1
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Kerget B, Aksakal A, Özmen S. Actinomycosis mimicking malignancy. Rev Soc Bras Med Trop 2024; 57:e00918. [PMID: 39082525 PMCID: PMC11290840 DOI: 10.1590/0037-8682-0180-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 06/14/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
- Buğra Kerget
- Ataturk University School of Medicine, Department of Pulmonary Diseases, 25240, Yakutiye, Erzurum, Turkey
| | - Alperen Aksakal
- Ataturk University School of Medicine, Department of Pulmonary Diseases, 25240, Yakutiye, Erzurum, Turkey
| | - Sevilay Özmen
- Ataturk University School of Medicine, Department of Pathology, 25240, Yakutiye, Erzurum, Turkey
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2
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Yi S, Ghimire R, Sporn TA, Sutton AT, Lebron Figueroa DA, Markantonis JE. Pulmonary Actinomycosis in a 65-Year-Old Female with Poor Oral Dentition. Diagnostics (Basel) 2024; 14:1421. [PMID: 39001311 PMCID: PMC11241123 DOI: 10.3390/diagnostics14131421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
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.
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Affiliation(s)
- Sha Yi
- Department of Pathology and Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (S.Y.); (T.A.S.); (A.T.S.)
| | - Rabindra Ghimire
- Department of Medicine, Division of Infectious Diseases, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (R.G.); (D.A.L.F.)
| | - Thomas A. Sporn
- Department of Pathology and Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (S.Y.); (T.A.S.); (A.T.S.)
- ECU Health, ECU Physicians-Pathology, Greenville, NC 27834, USA
| | - Ann T. Sutton
- Department of Pathology and Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (S.Y.); (T.A.S.); (A.T.S.)
- ECU Health, ECU Physicians-Pathology, Greenville, NC 27834, USA
| | - Dora A. Lebron Figueroa
- Department of Medicine, Division of Infectious Diseases, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (R.G.); (D.A.L.F.)
| | - John E. Markantonis
- Department of Pathology and Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (S.Y.); (T.A.S.); (A.T.S.)
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3
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Zhang N, Zhou K, Gao X, Duan X, Yang S, Kang L. Clinical Features of Actinomycosis in Older Adults: A 10-Year Experience of a Single Institute in Beijing, China. Cureus 2024; 16:e65734. [PMID: 39082044 PMCID: PMC11288168 DOI: 10.7759/cureus.65734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ning Zhang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Kanghao Zhou
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Xiu Gao
- Department of General Medicine, The First Hospital of Yulin City, Yulin, CHN
| | - Xinmin Duan
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Shengmin Yang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
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4
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Suliman AM, Alsayed A, Obiedat S, Massad E, Ul Haq I. Actinomyces-infected bronchopulmonary sequestration: An uncommon pathogen in a rare anomaly. Clin Case Rep 2024; 12:e8984. [PMID: 38845797 PMCID: PMC11154760 DOI: 10.1002/ccr3.8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/28/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
Bronchopulmonary sequestration, a rare congenital anomaly, involves a nonfunctioning lung tissue mass supplied by anomalous vessels. It is rarely infected by Actinomyces, further complicating the clinical presentation, with limited reported cases. This case highlights the distinctive clinical aspects, diagnostic challenges, and successful management strategies of such a rare clinical entity.
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Affiliation(s)
- Aasir M. Suliman
- Pulmonology DepartmentHamad General Hospital, Hamad Medical CorporationDohaQatar
| | - Ahmed Alsayed
- Pulmonology DepartmentHamad General Hospital, Hamad Medical CorporationDohaQatar
| | - Sarah Obiedat
- Laboratory Medicine and Pathology DepartmentHamad General Hospital, Hamad Medical CorporationDohaQatar
| | - Ehab Massad
- Thoracic Surgery DepartmentHamad General Hospital, Hamad Medical CorporationDohaQatar
| | - Irfan Ul Haq
- Pulmonology DepartmentHamad General Hospital, Hamad Medical CorporationDohaQatar
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5
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Siregar DRG, Kawilarang AP, Kusumaningrum D, Purwanta M. A rare case report of liver masses caused by Actinomyces species. Indian J Med Microbiol 2024; 49:100573. [PMID: 38556249 DOI: 10.1016/j.ijmmb.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/19/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Actinomycosis is a rare infection caused by Actinomyces spp. Of all actinomycosis infections, only 5% of Hepatic Actinomycosis (HA) infection has been reported. This disease is often misdiagnosed as a malignancy. This case report presents a 45-year-old woman with diabetes, initially suspected of intrahepatic cholangiocarcinoma, but after careful tissue staining, we found the results supported HA infection.
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Affiliation(s)
| | - Arthur Pohan Kawilarang
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Clinical Microbiology, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Deby Kusumaningrum
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Clinical Microbiology, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia; Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Tuberculosis Laboratory, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Marijam Purwanta
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Clinical Microbiology, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia.
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6
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Zhang N, Liu C, Kang L, Zhou J, Liu W, Qu X. A Case of Pulmonary Actinomycosis With Concurrent Gastric Adenocarcinoma in an Older Adult. Cureus 2024; 16:e60180. [PMID: 38746489 PMCID: PMC11091935 DOI: 10.7759/cureus.60180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/16/2024] Open
Abstract
Actinomycosis is a chronic granulomatous disease that can affect various parts of the body, including the head and neck, lungs, abdominal and pelvic cavities, and wounds. It is caused by different actinomycetes like Actinomyces sherdii, Actinomyces glasii, Actinomyces cariosa, Actinomyces zurichensis, and Actinomyces europaea. Reported infections caused by actinomycetes include pulmonary actinomycosis, pelvic and abdominal infections, bone or artificial joint infections, endocarditis, complicated urinary tract infections, and soft tissue abscesses. The combination of pulmonary actinomycosis with gastric cancer is exceptionally rare in clinical practice, and the presence of actinomycetal infection alongside tumors in elderly patients poses significant challenges in treatment. This article presents the diagnosis and treatment process of an elderly patient with pulmonary actinomycosis and gastric adenocarcinoma.
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Affiliation(s)
- Ning Zhang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Changyi Liu
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Jianfeng Zhou
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Wenjing Liu
- Department of Geriatrics, Gansu Provincial Second People's Hospital, Lanzhou, CHN
| | - Xuan Qu
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
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7
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Liu P, Sun K, Li R, Chen X. Case report: A rare case of skin abscess caused by coinfection of Actinobaculum schaalii and Actinomyces turicensis. Front Cell Infect Microbiol 2024; 14:1378197. [PMID: 38601737 PMCID: PMC11004288 DOI: 10.3389/fcimb.2024.1378197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Skin abscess is one of the most common infections of the skin and soft tissues. However, anaerobic bacteria are infrequently identified as the causative agents of this particular form of abscess. In this case, a 34-year-old pregnant woman was diagnosed with a skin abscess with the use of ultrasonography. The microbiological analysis results of the purulent fluid revealed the coinfection of Actinobaculum schaalii and Actinomyces turicensis. The patient was first treated empirically with 3 days of cefathiamidine, which resulted in no symptom improvement. Subsequently, a surgical procedure involving incision and draining was performed, with the administration of ceftriaxone. After 7 days of antibiotic intervention, the patient exhibited a satisfactory recovery. Clinicians need to be aware of other types of infections that might be attributed to Actinobaculum schaalii and Actinomyces turicensis, in addition to urinary tract infections.
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Affiliation(s)
| | | | | | - Xiaodi Chen
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
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8
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Suliman AM, Alsayed A, Obiedat S, Massad E, Ul Haq I. Thoracic actinomycosis in a bronchopulmonary sequestration: An extremely rare encounter. Qatar Med J 2024; 2024:10. [PMID: 38680393 PMCID: PMC11046119 DOI: 10.5339/qmj.2024.qitc.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/31/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Aasir M Suliman
- Pulmonology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Alsayed
- Pulmonology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sarah Obiedat
- Laboratory Medicine and Pathology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ehab Massad
- Thoracic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Irfan Ul Haq
- Pulmonology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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9
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Khoshbayan A, Amirmozafari N, Mirkalantari S. An overview of case reports and case series of pulmonary actinomycosis mimicking lung cancer: a scoping review. Front Med (Lausanne) 2024; 11:1356390. [PMID: 38523909 PMCID: PMC10960364 DOI: 10.3389/fmed.2024.1356390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background Pulmonary actinomycosis (PA) is a rare type of Actinomyces infection that can be challenging to diagnose since it often mimics lung cancer. Methods Published case reports and case series of PA in patients with suspicion of lung cancer were considered, and data were extracted by a structured search through PubMed/Medline. Results After analyzing Medline, 31 studies were reviewed, from which 48 cases were extracted. Europe had the highest prevalence of reported cases with 45.1%, followed by Asia (32.2%), America (19.3%), and Africa (3.2%). The average age of patients was 58.9 years, and 75% of all patients were above 50 years old. Male patients (70%) were predominantly affected by PA. The overall mortality rate was 6.25%. In only eight cases, the causative agent was reported, and Actinomyces odontolyticus was the most common isolated pathogen with three cases. Based on histopathological examination, 75% of the cases were diagnosed, and the lobectomy was performed in 10 cases, the most common surgical intervention. In 50% of the cases, the selective antibiotics were intravenous and oral penicillin, followed by amoxicillin (29.1%), amoxicillin-clavulanic acid, ampicillin, levofloxacin, and doxycycline. Conclusion The non-specific symptoms resemble lung cancer, leading to confusion between PA and cancer in imaging scans. Radiological techniques are helpful but have limitations that can lead to unnecessary surgeries when confusing PA with lung cancer. Therefore, it is important to raise awareness about the signs and symptoms of PA and lung cancer to prevent undesirable complications and ensure appropriate treatment measures are taken.
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Affiliation(s)
| | | | - Shiva Mirkalantari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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10
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Kuang J, Luo Z, Zhou F. Acute Pulmonary Actinomycosis Induced by Immunotherapy and Chemotherapy Used for SCLC Treatment: A Case Report and Literature Review. Infect Drug Resist 2023; 16:7575-7580. [PMID: 38107432 PMCID: PMC10723074 DOI: 10.2147/idr.s429699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
A 66-year-old male patient diagnosed with small-cell lung cancer received chemotherapy and immunotherapy, resulting in successful tumor control. However, the patient subsequently experienced a fever and rapid progression of the pulmonary cavity. Despite sampling bronchoscopic bronchoalveolar lavage fluid for targeted next-generation sequencing (tNGS), the cause remained unidentified. Adding bronchoalveolar lavage fluid to sense metagenomic next-generation sequencing (mNGS) confirmed the infection caused by actinomycetes. The patient's condition improved after active anti-infection treatment. This case was further analyzed and discussed through a comprehensive literature review, focusing on molecular microbiological diagnosis and treatment processes. The points outlined were as follows: the advancement of molecular microbiology has gradually reduced the challenges associated with diagnosing rare infectious diseases such as pulmonary actinomycosis. Additionally, in immunodeficient individuals, certain infectious diseases with a chronic course may exhibit acute and aggressive characteristics, which is of concern to all colleagues. Currently, tNGS and mNGS are widely employed in clinical settings as practical tools for diagnosing infectious diseases. Notably, these two methods are not substitutes for each other but complement each other.
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Affiliation(s)
- Ju Kuang
- Department of Respiratory and Critical Care Medicine, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhihai Luo
- Department of Respiratory and Critical Care Medicine, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Fu Zhou
- Department of Respiratory and Critical Care Medicine, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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11
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Allan L, Said H, Shanks AM. Pulmonary actinomycosis presenting with empyema. BMJ Case Rep 2023; 16:e256320. [PMID: 37940195 PMCID: PMC10632809 DOI: 10.1136/bcr-2023-256320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Affiliation(s)
- Liam Allan
- Respiratory Medicine, NHS Highland, Inverness, Highland, UK
| | - Hussein Said
- Respiratory Medicine, NHS Highland, Inverness, Highland, UK
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12
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Rouis H, Moussa C, Ayadi A, Khattab A, Khouaja I, Zendah I, Maâlej S. Pulmonary actinomycosis mimicking lung malignancy: About two cases. Heliyon 2023; 9:e20070. [PMID: 37767510 PMCID: PMC10520318 DOI: 10.1016/j.heliyon.2023.e20070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Pulmonary actinomycosis is a rare anaerobic infection with non specific clinical and radiographic presentations that delay diagnosis. Throughout literature, a significant number of misdiagnosed cases have been reported. The diagnosis is substantially based on histopathological pattern. We describe the cases of two patients evaluated and treated in pulmonary department 1 of Abderrahmane Mami hospital of Tunisia with a diagnosis of pulmonary actinomycosis. There are two men. The first patient had hypertension and chronic obstructive pulmonary disease and the second one underwent surgery for bronchiectasis. Clinical presentation was consistent with productive cough, hemoptysis, and deterioration of general status. The medical examination was non-specific. The chest X-ray revealed an apical opacity, excavated in the first case and retractable in the second one. Biology showed an inflammatory syndrome. Bronchoscopy was performed in the two cases and showed lesions mimicking lung malignancy. Diagnosis is confirmed by histopathological examinations of surgical specimens in the two cases. Both patients were received antibiotic therapy. The results were excellent with a favorable clinical course and no deaths. This study highlights the misleading patterns of actinomycosis to prompt accurate diagnosis and earlier treatment, thus improving the outcome. Given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice, histological examination of lung tissue specimens is crucial to get the correct diagnosis.
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Affiliation(s)
- Houda Rouis
- Pulmonary Department 1, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Chirine Moussa
- Pulmonary Department 1, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Aida Ayadi
- Pathology Department, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Amel Khattab
- Pulmonary Department 1, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Ibtihel Khouaja
- Pulmonary Department 1, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Ines Zendah
- Pulmonary Department 1, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Sonia Maâlej
- Pulmonary Department 1, Abderrahmane Mami Hospital, Ariana, Tunisia
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Kövér Z, Johansen Nordskag V, Bán Á, Gajdács M, Urbán E. The role of Actinomyces spp. and related organisms in cervicofacial infections: Pathomechanism, diagnosis and therapeutic aspects. Anaerobe 2023; 82:102767. [PMID: 37482285 DOI: 10.1016/j.anaerobe.2023.102767] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
Members of the Actinomyces genus and Actinomyces-like organisms (ALOs; namely Actinotignum, Arcanobacterium, Schaalia and Varibaculum) are Gram-positive, non-spore-forming rods that are commensal members of the human oral cavity, gastrointestinal tract, female genital tract and skin microbiota. Cervicofacial actinomycosis or "lumpy jaw syndrome" - the chronic, suppurative granulomatous disease caused by Actinomyces spp. And ALOs - is characterized by an initially slow and unspecific disease-presentation, which often mimics other pathologies, followed by the formation of painful abscesses and severe tissue destruction. Actinomycosis has been described as a rare disease, however, reliable epidemiological data are lacking. In addition, there is increasing awareness regarding the role of Actinomyces spp. in the development of osteoradionecrosis and medication-related osteonecrosis of the jaw. The aim of this narrative review is to succinctly summarize the current advances regarding the microbiological, clinical, diagnostic and therapeutic aspects of cervicofacial actinomycosis, in addition to the roles of Actinomyces species and ALOs as members of the oral microbiota and in dental biofilm, in other dental infections (caries, root canal infection, periapical infection, periodontitis) and osteonecrosis of the jaw, in the context of recent taxonomic changes affecting the genus. Our paper aims to be a blueprint for dentists, other physicians, microbiologists and researchers regarding the multifaceted field of cervicofacial actinomycosis.
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Affiliation(s)
- Zsanett Kövér
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér U. 1., 7623, Pécs, Hungary.
| | - Vidar Johansen Nordskag
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér U. 1., 7623, Pécs, Hungary.
| | - Ágnes Bán
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér U. 1., 7623, Pécs, Hungary.
| | - Márió Gajdács
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6725, Szeged, Hungary.
| | - Edit Urbán
- Department of Medical Microbiology and Immunology, Clinical Center, University of Pécs, Szigeti út 12., 7624, Pécs, Hungary.
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Vargas-Garcia EK, Fernandez-Aristi AR, Cornejo-Venegas G, Montenegro-Idrogo JJ, Chirinos-Vega J, Chiappe-Gonzalez A. Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report. AIDS Res Ther 2023; 20:48. [PMID: 37452343 PMCID: PMC10347741 DOI: 10.1186/s12981-023-00526-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. CASE PRESENTATION A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. CONCLUSION Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.
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Affiliation(s)
- Elsa K. Vargas-Garcia
- Universidad Peruana de Ciencias Aplicadas, Avenida Alameda San Marcos cuadra 2 S/N, Chorrillos, Lima, 15023 Peru
| | - Augusto R. Fernandez-Aristi
- Universidad Peruana de Ciencias Aplicadas, Avenida Alameda San Marcos cuadra 2 S/N, Chorrillos, Lima, 15023 Peru
| | - Gonzalo Cornejo-Venegas
- Universidad Peruana de Ciencias Aplicadas, Avenida Alameda San Marcos cuadra 2 S/N, Chorrillos, Lima, 15023 Peru
| | - Juan José Montenegro-Idrogo
- Hospital Nacional Dos de Mayo. Parque “Historia de la Medicina Peruana” S/N, Lima, 15003 Peru
- Facultad de Ciencias de la Salud, Universidad Científica del Sur. Carretera Panamericana, Sur km19, Villa El Salvador, Lima, 15067 Peru
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, 070102 Peru
| | - Juan Chirinos-Vega
- Clínica Angloamericana, Calle Alfredo Salazar 350, Lima, San Isidro 15073 Peru
| | - Alfredo Chiappe-Gonzalez
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru
- Clínica Angloamericana, Calle Alfredo Salazar 350, Lima, San Isidro 15073 Peru
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Dimeas IE, Sinis S, Dimeas G, Skrimizeas S, Daniil Z. A Unique Case of Conservatively Treated Actinomyces Empyema Complicated Due to Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome. Cureus 2023; 15:e41954. [PMID: 37588329 PMCID: PMC10426645 DOI: 10.7759/cureus.41954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/18/2023] Open
Abstract
This case contemplates the unusual presentation, challenging diagnostic workup and conservative therapeutic process of a patient with Actinomyces empyema complicated along the way due to drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The patient was a 40-year-old male, who presented with pleurodynia and fever. Laboratory exams showed elevated inflammatory markers and imaging revealed two biconvex fluid pockets located in the right lower lobe, from which the fluid was positive for Actinomyces meyeri. The initial conservative process with intravenous antibiotics and successful drainage with intrapleural fibrinolysis improved our patient. However, after a few days, the patient's fevers relapsed, and as regress of the empyema was discussed as a complication, he developed a maculopapular symmetrical rash of the trunk and legs accompanied by enlarged lymph nodes, eosinophilia, thrombocytopenia, and atypical lymphocytes. The diagnosis of DRESS syndrome due to antibiotic therapy for actinomyces empyema was established and a balance between bactericidal and immunosuppression medication had to be found. Fortunately, the patient withstood prolonged antibiotic therapy and got fully treated without any relapses.
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Affiliation(s)
- Ilias E Dimeas
- Respiratory Medicine, University Hospital of Larissa, Larissa, GRC
| | - Sotirios Sinis
- Respiratory Medicine, University Hospital of Larissa, Larissa, GRC
| | - George Dimeas
- Respiratory Medicine, University Hospital of Larissa, Larissa, GRC
| | | | - Zoe Daniil
- Respiratory Medicine, University Hospital of Larissa, Larissa, GRC
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