Nasopharyngeal actinomycosis

A Case of Actinomycosis of the Nasopharynx

Actinomycosis is a progressive granulomatous infection caused by the bacteria Actinomyces israelii. Classically, the three most common clinical forms are cervicofacial, thoracic, and abdominopelvic. On the contrary, nasopharyngeal actinomycosis is considered to be a rare clinical disease, and its occurrence is extremely low. The infection can take place without any preceding infection or on immunocompromised status. A 25-year-old male with no previous medical history presented with persistent nasal congestion and rhinorrhea. A nasal endoscopy examination revealed an unclearly demarcated nasopharyngeal mass, and a complete microbiology and pathology analysis showed actinomycetes colonies. After two weeks of oral Augmentin therapy, the patient's illness was completely eradicated. Diagnosis of nasopharyngeal actinomycosis is exceptionally crucial, and with early treatment of appropriate antibiotic therapy, the prognosis is excellent. Careful follow-up after adequate treatment as the possibility of frequent relapse is common.

A rare case of abdominal wall necrotizing fasciitis caused by Actinomyces europaeus-a novel pathogen

Actinomyces europaeus is a sub-species of actinomyces first isolated in humans in 1997. It is commensal bacteria found within the genitourinary and gastrointestinal tract. Although it is known to cause soft tissue infection and has been known to cause abscesses, it has never been identified as the primary pathogen in a case of necrotizing fasciitis. We present the case of a 59-year-old man with recurrent groin infections, poorly controlled Type 2 diabetes and obesity who developed necrotizing fasciitis of his lower abdominal wall secondary to Actinomyces europaeus. We discuss the clinical course and the value of early identification of the pathogen and specialist microbiologist advice.

Actinomyces europaeus Isolated from a Breast Abscess in a Penicillin-Allergic Patient

This is a case of Actinomyces europaeus in the breast abscess of a penicillin-allergic woman. The mainstay of treatment for actinomycosis is penicillin, and there is a lack of literature describing nonpenicillin treatment options. A 69-year-old woman presented acutely with a breast abscess which was managed with incision and drainage and antibiotic therapy to good response. 21 days after presentation, Actinomyces were grown from the culture of pus, so the patient was recalled and more rigorous treatment and follow-up were initiated. The penicillin allergy led to difficulty in the identification of an appropriate antimicrobial agent that was also logistically feasible to be given on an outpatient IV basis. IV tigecycline followed by oral clarithromycin was found to be effective treatment.