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El-Atoum M, Gailor ME, Segal BH, Bonnewell JP, Almyroudis NG. Microbiology of Actinomyces Species Isolated From Patients With Invasive Disease and Contaminated Samples in a Comprehensive Cancer Center. Open Forum Infect Dis 2024; 11:ofae580. [PMID: 39450394 PMCID: PMC11500449 DOI: 10.1093/ofid/ofae580] [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: 06/11/2024] [Accepted: 10/10/2024] [Indexed: 10/26/2024] Open
Abstract
Background Actinomyces are mucous membrane commensals that infrequently cause invasive disease. Our goal was to define Actinomyces species prevalence, the predominant disease site and risk factors for actinomycosis. Methods We retrospectively reviewed patients with growth of Actinomyces species from cultures in a single-cancer center from July 2007 to June 2020. Proven invasive actinomycosis was defined as the presence of compatible clinical syndrome and radiographic findings with histopathological confirmation or culture from a normally sterile site. Probable invasive actinomycosis was defined based on the same criteria but without histologic confirmation. Contaminants were defined as culture growth in the absence of clinical or radiological findings consistent with disease. Speciation of Actinomyces was performed by the bioMerieux VITEK 2 anaerobic and coryneform identification card. Results Of 235 patients, 179 (76.2%) had malignancy. Among 90 (38.3%) patients with invasive actinomycosis, A odontolyticus was isolated in 32 (35.6%), followed by A meyeri in 20 (22.2%), and A naeslundii in 17 (18.9%). Among 145 (61.7%) colonized patients, A odontolyticus was isolated in 67 (46.2%), followed by A naeslundii in 27 (18.6%). Abdominopelvic infection was the most common site for invasive actinomycosis documented in 54 patients (60.0%) followed by orocervicofacial in 14 (15.6%) and thoracic in 10 (11.1%). Conclusions A odontolyticus, A meyeri, and A naeslundi were the most frequently isolated species causing invasive actinomycosis, and A odontolyticus and A nauslendii among colonizers. Abdominopelvic represented the most frequent site for invasive disease. Further studies are needed to investigate the epidemiology of Actinomyces species in this population.
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Affiliation(s)
- Mohammad El-Atoum
- Department of Internal Medicine, University at Buffalo—The State University of New York, Buffalo, New York, USA
| | - Mary E Gailor
- Division of Infectious Diseases, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center and Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York, USA
| | - Brahm H Segal
- Division of Infectious Diseases, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center and Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York, USA
| | - John P Bonnewell
- Division of Infectious Diseases, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center and Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York, USA
- Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Nikolaos G Almyroudis
- Division of Infectious Diseases, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center and Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York, USA
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Kim HG, Lee HK, Park E. Abdominal Actinomycotic Abscess after Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1516. [PMID: 37763634 PMCID: PMC10534873 DOI: 10.3390/medicina59091516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Actinomycosis is a rare, chronic, suppurative, and granulomatous bacterial disease. The Actinomyces species exist as normal flora in the oropharynx, gastrointestinal tract, and the female genital tract. They are incapable of penetrating the normal mucous membranes and become pathogenic only when this barrier has been destroyed by trauma, surgery, immunosuppression, or after viscus perforation. We report the first case of an actinomycotic abscess after laparoscopic sleeve gastrectomy. A 29-year-old man underwent a laparoscopic sleeve gastrectomy with no intra-operative complications. On postoperative day 3, the patient had a fever with elevated inflammatory markers. Abdominal computerized tomography (CT) with oral water-soluble contrast media showed no extra-luminal leakage and no fluid collection adjacent to the resected stomach, other than the fluid collection in the right subhepatic space. Percutaneous drainage was attempted, but the procedure failed due to the patient's thick abdominal wall. After two weeks of weight loss of about 12 kg, percutaneous drainage was successfully performed, and A. odontolyticus was identified through pus culture. After effective abscess drainage and high-dose antibiotics, the patient's symptoms improved and the abscess pocket disappeared. We reported Actinomyces infection after gastric sleeve surgery. In the case of abscess formation after gastric sleeve surgery caused by actinomycete infection, antibiotic treatment and percutaneous drainage are effective together.
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Affiliation(s)
- Ho-Goon Kim
- Department of General Surgery, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju 61469, Republic of Korea;
| | - Ho-Kyun Lee
- Department of General Surgery, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju 61469, Republic of Korea;
| | - Eunkyu Park
- Department of General Surgery, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
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Thapa K, Sarker M, Graman P. Thoracoabdominal actinomycosis associated with laparoscopic cholecystectomy and mimicking metastatic pulmonary malignancy. BMJ Case Rep 2022; 15:e250921. [PMID: 35906040 PMCID: PMC9344986 DOI: 10.1136/bcr-2022-250921] [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] [Accepted: 07/18/2022] [Indexed: 11/03/2022] Open
Abstract
Actinomyces naeslundii is rarely isolated in cases of actinomycosis. We present a case of thoracoabdominal actinomycosis caused by inadvertent enterotomy and gallstone spillage during a laparoscopic cholecystectomy. The actinomycosis initially presented as recurrent episodes of pneumonia, shortness of breath and unintentional weight loss. Initial CT imaging demonstrated pleural thickening along the right lung base as well as ill-defined consolidation in the right lower lobe. Repeat CT imaging showed progression of the mass-like region of consolidation with extrapulmonary spread to involve the abdomen, retroperitoneum and retrohepatic areas. Treatment involved intravenous antibiotics with concurrent abscess drainage followed by oral antibiotics.
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Affiliation(s)
- Kriti Thapa
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Moumita Sarker
- Department of Infectious Diseases, Mary Washington Healthcare, Fredericksburg, Virginia, USA
| | - Paul Graman
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Fra MC, Brenna M, Di Benedetto C, De Monti M. Abdominal actinomycosis after reparative surgery for cholecystogastric fistula in an immunosuppressed patient. BMJ Case Rep 2021; 14:14/7/e243445. [PMID: 34301686 PMCID: PMC8311317 DOI: 10.1136/bcr-2021-243445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A male patient, aged over 75 years, was referred to the emergency room for pain in his right hypochondrium. This pain, which persisted for approximately 3 days, radiated to his right flank and right iliac quadrant and worsened after meals. The patient reported no nausea, vomiting, diarrhoea, fever or recent traumatic events. Blood laboratory tests, ultrasonography, an MRI and a CT scan were performed, leading to the diagnosis of a mass in the Morrison's pouch with ultrasound features of adipose tissue compatible with a liposarcoma, infiltrating the liver and the right kidney. Subsequent CT-guided needle aspiration and a histological examination led to the diagnosis of actinomycosis. The patient was initially treated with a daily dose of 18 million IU of benzylpenicillin for 4 weeks and subsequently prescribed the oral administration of 3 g/day of amoxicillin for 11 months. A monitoring CT scan was performed after 1, 5, 8 and 12 months, and a CT scan re-evaluation confirmed that the mass had completely healed.
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5
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Kansara T, Majmundar M, Doshi R, Ghosh K, Saeed M. A Case of Life-threatening Actinomyces turicensis Bacteremia. Cureus 2020; 12:e6761. [PMID: 32140329 PMCID: PMC7039365 DOI: 10.7759/cureus.6761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Actinomyces turicensis (A. turicensis) are normal commensals of the oral, gut, vagina, and skin flora. Infection with these organisms is usually benign, and bacteremia is rare. Here, we describe a case of an otherwise healthy female patient presenting with renal calculi and life-threatening A. turicensis bacteremia. The patient did not have any risk factors for A. turicensis bacteremia. The patient developed multi-organ dysfunction syndrome and received a biodegradable right ureter stent. The patient improved with urosurgical intervention and appropriate antibiotic coverage.
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Affiliation(s)
- Tikal Kansara
- Internal Medicine, New York Medical College-Metropolitan Hospital Center, New York City, USA
| | - Monil Majmundar
- Internal Medicine, New York Medical College-Metropolitan Hospital Center, New York City, USA
| | - Rajkumar Doshi
- Internal Medicine, University of Nevada, Reno School of Medicine, Reno, USA
| | - Kuldeep Ghosh
- Internal Medicine, New York Medical College-Metropolitan Hospital Center, New York City, USA
| | - Mohammad Saeed
- Internal Medicine, New York Medical College-Metropolitan Hospital Center, New York City, USA
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6
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Infected Renal Cyst as a Complication of Dropped Gallstones during Laparoscopic Cholecystectomy. Case Rep Gastrointest Med 2018; 2018:2478245. [PMID: 30405920 PMCID: PMC6186367 DOI: 10.1155/2018/2478245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Dropped gallstones are a relatively common complication, occurring in 3% to 32% of laparoscopic cholecystectomies performed, depending on various intraoperative risk factors. However, complications arising from dropped gallstones are relatively rare, occurring in fewer than 1% of such patients, and can include abscesses and inflammatory masses confined to the subhepatic space, presenting days to years later. We report a patient who developed an infected renal cyst as a result of dropped gallstones, which created a fistula from the duodenum to a previously simple right renal cyst, which was initially identified on an abdominal CT scan. Dropped gallstones can result in substantial morbidity in a minority of patients following cholecystectomy performed for cholecystitis, and a high clinical as well as radiological index of suspicion may be required for accurate early recognition and treatment.
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7
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Alhumoud Z, Salem A. Actinomycosis presenting as an anterior abdominal mass after laparoscopic cholecystectomy. BMJ Case Rep 2017; 2017:bcr-2017-220357. [PMID: 28536234 DOI: 10.1136/bcr-2017-220357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal actinomycosis is a rare disease caused by different anaerobic Actinomyces species. We report the case of a 55-year-old woman who presented with a painless, slow growing, left upper abdominal mass that developed after a laparoscopic cholecystectomy. A CT scan and MRI of the abdomen revealed a desmoid tumour of the left rectus abdominis muscle.Surgical excision was performed with an uneventful postoperative course. The histological analysis of the specimen was inconsistent with a desmoid tumour and revealed an infection of Actinomyces israelii in the anterior abdominal wall that was confirmed with a microbiology culture. The surgical treatment was followed by a course of penicillin antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications. Although it is rare, the patient's history of laparoscopic cholecystectomy was identified as the likely source of infection.
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Affiliation(s)
- Zainab Alhumoud
- Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amro Salem
- Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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8
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Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article. Surg Laparosc Endosc Percutan Tech 2017; 26:183-92. [PMID: 27258908 DOI: 10.1097/sle.0000000000000274] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC. METHODS We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications. RESULTS Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions. CONCLUSIONS Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.
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9
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Sahay S, McKelvy BJ. Actinomycosis Presenting as Recurrent Hepatic Abscess. Am J Med 2017; 130:e21-e22. [PMID: 27593605 DOI: 10.1016/j.amjmed.2016.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Sandeep Sahay
- Houston Methodist Lung Center, Houston Methodist Hospital, Texas.
| | - Brandy Jo McKelvy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston, Texas
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10
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Xing J, Rodriguez EF, Monaco SE, Pantanowitz L. Cytopathology of Hepatobiliary-Related Actinomycosis. Acta Cytol 2016; 60:179-84. [PMID: 27199159 DOI: 10.1159/000445971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/01/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The clinical diagnosis of hepatobiliary-related actinomycosis can be challenging owing to its rarity and variable presentation. Moreover, actinomycotic pseudotumors may mimic malignancy and result in unnecessary surgical resection. Herein, we present the clinical and cytopathological features of 3 cases with hepatobiliary-related actinomycosis. CASES The first patient was a 73-year-old man who presented with an exophytic liver lesion. The second patient was a 78-year-old woman who presented with a biliary stricture. The third patient was an 88-year-old woman with a right flank mass extending to the liver. The aspirate smears in these 3 cases demonstrated 'cotton ball' clusters of filamentous microorganisms and abscesses. The cell blocks of 2 of the patients showed sulfur granules with peripheral filamentous microorganisms positive with a Gram stain but negative with an acid fast stain, consistent with Actinomyces species. All patients were elderly and shared a past surgical history of laparoscopic cholecystectomy. CONCLUSION These cases demonstrate the complementary role of cytology in the diagnosis of hepatobiliary actinomycosis. A cytologic diagnosis of actinomycosis is minimally invasive and quick. It can prompt proper culture medium selection and avoid unnecessary or extensive surgery. Based on our experience, laparoscopic cholecystectomy may be a precipitating factor for the subsequent development of hepatobiliary-related actinomycosis.
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Affiliation(s)
- Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA
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11
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Tankel JA, Gurjar SV, Holford NC, Williams S. Abdominal actinomycosis after laparoscopic cholecystectomy: an uncommon presentation of an uncommon problem. Oxf Med Case Reports 2015; 2015:185-7. [PMID: 25988074 PMCID: PMC4370009 DOI: 10.1093/omcr/omv003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/30/2022] Open
Abstract
Actinomycosis is a rare bacterial infection with a broad clinical presentation that is seldom reported after elective cholecystectomy. We present an as-of-yet unreported case of actinomycosis in an 81-year-old gentleman who was found to have right-sided peritonitis and small bowel obstruction 11 months after elective laparoscopic cholecystectomy. A complex loculated lesion was found on laparotomy with a protracted course of antibiotics being needed for treatment. The rarity of this condition will mean it remains a surprise diagnosis to many clinicians. However, it is important that clinicians maintain some index of suspicion to prevent unnecessary surgery and are aware of the protracted course of antibiotics that is needed for successful treatment.
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Affiliation(s)
- James A Tankel
- Department of Surgery , Luton and Dunstable University Hospital Foundation Trust , Luton, Bedfordshire , UK
| | - Shashank V Gurjar
- Department of Surgery , Luton and Dunstable University Hospital Foundation Trust , Luton, Bedfordshire , UK
| | - Nicholas C Holford
- Department of Surgery , Luton and Dunstable University Hospital Foundation Trust , Luton, Bedfordshire , UK
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12
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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.
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13
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Pierre I, Zarrouk V, Noussair L, Molina JM, Fantin B. Invasive actinomycosis: surrogate marker of a poor prognosis in immunocompromised patients. Int J Infect Dis 2014; 29:74-9. [PMID: 25449239 DOI: 10.1016/j.ijid.2014.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Actinomycosis is a rare disease favored by disruption of the mucosal barrier. In order to investigate the impact of immunosuppression on outcome we analyzed the most severe cases observed in patients hospitalized in three tertiary care centers. METHODS We reviewed all cases of proven invasive actinomycosis occurring over a 12-year period (1997 to 2009) in three teaching hospitals in the Paris area. RESULTS Thirty-three patients (16 male) were identified as having an invasive actinomycosis requiring hospitalization. The diagnosis was made by microbiological identification in 26 patients, pathological examination in eight patients, and by both methods in one. Twenty patients (61%) were immunocompromised. Actinomycosis localization was abdominal or pelvic in 17 patients, thoracic in 11, cervicofacial in three, and neurological in two. Twenty patients (61%) underwent surgery. All strains were susceptible to amoxicillin. All patients were treated with a beta-lactam antibiotic, for a median length of 82 days. Twenty-eight patients (85%) were considered as cured. Overall mortality at hospital discharge was 21% (7/33). Mortality was higher in immunocompromised patients (7/20; 21%) compared to non-immunocompromised patients (0/13) (p=0.027). However, six of seven deaths were directly related to the underlying disease. CONCLUSIONS Actinomycosis is a cause of severe infection in immunocompromised patients and a surrogate marker of a poor prognosis in this specific population.
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Affiliation(s)
- Isabelle Pierre
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, 100 boulevard du général Leclerc, 92110 Clichy, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, 100 boulevard du général Leclerc, 92110 Clichy, France
| | - Latifa Noussair
- Service de Microbiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Jean-Michel Molina
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Bruno Fantin
- Service de Médecine Interne, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, 100 boulevard du général Leclerc, 92110 Clichy, France; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France.
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Yonetani S, Ohnishi H, Araki K, Hiroi M, Takagi Y, Ichimura S, Watanabe T. A psoas abscess caused by Propionibacterium propionicum. J Infect Chemother 2014; 20:650-2. [PMID: 25129856 DOI: 10.1016/j.jiac.2014.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/10/2014] [Accepted: 06/27/2014] [Indexed: 11/17/2022]
Abstract
Pelvic actinomycosis-like disease due to Propionibacterium propionicum has been very rare and only a few cases have been reported in the literature. We herein report a probable first case of a psoas abscess caused by P. propionicum. Since P. propionicum is indistinguishable from Actinomyces israelii by morphological features or routine biochemical tests, 16S rRNA gene sequencing was useful to discriminate these two species in this case.
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Affiliation(s)
- Shota Yonetani
- Department of Laboratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
| | - Koji Araki
- Department of Laboratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Megumi Hiroi
- Department of Laboratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yasushi Takagi
- Department of Laboratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Shoichi Ichimura
- Department of Orthopedic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Takashi Watanabe
- Department of Laboratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
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Robinson MH, Graupensperger K, Davidson M. Gastric Remnant Fistula due to Gallstone Abscess Diagnosed 12 Years After Laparoscopic Cholecystectomy: Clinical and Pathologic Characteristics of a Rare Case. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew H. Robinson
- Department of General Surgery, Pinnacle Health System, Harrisburg, Pennsylvania
| | - Kurt Graupensperger
- Department of General Surgery, Pinnacle Health System, Harrisburg, Pennsylvania
| | - Matthew Davidson
- Department of General Surgery, Pinnacle Health System, Harrisburg, Pennsylvania
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16
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Ladic A, Petrovic I, Augustin G, Puretic H, Skegro M, Gojevic A, Nikolic I. Hemoptysis as an early symptom of abdominal actinomycosis with thoracic extension ten years after cholecystectomy with retained gallstone. Surg Infect (Larchmt) 2013; 14:408-11. [PMID: 23859691 DOI: 10.1089/sur.2012.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thoracoabdominal actinomycosis is rare, especially in the context of readily available medical facilities. METHODS Case report and review of the literature. CASE REPORT A 54-year-old male patient was admitted because of hemoptysis and a pulmonary infiltrate in the left lower lobe. His history was unremarkable except for chronic gastritis and an elective laparoscopic cholecystectomy performed 10 years earlier. Following persistent hemoptysis, elevated inflammatory markers, and a non-revealing bronchoscopy, a computed tomography scan of the thorax and upper abdomen revealed a tumor in the upper part of the left kidney spreading directly to the adjacent diaphragm and left lower lobe. Laparotomy revealed a granulomatous mass containing a gallstone, as well as orange granular content. The treatment involved surgical removal of the mass, splenectomy, excision of the infiltrated part of the left hemidiaphragm, and decortication of the left lower lobe. Because of a prolonged post-operative low-grade fever and radiologically confirmed encapsulation in the lingula, the patient was given ceftriaxone. Repeat bronchoscopy revealed Actinomyces meyeri. The initial antibiotic therapy was replaced with amoxicillin-clavulanic acid, after which the patient's health improved. CONCLUSION Actinomycosis is still a highly intriguing disease, as initial symptoms often mislead clinicians. It is important to consider the disease whenever we are challenged diagnostically or when risk factors are present.
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Affiliation(s)
- Agata Ladic
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia.
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17
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Zbar AP, Ranasinghe W, Kennedy PJ. Subphrenic abscess secondary to Actinomycosis meyeri and Klebsiella ozaenae following laparoscopic cholecystectomy. South Med J 2009; 102:725-7. [PMID: 19487988 DOI: 10.1097/smj.0b013e3181abddc5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism has not previously been reported in a subphrenic abscess. The etiopathogenesis and management of this condition are presented.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery, Universities of New England and Newcastle, Tamworth Rural Referral Hospital, Newcastle, New South Wales, Australia.
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18
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Ozgediz D, Zheng J, Smith EB, Corvera CU. Abdominal actinomycosis after laparoscopic cholecystectomy: a rare complication of bile spillage. Surg Infect (Larchmt) 2009; 10:297-300. [PMID: 19485786 DOI: 10.1089/sur.2007.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Abdominal actinomycosis has not been reported after elective cholecystectomy. METHODS Case report and review of the pertinent English-language literature. CASE REPORT A 69-year-old man with abdominal actinomycosis presented with an abdominal mass mimicking a malignant tumor two years after laparoscopic cholecystectomy. Investigation revealed the likely source of infection to be bile spillage during surgery. CONCLUSION This is the first reported case of abdominal actinomycosis probably attributable to bile spillage during laparoscopic cholecystectomy.
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Affiliation(s)
- Doruk Ozgediz
- Department of Surgery, University of California-San Francisco, San Francisco, California 94121, USA
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