1
|
Del Fabro G, Volpi S, Fumarola B, Migliorati M, Bertelli D, Signorini L, Matteelli A, Meschiari M. Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature. Microorganisms 2023; 11:2931. [PMID: 38138076 PMCID: PMC10745418 DOI: 10.3390/microorganisms11122931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Actinomycosis represents a challenging and under-reported complication of vascular surgery. Optimal management of Actinomyces spp. prosthetic vascular graft infection (PVGI) is highly uncertain because of the paucity of reports on this disease. METHODS We conducted a retrospective case-series of Actinomyces-PVGI that occurred in the last five years in two major university hospitals in northern Italy. We searched for previously published cases in the scientific literature. RESULTS We report five original cases of Actinomyces spp. prosthetic vascular graft infection following aortic aneurysm repair. Our literature review retrieved eight similar cases. Most patients were immunocompetent males. Most infections were polymicrobial (11/13 cases), with a prevalence of A. odontolyticus involvement (3/13 cases were associated with. Salmonella spp. infection). All cases had a late presentation (≥4 months from graft placement), with 61% associated with an aorto-enteric fistula. All patients received antibiotic therapy, but the duration was highly heterogeneous (from two weeks to life-long antibiotics). The patients without surgical revision experienced septic recurrences (2/13), permanent dysfunction (1/13), or a fatal outcome (2/13), while of the remainder who underwent vascular graft explant, six recovered completely and one developed a periprosthetic abscess. In two cases follow-up was not available. CONCLUSIONS This case-series aims to raise the diagnostic suspicion and to describe the current management of Actinomyces-PVGIs. We highlight a high heterogeneity in antibiotic duration, choice of the antibiotic regimen, and surgical management. Higher reporting rate is advisable to produce better evidence and optimize management of this rare complication of vascular surgery.
Collapse
Affiliation(s)
- Giovanni Del Fabro
- Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Sara Volpi
- Clinic of Infectious Diseases, University Hospital of Modena, 41124 Modena, Italy
| | - Benedetta Fumarola
- Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Manuela Migliorati
- Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Davide Bertelli
- Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Liana Signorini
- Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Alberto Matteelli
- Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Marianna Meschiari
- Clinic of Infectious Diseases, University Hospital of Modena, 41124 Modena, Italy
| |
Collapse
|
2
|
Diaz A, Cyberski T, Singh A, Fenton D, Cipriani NA, Lusardi JJ, Corey JP, Blair EA. Laryngeal and pharyngeal actinomycosis: a systematic review and report of 3 cases. Am J Otolaryngol 2022; 43:103609. [PMID: 36029619 DOI: 10.1016/j.amjoto.2022.103609] [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: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Actinomycosis is a granulomatous infection that rarely involves the larynx or pharynx. Three cases of actinomycosis of the larynx or pharynx from our institution were reviewed and a systematic literature review was performed to better define surgical management, antibiotic therapy, risk factors, and incidence of recurrence or complications. MATERIALS AND METHODS PubMed/Medline, Cochrane, Embase, and Google Scholar were searched on November 30, 2021 using the terms "laryngeal actinomycosis", "pharyngeal actinomycosis", "actinomycosis AND larynx", and "actinomycosis AND pharynx." Articles which did not describe appropriate sites or were non-English were excluded. Results were collected for demographic information, site(s) of infection, comorbidities, lesion characteristics and treatments. RESULTS Along with three cases reported from our institution, 40 unique cases were reviewed from 37 studies for a total of 43 patients (Table 1). 34 (81.0 %) of the patients were male with the highest incidence of infection in the seventh decade (54.8 %). The most common site for the infection was the larynx (69.0 %) followed by the pharynx (16.7 %). Risk factors included a history of radiation therapy, immunosuppression, inhalational irritant, and diabetes (Table 3). The duration of antibiotic therapy varied greatly, from one month to one year and total follow up ranged from 1 month to 2.5 years (Table 1). CONCLUSIONS A comprehensive review of the literature on pharyngolaryngeal actinomycosis shows that this infection has increased prevalence within the head and neck cancer patient population. Similar to cervicofacial actinomycosis, these atypical sites have shown favorable responses to extended antibiotic therapy and generally do not require aggressive surgical management.
Collapse
Affiliation(s)
- Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Thomas Cyberski
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan J Lusardi
- Department of Otolaryngology - Head and Neck Surgery, Mercy Medical Center, St. Louis, MO, USA
| | - Jacquelynne P Corey
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, IL, USA
| | - Elizabeth A Blair
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, IL, USA.
| |
Collapse
|
3
|
Agarwal A, Kahn C, McClain K, Aaronson N. Pediatric Post-Cricoid Actinomyces. EAR, NOSE & THROAT JOURNAL 2022:1455613221103078. [PMID: 35575187 DOI: 10.1177/01455613221103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aarti Agarwal
- Department of Otolaryngology, Head and Neck Surgery, 23217Thomas Jefferson University, Philadelphia, PA, USA
| | - Chase Kahn
- Department of Otolaryngology, Head and Neck Surgery, 23217Thomas Jefferson University, Philadelphia, PA, USA
| | - Kathleen McClain
- Division of Otolaryngology, Department of Surgery, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Nicole Aaronson
- Department of Otolaryngology, Head and Neck Surgery, 23217Thomas Jefferson University, Philadelphia, PA, USA
- Division of Otolaryngology, Department of Surgery, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| |
Collapse
|
4
|
Raggio B, Mayer S, Friedlander P. Laryngeal Actinomycosis: A Rare Cause of Dysphonia. EAR, NOSE & THROAT JOURNAL 2019; 99:175-176. [PMID: 30943809 DOI: 10.1177/0145561319838429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Blake Raggio
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Scott Mayer
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| |
Collapse
|
5
|
Sei H, Nouta J, Miyaji S, Hato N. Post-transplantation laryngeal actinomycosis. Auris Nasus Larynx 2018; 46:917-920. [PMID: 30579693 DOI: 10.1016/j.anl.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/29/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
A case of laryngeal actinomycosis occurred after bone marrow transplantation was reported. The patient was a 14-year-old girl who had a history of bone marrow transplantation for the treatment of acute lymphocytic leukemia 4month before the onset of the disease. She was referred to our hospital complaining persistent sore throat since 2weeks ago. Fiberscopic observation proved the presence of white tumor-like mass on her right arytenoid of the larynx. As CT image demonstrated that the mass was localized at the arytenoid region with central low-density area surrounded by granulation tissue, we underwent biopsy under local anesthesia. Excision of the mass proved it to be a soft granulation including sulfur granules. Oral administration of amoxicillin 750mg per day was initiated as a postoperative medication. On day 17, histological study confirmed that the tumor-like mass was Actinomyces granuloma, and therefore amoxicillin administration continued. The medication was effective to subside the disease and the arytenoid lesion healed on day 31. Amoxicillin was further administered until day 70 to prevent recurrence. At 6month after the biopsy, she was free from the disease.
Collapse
Affiliation(s)
- Hirofumi Sei
- Department of Otolaryngology, Ehime University, School of Medicine, Toon, Shitsukawa, Ehime 91-0295, Japan.
| | - Jumpei Nouta
- Department of Otolaryngology, Takamatsu Red Cross Hospital, Takamatsu 4-1-3, Kagawa 760-0017, Japan
| | - Shota Miyaji
- Department of Otolaryngology, Ehime University, School of Medicine, Toon, Shitsukawa, Ehime 91-0295, Japan
| | - Naohito Hato
- Department of Otolaryngology, Ehime University, School of Medicine, Toon, Shitsukawa, Ehime 91-0295, Japan
| |
Collapse
|
6
|
Pujani M, Khan S, Jetley S, Monga S. Laryngeal actinomycosis with dysplasia in a young male with a recurrent laryngeal polyp. Trop Doct 2017; 47:183-185. [DOI: 10.1177/0049475516688161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mukta Pujani
- Associate Professor, Pathology, ESIC Medical College, Faridabad, India
| | - Sabina Khan
- Associate Professor, Pathology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India
| | - Sujata Jetley
- Professor & Head, Pathology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India
| | - Seema Monga
- Assistant Professor, Dept of Otorhinolaryngology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India
| |
Collapse
|
7
|
Abstract
Actinomyces israelii has long been recognized as a causative agent of actinomycosis. During the past 3 decades, a large number of novel Actinomyces species have been described. Their detection and identification in clinical microbiology laboratories and recognition as pathogens in clinical settings can be challenging. With the introduction of advanced molecular methods, knowledge about their clinical relevance is gradually increasing, and the spectrum of diseases associated with Actinomyces and Actinomyces-like organisms is widening accordingly; for example, Actinomyces meyeri, Actinomyces neuii, and Actinomyces turicensis as well as Actinotignum (formerly Actinobaculum) schaalii are emerging as important causes of specific infections at various body sites. In the present review, we have gathered this information to provide a comprehensive and microbiologically consistent overview of the significance of Actinomyces and some closely related taxa in human infections.
Collapse
|