Die Aktinomykose des Sigma als obstruierende Raumforderung im kleinen Becken Eine Falldarstellung

Abdominal actinomycosis is a rare chronic infectious disease, which may mimic abdominal cancer, inflammatory bowel disease or diverticulitis. We report the case of a 46-year-old women with a large bowel obstruction caused by extensive abdominal actinomycosis. Colon contrast examination revealed a stenosis in the sigmoid colon, while abdominal ultrasound showed a stenosis of the left ureter with left hydronephrosis. Preoperative presumptive diagnosis was a carcinoma of the sigmoid colon. She required emergency surgery, which involved both resection and colostomy. As in most cases reported in the literature, diagnosis was made postoperatively. Pathological examination following the sigmoid colon resection surprisingly revealed an actinomycosis. This case illustrates that consideration of actinomycosis in women with bowel obstruction and prolonged use of an intrauterine device could help to improve the preoperative diagnosis of this rare disease.

Simultaneous occurrence of two rare diseases: actinomycosis and melanoma of the rectum

The simultaneous occurrence of two rare conditions in a single patient is uncommon. We report the case of a patient with rectal actinomycosis covering an anorectal melanoma (both infrequent conditions), the last one being later recognized, only after surgical excision. We underline here the role of thinking "outside the box" when an unusual situation is experienced.

[A case of thoracic actinomycosis]

A case of thoracic actinomycosis manifest as round shadow in the lung is described. Diagnosis was based on the presence of actinomycetes in a transthoracic lung biopsy sample. Treatment for 3 months resulted in recovery. No relapse was documented during 1 year follow-up period.

[The multiple thoracic actinomycosis in immunocompetent subjects]

L′actinomycose est une affection bactérienne granulomateuse, suppurative, étendue et chronique provoquée par la bactérie anaérobique gram positif Actinomyces israelii . La localisation thoracique est rare, elle peut simuler une pathologie néoplasique ou une tuberculose. Il s’agit d’un patient de 54ans sans antécédents pathologiques, qui s’est présenté avec deux tuméfactions pariétales basithoarciques droites, l’une antérieure et l’autre postérieure s’accompagnant d’une altération de l’état général. L’examen clinique ainsi que le bilan radiologique ont montré deux masses de la paroi thoracique et une atteinte parenchymateuse basale droite. L’examen anatomopathologique de la biopsie de la masse antérieure a montré des foyers d’actinomycose permettant d’établir le diagnostic d’actinomycose thoraco-pulmonaire. Un bilan immunologique s’est révélé normal. Le patient est alors mis sous traitement antibiotique à base d’amoxicilline protégée avec bonne évolution clinique et radiologique. Le but de cette observation est de rappeler les aspects radio-clinique, histologiques, thérapeutiques et évolutifs ainsi que les difficultés diagnostiques de cette affection.

Actinomycosis: an unusual cause of unresectable rectal cancer

We present a very unusual case of a woman with an intrauterine contraceptive device (IUCD) who developed pelvic actinomycosis during long course chemoradiotherapy for rectal cancer, which presented a significant diagnostic challenge and eventually rendered the cancer unresectable. IUCDs are often implicated in the development of pelvic actinomycosis but there is no current evidence or guideline to suggest that they should be removed prior to oncological treatment. Owing to the devastating consequences of this combination of disease, we suggest that it may be prudent to remove IUCDs in this setting.

[Ileocaecal actinomycosis - a case report]

Abdominal actinomycosis as an aetiological cause of acute abdomen in immunocompetent patients is considered to be very rare. The authors present a case of a young patient with acute appendicitis in the terrain of specific colitis imitating caecal tumour. Especially nowadays, in the era of globalization, it would be an unnecessary mistake not to think of this aetiological unit when the pain and tenderness in the right hypogastrium with signs of peritonism are expressed.

[Abdominal actinomycosis - 3 case reports and literature overview]

The authors present three cases of abdominal actinomycosis that were initially diagnosed as acute appendicitis, an abscess in the left groin and pelvic tumour, probably of gynaecological origin. Definitive diagnosis of abdominal actinomycosis was established as late as postoperatively. Abdominal actinomycosis is a chronic, infectious disease characterized most frequently by non-specific symptoms such as abdominal pain, fever, vomiting, bowel obstruction, weight loss, sometimes palpable resistance, and leukocytosis [1-9]. Diagnosis may be difficult and needs to be taken into account, especially in patients with risk factors.

Identification of coryneform Actinomyces neuii by MALDI-TOF MS: 5 case reports and review of literature

OBJECTIVES

We describe five cases of Actinomyces neuii, isolated from different clinical specimens over a period of five months (from June to October 2011), followed by a review of literature on infections with this micro-organism.

METHODS

All Actinomyces neuii strains were cultured or subcultured on horse blood agar. Identification took place using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Identification was confirmed by conventional biochemical tests and API Coryne test strips (BioMérieux SA). Susceptibility testing was performed on Mueller-Hinton agar supplemented with horse blood, using E-tests (BioMérieux SA). The minimal inhibitory concentrations were determined after 24 and 48 hours of incubation in a 5% CO2 environment.

RESULTS

Isolation of this micro-organism was associated with abscesses in two patients and chronic osteomyelitis in one patient. The remaining two patients had positive blood cultures which grew Actinomyces neuii, either as contamination or as catheter-related infection. All Actinomyces neuii identifications were obtained by MALDI-TOF MS and were confirmed by conventional biochemical and API Coryne tests. Identification of one isolate was also confirmed by 16S rRNA sequencing. All strains were susceptible to penicillin. One strain showed heteroresistance for macrolides and lincosamides. Minimal inhibitory concentrations were more reliable and easier to read after 48 hours of incubation, as compared to 24 hours.

CONCLUSION

MALDI-TOF MS analysis allows rapid and reliable identification of Actinomyces neuii, even at subspecies level.

Comparison of PCR, culturing and Pap smear microscopy for accurate diagnosis of genital Actinomyces

Members of the genus Actinomyces, Gram-positive, non-spore-forming anaerobic bacteria, are normal inhabitants of the mucosal surfaces of the oral, gastrointestinal and genital tracts. Identification of these bacteria using conventional methods is generally difficult because of their complex transport and growth requirements and their fastidious and slow-growing nature. However, in recent years, the advancement of molecular techniques has provided much improved identification and differentiation of closely related Actinomyces species. The aim of the present study was to evaluate the efficacy of the PCR technique in the diagnosis of genital Actinomyces in comparison with culturing and Papanicolaou (Pap) smear microscopy. Multiple sampling was conducted from 200 women using smear microscopy, culturing and PCR. Cyto-brushes were smeared on glass slides and stained using the routine Pap technique. Culturing was performed from a sterile swab, and Actinomyces were determined using the BBL Crystal ANR ID kit. PCR was performed from a second swab, and the Actinomyces type was determined using type-specific primers designed in our laboratory. Only one vaginal fluid sample (0.5%) revealed Actinomyces-like organisms on Pap smear examination. Actinomyces were detected in nine samples (4.5%) using the BBL Crystal ANR ID kit. Using PCR, eight samples (4%) were found positive for Actinomyces. No specimens that gave positive results by Pap smear microscopy and culturing could be confirmed by PCR. Pap smear microscopy and culturing were both found to have zero sensitivity for Actinomyces. PCR appears to be a sensitive and reliable diagnostic method for the detection of Actinomyces, which are difficult to cultivate from genital samples. PCR can be used for diagnostic confirmation in cases diagnosed by conventional methods, to prevent false-positive results.

To determine of the prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp in Turkish women from Ankara, Turkey

OBJECTIVE

To determine of the prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp in Ankara, Turkey and analyze whether there is seasonal variation in these infectious agents.

METHODS

A retrospective study on the results of 23298 cervical cytology examinations of patients which were performed in Fatih University Faculty of Medicine, Pathology Laboratory in Ankara, Turkey from January 2007 to July 2011. Patients were included in the study if a Pap smear was performed for any reason.

RESULTS

The prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp was 7.76%, 2.81%, 0.32%, 0.13%, and 0.27%, respectively A seasonal variation was not observed in the prevalence of any of the infectious agents (p>0.05).

CONCLUSION

We conclude that cervical cytology is well suited for diagnosis of cervical infections. Bacterial vaginosis appears to be the predominant cause of vaginitis.

Abdominopelvic actinomycosis associated with an intrauterine device and presenting with a rectal mass and hydronephrosis: a troublesome condition for the clinician

Actinomycosis is an uncommon, chronic, granulomatous disease that can be mistaken for a malignant tumor. Abdominopelvic actinomycosis constitutes about 20% of all actinomycosis cases and may mimic malignancy, tuberculosis, or other abdominopelvic inflammatory diseases. This condition is more prevalent in women who use an intrauterine device. We treated a 44-year-old woman who presented with vaginal discharge, right flank pain, dysuria, and difficulty with defecation. She had anorexia and weight loss (8 kg) during the previous 2 months and had a history of intrauterine device use for 12 years. Clinical, radiologic, and endoscopic examinations revealed a rectal mass and right hydronephrosis. Rectal biopsy showed nonspecific colitis. Laparotomy showed a mass that was invading and obstructing the pelvic orifice. Surgery included total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, low anterior resection, and Hartmann colostomy. Histopathologic evaluation of surgical specimens showed actinomycosis originating from the tubo-ovarian structures and invading the rectal wall. The patient was placed on penicillin for 6 months, and then had closure of the colostomy with no complication.

[Solitary actinomycotic brain abscess: case report]

Actinomycotic brain abscess is a rare condition with uncertain clinical features. Here we report the case of a 66-year-old immune-competent woman with an actinomycotic brain abscess who presented with sensory aphasia and mild right hemiparesis. She had no febrile episode or headache. Moreover, she did not have any periodontal or oto-rhino-laryngological disease, and the results of laboratory tests were normal. A computed tomography scan showed an irregular, low-density area in the left parietal lobe. Subsequent magnetic resonance imaging showed low-signal intensity in a T1 weighted image, high-signal intensity in a T2 weighted image, and mixed intensity on a diffusion weighted image. Thallium-201 chloride scintigraphy showed definite accumulation of thallium in the lesion and the patient's condition gradually deteriorated. Ten days after gadolinium administration, a T1 weighted image showed a multi- lobulated irregular mass in the left parietal lobe. The patient subsequently underwent craniotomy and evacuation of the yellowish abscess. Gram staining of the tissue showed the presence of gram-positive filamentous rods, and abscess cultures were positive for Actinomyces and Prevotella disiens. The abscess resolved after treatment with a high dose of intravenous penicillin G (24 million units/day) for 8 weeks, followed by an oral dose of amoxicillin for 4 months. The patient was discharged with a rudimentary limitation of the visual field.

An unexpected cause of multiple intra-abdominal abscesses in an HIV-positive patient

This case report describes a female HIV-positive patient diagnosed with pelvic actinomycosis using 16S rRNA gene sequence analysis. Actinomycosis is notoriously difficult to diagnose by microbiological culture. 16S rRNA gene sequence analysis allows rapid definitive diagnosis of actinomycosis and is potentially of great value in a clinical setting. This is the first report of pelvic actinomycosis in an HIV-1 infected patient.