopic and the CT aspects; there was a suspect around a pulmonary neoplasia diagnosis, thus raising the need of a surgical treatment for diagnostic and therapeutic purposes. The anatomopathological examination of the resected specimen was in favour of the actinomycosis. The aim of these observations is to draw the attention to the radio-clinical, histological, therapeutic and evolutive aspects as well as the diagnostic difficulties of this condition.

CONCLUSION

The radio-clinical presentation of the actinomycosis is often misleading, thus a diagnostic confirmation is required before any useless surgical resection.

Pulmonary Actinomyces graevenitzii Infection Diagnosed by Bronchoscopy using Endobronchial Ultrasonography with a Guide Sheath

A 75-year-old man visited our hospital complaining of a low-grade fever, dry cough, and chest abnormal shadow. Chest computed tomography revealed a nodule with a cavity in the right upper lobe. Endobronchial ultrasonography (EBUS) of the lesion suggested that the lesion was benign. Actinomyces graevenitzii was cultured from the specimen obtained by bronchoscopy using endobronchial ultrasonography with a guide sheath technique and was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA sequencing. The patient was treated with intravenous ampicillin; subsequently, his condition improved. We believe that careful observation of EBUS findings may be useful for the differential diagnosis.

Prevalence of Infectious Organisms Observed in Cervical Smears Between 1997-2014 at Mubarak Al-Kabeer Hospital, Kuwait

OBJECTIVES

This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears (CS) at a tertiary care hospital in Kuwait.

METHODS

This retrospective study analysed 121,443 satisfactory CS samples collected between 1997-2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997-2005, while modified CS were obtained between 2006-2014 following the introduction of ThinPrep® testing (Hologic Corp., Bedford, Massachusetts, USA). All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents.

RESULTS

Overall, 8,836 (7.28%) of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida species (76.05%), Trichomonas vaginalis (9.72%), human papillomavirus (HPV; 9.3%), Actinomyces-like organisms (3.23%), Chlamydia trachomatis (1.27%) and the herpes simplex virus (HSV; 0.43%). There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis, T. vaginalis and Actinomyces-like organisms detected in conventional compared to modified CS samples (P <0.050 each). However, there was no statistically significant difference in the frequency of HSV-associated changes (P = 0.938). The presence of two infectious agents in the same sample was identified in 0.87% of samples.

CONCLUSION

Among CS samples collected during an 18-year period, Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing.

Hepatic actinomycosis with immunoglobulin G4-related liver disease: A case report

RATIONALE

Immunoglobulin (Ig)G4-related pseudotumors of the liver are very rare diseases that are difficult to distinguish from malignant tumors. They can be usually improved by steroid therapy. Actinomycosis is a chronic, suppurative, granulomatous infection, for which immune suppression is a predisposing factor. It can also mimic malignant tumors.

PATIENT CONCERNS

A 67-year-old man presented with mild abdominal discomfort and a 5-kg weight loss for 3 months. Initially, he visited another hospital and was treated with antibiotics under the assumption of a liver abscess. Symptom was not resolved.

DIAGNOSES

He diagnosed as having an IgG4-related pseudotumor of the right lobe of the liver after liver biopsy. Despite 2 months of steroid therapy, the liver mass was aggravated and invaded the right lung, as observed on follow-up computed tomography scan.

INTERVENTIONS

We performed en bloc resection of the tumor under the assumption that it was a malignant tumor.

OUTCOMES

The pathology of the tumor was revealed as actinomycotic colonies and IgG4-positive plasma cells of the liver. He recovered well and was discharged with ursodeoxycholic acid tablet for 14 days. After 3 months, he underwent postoperative follow-up CT and there was no remarkable finding in remnant left hepatic lobe.

LESSONS

Hepatic actinomycosis and IgG4-related pseudotumors of the liver are both difficult to diagnose. As in our patient, combined diseases are more difficult to diagnose and to determine the optimal treatment. Since immunosuppression therapy of autoimmune diseases can cause and aggravate infection, management must be approached carefully. We can learn that various possibilities must be considered before diagnosing and treating a hepatic mass.

Osteoma with actinomycosis in a nasal cavity: A case report

RATIONALE

Osteoma with actinomycosis is a very rare disease in the nasal cavity.

PATIENT CONCERNS

We report a case of a 17-year-old female student who presented with nasal obstruction and rhinorrhea for 6 months.

DIAGNOSES

The preoperative finding was osteoma covered with yellowish polypoid material.

INTERVENTIONS

We performed endoscopic sinus surgery, which included excision of the tumor and medication with oral penicillin for 8 weeks.

OUTCOMES

Postoperative recovery was uneventful. There was no evidence of tumor recurrence during the 1-year period after surgery.

CONCLUSION

Anaerobic conditions as a result of allergic rhinitis and narrowed nasal cavity because of osteoma can be the cause of formation of actinomycosis. Clinicians should note that osteoma with actinomycosis can be treated with surgical removal of the tumor and short-term antibiotic therapy.

Pulmonary actinomycosis masquerading as lung cancer: A case report

Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up.

Pulmonary actinomycosis - the great imitator

Pulmonary localisation represents only 15% of all cases of actinomycosis. The clinical symptoms and radiological changes of this disease are non-specific and sometimes it can be misdiagnosed, usually as tuberculosis, lung cancer or lung abscess. In the reported case, what might look like the lung cancer, finally turned out to be actinomycosis. The interesting case is presented of lung actinomycosis in a 77-year-old farmer, admitted to the Department of Pneumonology, Oncology and Allegology in Lublin due to a massive haemoptysis. CT scan of the chest showed, apart from other changes, the spicular consolidation in the right lung which aroused oncology vigilance. The diagnostic path, which was a real medical challenge, led to the diagnosis of actinomycosis. The process of diagnosis and consequent treatment, which led to the complete regression of clinical and radiological changes, is presented.

Actinomycosis of the foot - A South African case

Mycetoma is a chronic infection, characterised by severe disability and discomfort to patients. This condition is common throughout tropical regions of the world. The Indian subcontinent and north-east Africa, especially Sudan, bear the majority of the disease burden. Due to the limited resources and isolation of these areas, the condition is usually misdiagnosed or incorrectly managed. The World Health Organisation listed the condition as a "neglected disease" in 2013. The creation of the Mycetoma Research Centre (MRC) by the University of Khartoum in 1991 has greatly contributed to the current understanding of this disabling condition. We report a case of a 17-year-old boy from Port Elizabeth, South Africa. Uncommon in South Africa, this condition is easily misdiagnosed and mismanaged.