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Touati MD, Saidani A, Kallel MA, Brahem E, Belhadj A, Chebbi F. Actinomycosis as a rare cause of acute appendicitis: Case report and comprehensive literature review. Int J Surg Case Rep 2024; 121:109975. [PMID: 38941730 PMCID: PMC11260565 DOI: 10.1016/j.ijscr.2024.109975] [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: 05/18/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species. While it commonly affects the cervicofacial region, thorax, and abdomen, appendicular involvement is extremely uncommon. This case report details the presentation, diagnosis, and management of a 45-year-old female patient with acute appendicitis secondary to actinomycosis. CASE PRESENTATION A 45-year-old woman, with an 8-year intrauterine device history, presented with three-day right iliac fossa pain, vomiting, and stable vital signs. Laboratory tests revealed an inflammatory syndrome. Suspecting acute appendicitis, a CT scan confirmed a swollen 10 mm appendix. Laparoscopic surgery revealed a phlegmonous appendix, leading to an uncomplicated appendectomy. Pathological examination confirmed actinomycotic granules, supporting the diagnosis of actinomycosis appendicitis. The patient received 18 million units of intravenous penicillin G daily for 6 weeks followed by a 6-month course of oral amoxicillin (1 g three times daily) thereafter, showing favorable progression with no symptoms. Normal clinical and ultrasound follow-ups were observed at one year. CLINICAL DISCUSSION Appendiceal actinomycosis is a rare condition. Women, especially those with intrauterine contraceptives, experience an increase in cases due to chronic inflammation. Typically underdiagnosed, actinomycosis mimics other conditions, presenting with nonspecific symptoms. Laboratory results offer limited assistance, and histological confirmation is crucial. Histopathological examination is mandatory for diagnosis confirmation. Management involves surgical resection and prolonged penicillin-based antibiotics, providing a favorable prognosis with low mortality. CONCLUSION This case underscores the importance of considering rare etiologies, such as actinomycosis, in the differential diagnosis of appendicitis. Timely recognition and management are crucial for optimal patient outcomes.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Med Ali Kallel
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Emna Brahem
- Department of Pathological Anatomy and Cytology, Abderrahmen-Mami Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
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Abera MT, Dumessa KA, Robele TJ, Tefera TG, Woldeyohannes AM. Dot-in-circle sign in cervical actinomycotic mycetoma: An extremely rare case report. Radiol Case Rep 2024; 19:2160-2167. [PMID: 38515773 PMCID: PMC10950569 DOI: 10.1016/j.radcr.2024.02.078] [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: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Actinomycosis is an unusual, chronic granulomatous infection caused by Actinomycetes spp. The organism also causes mycetoma, a neglected tropical disease in endemic regions. We present a very uncommon case of extensive actinomycosis of the soft tissues in the neck with perivertebral extension that showed the dot-in-circle sign on magnetic resonance imaging. A 29-year-old male patient presented with progressively enlarging hard posterior neck swelling of 4 years duration. Subsequently, magnetic resonance imaging showed the dot-in-circle sign in an avidly enhancing infiltrative lesion with extensive involvement of the neck and perivertebral soft tissue. The pathologic examination was in line with actinomycosis. The patient responded to high doses of combination parenteral and oral antibiotics.
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Affiliation(s)
- Michael T. Abera
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Kebron A. Dumessa
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Taye J. Robele
- MCM Comprehensive Specialized Hospital, Department of Pathology, Addis Ababa, Ethiopia
| | - Tesfaye G. Tefera
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Abebe M. Woldeyohannes
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
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3
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Arslan RS, Koca YS, Beyoğlu R, Yenipazar AE. Appendecular actinomycosis: A case series of 14 patients. Med Clin (Barc) 2024; 162:500-504. [PMID: 38570296 DOI: 10.1016/j.medcli.2024.02.005] [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: 12/11/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This study aims to assess the clinical, radiological, and histological characteristics of Actinomyces infection identified in appendectomy specimens. MATERIAL AND METHODS Between January 2013 and November 2023, 5834 patients underwent appendectomy in our clinic, and their pathology reports were retrospectively reviewed. RESULTS Actinomyces appendicites were reported in 14 specimens (0.23%). It was determined that appendectomy was performed in only 10 patients (71.4%), ileocecal resection was performed in two patients (14.2%) and right hemicolectomy in two patients (14.2%). The operations on five patients were performed by laparoscopy, and the operations on the other nine patients were performed by open surgery. Laparoscopy was started in three patients and converted to open surgery due to suspicion of an ileocecal mass and cecal perforation. It was found that the white blood cell count of three patients was within the normal range of reference (8-9.77mg/dL); leukocytosis was detected in other patients (10.2-18.7mg/dL). C-reactive protein was normal in one patient and high in the rest of the patients. While the first-hour erythrocyte sedimentation rate was normal in five patients, it was found to be high in the other patients. Findings on radiological imaging were reported as acute appendicitis, appendicular plastron, and ileocecal mass. As a result of the pathology findings, the patients were given oral penicillin or semi-synthetic penicillin derivatives during one month. CONCLUSION Ileocecal and appendecular actinomycosis are rare, and preoperative diagnosis is difficult. A definitive diagnosis is usually made after a histopathological examination. After surgery, long-term antimicrobial treatment of the patient is possible with penicillin.
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Affiliation(s)
| | - Yavuz Savaş Koca
- Servergazi State Hospital Department of General Surgery, Denizli, Turkey
| | - Reşad Beyoğlu
- Servergazi State Hospital Department of Emergency Medicine, Denizli, Turkey
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Bohara S, Khadka M, Bhat PS, Syangtang P, Karki B, Shrestha B, Acharya SA, Khetan K, Rayamajhi J, Rawal SB. Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal. Clin Case Rep 2023; 11:e7996. [PMID: 37786458 PMCID: PMC10541570 DOI: 10.1002/ccr3.7996] [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: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Key Clinical Message Actinomycosis is a rare cause of appendicitis with an incidence of 0.3-1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination. Abstract Appendicular actinomycosis, a rare, chronic granulomatous infection caused by actinomyces species, holds a significant preoperative diagnostic summons and is often diagnosed serendipitously during the regular histopathological examination. Herein, we present a case of a 36-year-old female who presented with features suggestive of acute appendicitis, underwent laparoscopic appendicectomy, and was diagnosed with appendicular actinomycosis from the histopathological examination.
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Affiliation(s)
- Sujan Bohara
- Department of Cardiovascular SurgerySahid Gangalal National Heart CentreKathmanduNepal
| | - Manoj Khadka
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Pawan Singh Bhat
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
| | - Prajwal Syangtang
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Badal Karki
- Department of General SurgeryMadan Bhandari Hospital, and Trauma CenterUrlabariNepal
| | - Bhagawan Shrestha
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | | | - Khusbhu Khetan
- Department of Laboratory medicine and pathologyNepal MedicitiLalitpurNepal
| | - Jyoti Rayamajhi
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
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Torun BC, Gök AFK, İlhan M, Yegen G, Başaran S, Ertekin C, Günay MK, Yanar H. A rare cause of acute abdominal pain: Actinomyces infection of colon mimicking a malignant neoplasm due to intrauterine device. ULUS TRAVMA ACIL CER 2022; 28:537-540. [PMID: 35485507 PMCID: PMC10520999 DOI: 10.14744/tjtes.2020.45672] [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: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 11/20/2022]
Abstract
Actinomycosis is a rare, chronic granulomatous disease that is challenging to diagnose because the clinical symptoms and signs are nonspecific. Usage of intrauterine device (IUD) or being immunocompromised is facilitating factors. Clinical and radiological findings can mimic malignant neoplasm, inflammatory bowel disorder, or acute diverticulitis. We report a case of actinomyces infection of the colon secondary to IUD, which is a rare cause of acute abdominal pain and can mimic a malignant neoplasm. We also provide a review of the literature. Unnecessary surgery can be avoided with the correct diagnosis of granulomatous infectious diseases that can be treated with antibiotics.
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Affiliation(s)
- Bahar Canbay Torun
- Department of General Surgery, Sultangazi Haseki Training and Research Hospital, İstanbul-Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mehmet İlhan
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Gülçin Yegen
- Department of Pathology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Seniha Başaran
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Cemalettin Ertekin
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mustafa Kayıhan Günay
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Hakan Yanar
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
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Baba H, Fassi Fihri J, Ramraoui ME, Elguazzar A, Zeroual A, Lahkim M, El Khader A, Achour A, El Barni R. When a rare simultaneous infection simulates a local extension of a rectal cancer: a case report. J Med Case Rep 2021; 15:401. [PMID: 34380562 PMCID: PMC8359103 DOI: 10.1186/s13256-021-02989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Actinomycosis is a rare chronic infection caused by Actinomyces. The abdominopelvic localization of this pathology makes preoperative diagnosis extremely exceptional. The following report is the case of a patient treated for adenocarcinoma of the middle rectum associated with mesorectal actinomycosis. The diagnosis of actinomycosis was made postoperatively. Case presentation A 69-year-old Caucasian male patient was admitted for rectal bleeding. Clinical and paraclinical assessment revealed a middle rectum adenocarcinoma with local extension in the mesorectum. The patient underwent an anterior resection of the rectum by laparotomy after neoadjuvant chemoradiotherapy. Postoperative follow-up was simple. Pathological study of the specimen noted complete sterilization of the rectal adenocarcinoma and the presence of large foci of suppurative necrosis containing actinomycotic grains in the mesorectum. Conclusion Abdominopelvic actinomycosis is a rare pathology and has therefore rarely been dealt with. This issue can lead to unnecessary and mutilating surgery. We report an exceptional coincidence of rectal adenocarcinoma and mesorectal actinomycosis mistaken for mesorectal extension of the cancer.
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Affiliation(s)
- Hicham Baba
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco. .,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
| | - Jawad Fassi Fihri
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Mohammed Essaid Ramraoui
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed Elguazzar
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed Zeroual
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Mohammed Lahkim
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed El Khader
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Abdessamad Achour
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Rachid El Barni
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
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Xu YY, Zhang J, Lu AL, Peng J, Xu XW. Clinical features of actinomycosis: A 20-year experience of a single institute in Southern China. J Mycol Med 2021; 31:101169. [PMID: 34224940 DOI: 10.1016/j.mycmed.2021.101169] [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: 06/16/2020] [Revised: 01/11/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Actinomycosis is a rare indolent infectious disease with nonspecific clinical presentations that delay diagnosis. Although actinomycosis is thought to be more prevalent in developing countries, data from developing countries are scarce. This study aimed to profile actinomycosis in developing countries and identify how it differed from profiles of developed countries. METHODS Patients fulfilling the inclusion criteria for actinomycosis from Nanfang Hospital in southern China between January 1999 and December 2018 were retrospectively analyzed. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance. RESULTS Thirty‑one patients were included in this study. The disease was diagnosed predominately in the orocervicofacial (n = 14), cardiothoracic (n = 11), abdominopelvic (n = 5), and soft tissue (n = 1) regions. Diagnosis was obtained by either histopathology (n = 29, 94%) or microbiology (n = 2, 6%). Only one-third of patients presented with general symptoms, such as fever and weight loss. Ten were lost during follow-up, and the median duration of antibiotic use was 93.5 days (interquartile range 28-300), whereas the median follow-up time was 34 months (interquartile range 9-132). Ten patients receiving complete resection of the lesion were cured without postoperative use of antibiotics. Only one patient relapsed during the follow-up period. CONCLUSIONS Actinomycosis is a rare disease even in developing countries, and both misdiagnosis and missed diagnosis are common. Diagnosis was often delayed and was obtained postoperatively from histopathology in developing countries. Hence, clinicians should be aware of this disease in patients with high risk factors. In the future, specific molecular methods may help to improve early diagnosis and treatment.
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Affiliation(s)
- Yu-Yuan Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jian Zhang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ai-Li Lu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xu-Wen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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Safety of Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Complex Perianal Fistulas Not Associated With Crohn's Disease: A Phase I Clinical Trial. Dis Colon Rectum 2021; 64:328-334. [PMID: 33538521 DOI: 10.1097/dcr.0000000000001863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anal fistula treatment aims to eradicate the fistula, preserve the sphincter, prevent recurrence, and allow an early return to daily activities for the patient. Because of the difficulty of achieving these goals, stem cell-based therapy has emerged for the treatment of complex perianal fistula with promising results. OBJECTIVE The objective of this study was to evaluate the safety of allogeneic mesenchymal stem cells in the treatment of complex anal fistula in patients without Crohn's disease. DESIGN This was a prospective nonrandomized phase I clinical trial. SETTINGS This study was conducted at a second-level hospital. PATIENTS Twenty consecutive patients diagnosed with a complex fistula were included. INTERVENTIONS All patients received 40 × 106 allogeneic mesenchymal stem cells. In patients with 2 tracts, 20 × 106 stem cells were applied on each tract. MAIN OUTCOME MEASURES The patients were discharged 24 hours after the procedure and were evaluated at 1, 2, 4, 8, 16, and 24 weeks after the application. The long-term follow-up was performed 1 year after the procedure. RESULTS The procedure was performed in a total of 20 patients from October 1, 2016, to October 31, 2017; 1 patient was eliminated from the final data analysis. No adverse effects were reported within the first 24 hours, and all the patients were discharged asymptomatic. Three patients (15%) presented with perianal abscess. In 1 patient, the abscess appeared at the fourth week, and, in the other 2 patients, the abscess was diagnosed at week 8. Complete closure was achieved in 13 (69%) patients. LIMITATIONS This was a nonrandomized controlled trial. CONCLUSION The use of allogeneic mesenchymal stem cells as a treatment is a safe option for the management of complex perianal fistula not associated with Crohn's disease. See Video Abstract at http://links.lww.com/DCR/B443. SEGURIDAD DE LAS CLULAS MADRE MESENQUIMALES ALOGNICAS DERIVADAS DEL TEJIDO ADIPOSO PARA EL TRATAMIENTO DE FSTULAS PERIANALES COMPLEJAS NO ASOCIADAS CON LA ENFERMEDAD DE CROHN ENSAYO CLNICO DE FASE I ANTECEDENTES:El tratamiento de la fístula anal tiene como objetivo erradicar la fístula, preservar el esfínter, prevenir la recurrencia y permitir un retorno temprano a las actividades diarias del paciente. Debido a la dificultad de alcanzar estos objetivos, ha surgido una terapia basada en células madre para el tratamiento de la fístula perianal compleja con resultados prometedores.OBJETIVO:El objetivo de este estudio fue evaluar la seguridad de las células madre mesenquimales alogénicas en el tratamiento de la fístula anal compleja en pacientes sin enfermedad de Crohn.DISEÑO:Este fue un ensayo clínico prospectivo no aleatorizado de fase I.AMBIENTE:Este estudio se realizó en un hospital de segundo nivel.PACIENTES:Veinte pacientes consecutivos diagnosticados de fístula compleja.INTERVENCIONES:Todos los pacientes recibieron 40 x 106 células madre mesenquimales alogénicas, en pacientes con dos tractos, se aplicaron 20 x 106 células madre en cada tracto.PRINCIPALES MEDIDAS DE RESULTADO:Los pacientes fueron dados de alta 24 horas después del procedimiento y fueron evaluados 1, 2, 4, 8, 16, 24 semanas después de la aplicación. El seguimiento a largo plazo se realizó un año después del procedimiento.RESULTADOS:El procedimiento se realizó en un total de 20 pacientes desde el 1 de octubre de 2016 al 31 de octubre de 2017; un paciente fue eliminado del análisis de datos final. No se informaron efectos adversos en las primeras 24 horas, todos los pacientes fueron dados de alta asintomáticos. Tres pacientes (15%) presentaron absceso perianal. En un paciente, el absceso apareció a la cuarta semana y en los otros dos pacientes el absceso se diagnosticó en la octava semana. El cierre completo se logró en 13 (69%) de los pacientes.LIMITACIONES:Este fue un ensayo controlado no aleatorio.CONCLUSIÓN:El uso de células madre mesenquimales alogénicas como tratamiento es una opción segura para el manejo de la fístula perianal compleja no asociada con la enfermedad de Crohn. Consulte Video Resumen en http://links.lww.com/DCR/B443.
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A rare cause of dysphagia: gastro-esophageal junction actinomycosis diagnosed with endoscopic ultrasound. Eur J Gastroenterol Hepatol 2021; 33:117-119. [PMID: 33259384 DOI: 10.1097/meg.0000000000001927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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10
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Džupová O, Kulichová J, Beneš J. Disseminated Pelvic Actinomycosis Caused by Actinomyces Naeslundii. Antibiotics (Basel) 2020; 9:antibiotics9110748. [PMID: 33137889 PMCID: PMC7694143 DOI: 10.3390/antibiotics9110748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
Actinomycosis is a chronic bacterial infection characterized by continuous local spread, irrespective of anatomical barriers, and granulomatous suppurative inflammation. Due to its expansive local growth, it can simulate a malignant tumour. Subsequent hematogenous dissemination to distant organs can mimic metastases and further increase suspicion for malignancy. A case of severe disseminated pelvic actinomycosis associated with intrauterine device is described here. The patient presented with a pelvic mass mimicking a tumour, bilateral ureteral obstruction, ascites, multinodular involvement of the liver, lungs and spleen, inferior vena cava thrombosis and extreme cachexia. Actinomycosis was diagnosed by liver biopsy and confirmed by culture of Actinomyces naeslundii from extracted intrauterine contraceptive device (IUD). Prolonged treatment with aminopenicillin and surgery resulted in recovery with moderate sequelae.
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Affiliation(s)
- Olga Džupová
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
- Department of Infectious Diseases, Hospital Na Bulovce, 100 81 Prague, Czech Republic;
- Correspondence:
| | - Jana Kulichová
- Department of Infectious Diseases, Hospital Na Bulovce, 100 81 Prague, Czech Republic;
| | - Jiří Beneš
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
- Department of Infectious Diseases, Hospital Na Bulovce, 100 81 Prague, Czech Republic;
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11
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Jabi R, Ramdani H, Elmir S, Elmejjati F, Serji B, El Harroudi T, Bouziane M. Pseudotumoral Actinomycosis Mimicking Malignant Colic Disease: A Case Report and Literature Review. Visc Med 2020; 36:333-337. [PMID: 33005660 DOI: 10.1159/000502895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/22/2019] [Indexed: 01/16/2023] Open
Abstract
Abdominal actinomycosis is a rare, chronic, and often unrecognized suppurative disease. It is caused by an anaerobic gram-positive bacterium, most commonly Actinomyces israeli. Colonic actinomycosis is rarely reported and may be responsible for a pseudotumoral syndrome leading, in the suspicion of malignancy, to a large and mutilating excisional surgery. It is usually the histopathological examination of the surgical specimens that accurately corrects the diagnosis. Here, we report a rare case of a colic actinomycotic involvement taking a pseudotumoral form. The diagnosis was made based on the pathological examination of the surgical piece. Intravenous and then adjuvant oral penicillin G treatment has allowed a favorable clinical evolution. This observation illustrates the preoperative diagnostic difficulties of this rare disease.
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Affiliation(s)
- Rachid Jabi
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Hanae Ramdani
- Radiology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Siham Elmir
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Fouad Elmejjati
- Radiotherapy Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Badr Serji
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Tijani El Harroudi
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Mohammed Bouziane
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
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12
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Ben Ismail I, Zenaidi H, Khanchel F, Rebii S, Zoghlami A. Actinomycosis: A rare etiology of chronic appendicitis in elderly. Int J Infect Dis 2020; 100:180-181. [PMID: 32800856 DOI: 10.1016/j.ijid.2020.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/03/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Imen Ben Ismail
- University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia.
| | - Hakim Zenaidi
- University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia.
| | - Fatma Khanchel
- University of Tunis El Manar, Department of Pathology, Habib Thameur Hospital, Tunisia.
| | - Saber Rebii
- University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia.
| | - Ayoub Zoghlami
- University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia.
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Manterola C, Grande L, Riffo‐Campos ÁL, Salgado C, Otzen T. Clinical aspects of abdominal actinomycosis: a systematic review. ANZ J Surg 2020; 90:1465-1468. [DOI: 10.1111/ans.16141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Manterola
- Department of SurgeryUniversidad de La Frontera Temuco Chile
- Center of Excellence in Morphological and Surgical Studies (CEMyQ)Universidad de La Frontera Temuco Chile
- PhD Program in Medical SciencesUniversidad de La Frontera Temuco Chile
| | - Luis Grande
- Department of SurgeryHospital del Mar/Institut Hospital del Mar d'Investigacions Mèdiques Barcelona Spain
- Department of SurgeryUniversitat Autònoma de Barcelona Barcelona Spain
| | | | - Carla Salgado
- Department of MedicineUniversidad del Azuay Cuenca Ecuador
| | - Tamara Otzen
- Center of Excellence in Morphological and Surgical Studies (CEMyQ)Universidad de La Frontera Temuco Chile
- PhD Program in Medical SciencesUniversidad de La Frontera Temuco Chile
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Asiri BI, Alshehri AA, Alqahtani AS, Albishi AM, Assiri YI, Asmiri EA. Caecum actinomycosis with acute abdomen: A case report. J Taibah Univ Med Sci 2020; 15:148-152. [PMID: 32368212 PMCID: PMC7184210 DOI: 10.1016/j.jtumed.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 11/19/2022] Open
Abstract
Abdominal actinomycosis, one of the causes of ileocaecal disorders, is usually considered when other more common clinical conditions have been excluded. Actinomycosis is a rare infectious bacterial disorder caused by the Actinomyces species. We present the case of a 38-year male Saudi soldier who presented with pain in the right iliac fossa since 4 days prior to presentation. This stabbing pain started gradually. Based on clinical examination and abdominal ultrasound findings, an appendectomy was performed. Histological examination revealed appendicular actinomycosis with lymphoid hyperplasia, serosa congestion, and filamentous bacteria in the appendicular lumen. The patient was treated with amoxicillin. During follow-up, contrast-enhanced abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4.3 × 2.9 cm thickened caecal wall. Thereafter, the patient underwent laparoscope-assisted ileocaecal resection with ileocolic anastomosis. The histological report revealed calcified food material in the diverticulum, with chronic inflammation without actinomycosis, which may have been eradicated by the previous antibiotic treatment.
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Affiliation(s)
- Bader I. Asiri
- Internal Medicine, Armed Forces Hospital Southern Region, KSA
- Corresponding address: Internal Medicine, Armed Forces Hospital Southern Region Armed Forces Hospital Southern Region, KSA.
| | - Ali A. Alshehri
- Infectious Diseases, Armed Forces Hospital Southern Region, KSA
| | | | - Abdullah M. Albishi
- Internal Medicine, Gastrology and Endoscopy, Armed Forces Hospital Southern Region, KSA
| | - Yahia I. Assiri
- Radiology, College of Medicine in King Khalid University, KSA
| | - Esam A. Asmiri
- Internal Medicine, Armed Forces Hospital Southern Region, KSA
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Carrara J, Hervy B, Dabi Y, Illac C, Haddad B, Skalli D, Miailhe G, Vidal F, Touboul C, Vaysse C. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. J Clin Med 2020; 9:jcm9030821. [PMID: 32197366 PMCID: PMC7141382 DOI: 10.3390/jcm9030821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/02/2022] Open
Abstract
The particularity of pelvic actinomycosis lies in the difficulty of establishing the diagnosis prior to treatment. The objective of this retrospective bicentric study was to evaluate the pertinence and efficacy of the different diagnostic tools used pre- and post-treatment in a cohort of patients with pelvic actinomycosis. The following data were collected: clinical, paraclinical, type of treatment, and the outcome and pertinence of the two diagnostic methods, bacteriological or histopathological, were evaluated. Twenty-seven women were included, with a pre-treatment diagnosis proposed for 66.7% (n = 18) of them. The diagnosis was established in 13.6% (n = 3) of cases through bacteriological samples, and in 93.8% (n = 15) of cases through histopathological samples, with endometrial biopsy positive in 100% of cases. The treatment was surgical with antibiotics for 55.6% (n = 15) of patients, medical with antibiotic therapy for 40.7% (n = 11) of patients, and surgical without antibiotics for one patient. All patients achieved recovery without recurrence, with a median follow-up of 96 days (4–4339 days). Our study suggested an excellent performance of histopathological analysis, and in particular endometrial biopsy, in the diagnosis of pelvic actinomycosis. This tool allowed early diagnosis and, in some cases, the use of antibiotic therapy alone, making it possible to avoid surgery.
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Affiliation(s)
- Julie Carrara
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Blandine Hervy
- Service de Chirurgie générale et gynécologique, Université de Toulouse, CHU de Toulouse, UPS, 31059 Toulouse, France; (B.H.); (F.V.)
| | - Yohann Dabi
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Claire Illac
- Service d’Anatomie-Pathologie, Université de Toulouse, CHU de Toulouse, 31059 Toulouse, France;
| | - Bassam Haddad
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Dounia Skalli
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Gregoire Miailhe
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Fabien Vidal
- Service de Chirurgie générale et gynécologique, Université de Toulouse, CHU de Toulouse, UPS, 31059 Toulouse, France; (B.H.); (F.V.)
| | - Cyril Touboul
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Charlotte Vaysse
- Service de Chirurgie générale et gynécologique, Université de Toulouse, CHU de Toulouse, UPS, 31059 Toulouse, France; (B.H.); (F.V.)
- Correspondence: ; Tel.: +33-5-6132-2828; Fax: +33-5-3115-5318
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16
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Nahum A, Filice G, Malhotra A. A Complicated Thread: Abdominal Actinomycosis in a Young Woman with Crohn Disease. Case Rep Gastroenterol 2017; 11:377-381. [PMID: 28690491 PMCID: PMC5498965 DOI: 10.1159/000475917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/18/2017] [Indexed: 12/31/2022] Open
Abstract
Crohn disease is a chronic inflammatory condition that primarily affects the gastrointestinal tract. Typical manifestations include fever, weight loss, fatigue, and abdominal pain, and abdominal abscesses and fistulae are frequent complications. Abdominal actinomycosis is a subacute or indolent disease associated with Actinomyces spp. Symptoms can be very similar to those of Crohn disease, and fistulae are also common. Since ulcerations in the intestinal tract are thought to be caused by Actinomyces escaping from the gut lumen and establishing intra-abdominal infection, it seems likely that abdominal actinomycosis may occur in patients with inflammatory bowel disease. We report a case of abdominal actinomycosis in a woman with active Crohn disease.
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Affiliation(s)
- Ari Nahum
- Minneapolis Veterans Hospital, Minneapolis, Minnesota, USA
| | - Gregory Filice
- Minneapolis Veterans Hospital, Minneapolis, Minnesota, USA
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Gómez-Torres GA, Ortega-Gárcia OS, Gutierrez-López EG, Carballido-Murguía CA, Flores-Rios JA, López-Lizarraga CR, Bautista López CA, Ploneda-Valencia CF. A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review. Int J Surg Case Rep 2017; 36:46-49. [PMID: 28531869 PMCID: PMC5440354 DOI: 10.1016/j.ijscr.2017.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 12/27/2022] Open
Abstract
Actinomycosis represents only the 0.02% of causes of acute apendicitis. We present the first case of appendiceal actinomycosis reported in México. As to our knowledge, this is the first case in the literature with appendiceal actinomycosis without been perforated.
Introduction Acute appendicitis is the most common indication for an emergency abdominal surgery in the world, with a lifetime incidence of around 10%. Actinomycetes are the etiology of appendicitis in only 0.02%–0.06%, having as the final pathology report a chronic inflammatory response; less than 10% of the cases are diagnosed before surgery. Here, we present the case of a subacute appendicitis secondary to actinomycosis. Case report A 39-year-old male presented with a twelve-day evolution of intermittent abdominal pain in the right lower quadrant, treated at the beginning with ciprofloxacin and urinary analgesic. The day of the admission he referred intense abdominal pain with nausea. An open appendectomy was preformed, finding a tumor-like edematous appendix with a diameter of approximately 2.5 cm. Discussion Actinomyces are part of the typical flora of the oral cavity, gastrointestinal tract and vagina. The predominant form of human disease is A. Israelii, it requires an injury to the normal mucosa to penetrate and cause disease. Abdominal actinomycosis involves the appendix and caecum in 66% of the presentations, of these, perforated appendicitis is the stimulus in 75% of the cases. A combination of antibiotic therapy and operative treatment resolves actinomycosis in 90% of cases. Conclusion Abdominal actinomycosis is an uncommon disease been the common presentation a perforated appendicitis, here we present a less common presentation of it with a non-perforated appendix.
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Affiliation(s)
- G A Gómez-Torres
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México.
| | - O S Ortega-Gárcia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - E G Gutierrez-López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | | | - J A Flores-Rios
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C R López-Lizarraga
- Division of Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C A Bautista López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C F Ploneda-Valencia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
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Ahmadi A, Salem MM, Safdarian M, Ilkhani S, Hamidian R, Cheraghipour M, Daneshvar A, Izadi F. Chondroradionecrosis of the Larynx in a Patient with Laryngeal: A Case Report. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2017; 29:179-180. [PMID: 28589113 DOI: pmid/28589113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Actinomycosis of the larynx has been rarely reported in the literature and usually occurs in patients with a history of laryngeal carcinoma and radiation therapy. However, its co-existence with chondroradionecrosis due to radiotherapy is even rarer. The most common site of infection is the cervicofacial region, especially in the submandibular area. CASE REPORT Here we report a 63-year-old male with a history of chemoradiotherapy because of laryngeal cancer 1 year earlier who presented with laryngeal actinomycosis. After prolonged penicillin-based treatment, the patient underwent thyroid cartilage defect reconstructive surgery because of a laryngocutaneous fistula due to chondroradionecrosis. The diagnosis, work-up, and management of the case are discussed, as well as a review of the literature. CONCLUSION Although actinomycotic infection of the larynx is rare, it should be considered in the differential diagnosis of laryngeal complaints, especially in immunocompromised patients.
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Affiliation(s)
- Aslan Ahmadi
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Mohammad Mahdi Salem
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Mahdi Safdarian
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Shahriar Ilkhani
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Roghaieh Hamidian
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Mostafa Cheraghipour
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Ali Daneshvar
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
| | - Farzad Izadi
- ENT-Head and Neck Surgery Research Center, Hazrat Rasoul Akram Hospital , Iran University of Medical Science, Tehran, Iran
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Lisa-Gracia M, Martín-Rivas B, Pajarón-Guerrero M, Arnáiz-García A. Abdominal actinomycosis in the last 10 years and risk factors for appendiceal actinomycosis: review of the literature. Turk J Med Sci 2017; 47:98-102. [PMID: 28263474 DOI: 10.3906/sag-1511-52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/07/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Actinomycosis is a granulomatous disease caused by filamentous, gram-positive, anaerobic bacteria. Actinomycetes are commensal inhabitants of the oral cavity and intestinal tract but acquire pathogenicity through invasion of breached or necrotic tissue.1397645907In abdominal actinomycosis (AA), the appendix and ileocecal region are usually involved. The aim of this study was to characterize patients diagnosed with AA and to establish the risk factors for appendiceal actinomycosis, including a short review of the literature. MATERIALS AND METHODS We conducted a prospective cohort study of all patients diagnosed with AA in the University Hospital Marques de Valdecilla (Santander-Cantabria) from January 2003 to October 2013. We also conducted a short review of the literature. RESULTS We characterized the epidemiological features of patients diagnosed with AA and risk factors for the involvement of the appendix, as most of the cases were misdiagnosed as appendicitis. Risk factors for appendiceal actinomycosis are no antecedents of carcinoma (P = 0.034) and previous incorrect diagnosis (P = 0.006). CONCLUSION AA is a rare and chronic infection. It is only reported in case reports in the literature. We present the largest series of patients diagnosed with AA. Half of the patients had morbidities, mostly carcinoma, and penicillin was the preferred treatment. More studies are needed to characterize patients affected with AA and to establish the correct treatment.
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Affiliation(s)
- Marta Lisa-Gracia
- Department of General Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Berta Martín-Rivas
- Department of General Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ana Arnáiz-García
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Eenhuis LL, de Lange ME, Samson AD, Busch ORC. Spontaneous Bacterial Peritonitis due to Actinomyces Mimicking a Perforation of the Proximal Jejunum. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:616-20. [PMID: 27561364 PMCID: PMC5003149 DOI: 10.12659/ajcr.897956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 42 Final Diagnosis: Spontaneous pelvic-abdominal peritonitis due to actinomyces Symptoms: Abdominal distension • abdominal pain • acute abdomen • fever • intermenstrual bleeding • nausea • sepsis • septic shock Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Louise L Eenhuis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marleen E de Lange
- Department of Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anda D Samson
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Olivier R C Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Bonnefond S, Catroux M, Melenotte C, Karkowski L, Rolland L, Trouillier S, Raffray L. Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations. Medicine (Baltimore) 2016; 95:e3923. [PMID: 27311002 PMCID: PMC4998488 DOI: 10.1097/md.0000000000003923] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60-180), whereas the median follow-up time was 12 months (interquartile range 5.25-18). Two patients died.This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.
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Affiliation(s)
- Simon Bonnefond
- Internal Medicine Unit, Teaching Hospital of La Réunion, France
| | - Mélanie Catroux
- Department of internal Medicine and Infectious Diseases, Teaching Hospital of Poitiers, France
| | - Cléa Melenotte
- Department of Internal Medicine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Ludovic Karkowski
- Internal Medicine Unit, French Army Teaching Hospital of Metz, France
| | | | | | - Loic Raffray
- Internal Medicine Unit, Teaching Hospital of La Réunion, France
- Internal Medicine Unit, Teaching Hospital of Bordeaux, France
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Boyanova L, Kolarov R, Mateva L, Markovska R, Mitov I. Actinomycosis: a frequently forgotten disease. Future Microbiol 2016; 10:613-28. [PMID: 25865197 DOI: 10.2217/fmb.14.130] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Actinomycosis is a rare subacute or chronic, endogenous infection mainly by Actinomyces species, showing low virulence through fimbriae and biofilms. Cervicofacial, thoracic, abdominal, pelvic and sometimes cerebral, laryngeal, urinary and other regions can be affected. Actinomycosis mimics other diseases, often malignancy. Disease risk in immunocompromised subjects needs clarification. Diagnosis is often delayed and 'sulfur granules' are helpful but nonspecific. Culture requires immediate specimen transport and prolonged anaerobic incubation. Imaging, histology, cytology, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and molecular methods improve the diagnosis. Actinomycetes are β-lactam susceptible, occasionally resistant. Treatment includes surgery and/or long-term parenteral then oral antibiotics, but some 1-4-week regimens or oral therapy alone were curative. For prophylaxis, oral hygiene and regular intrauterine device replacement are important.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Bulgaria
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Dhillon AK, Fairlie N, Finch G. Pelvic Actinomyces israelii abscess: a differential diagnosis of a pelvic mass. BMJ Case Rep 2015; 2015:bcr-2015-211595. [PMID: 26607184 DOI: 10.1136/bcr-2015-211595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old woman was admitted to our district general hospital, with a rapidly growing, increasingly tender mass in the right iliac fossa, difficulty mobilising with a fixed flexion deformity of the right hip and 15 kg weight loss in 5 months. Her 8-month long surgical history for investigation of a pelvic mass stemmed from the removal of an intrauterine device. It included radiological and surgical investigations. We report the second case in the literature, of a patient presenting with abdominal wall abscess, psoas abscess and hydronephrosis as a long-term complication of Actinomyces israelii infection of the ipsilateral ovary with a favourable outcome having excluded ovarian malignancy.
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Affiliation(s)
- Ajit Kaur Dhillon
- Department of Vascular Surgery, Derby Hospital NHS Foundation Trust, Derby, UK
| | - Neil Fairlie
- Department of Radiology, Northampton General Hospital, Northampton, UK
| | - Guy Finch
- Department of General Surgery, Northampton General Hospital, Northampton, UK
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García-Zúñiga B, Jiménez-Pastrana MT. [Acute abdomen with actinomycosis of the colon: A case report]. CIR CIR 2015; 84:240-4. [PMID: 26272424 DOI: 10.1016/j.circir.2015.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Actinomyces infection is a chronic inflammatory process that can sometimes, clinically and radiographically, closely mimic a malignant tumour, which may lead to giving a delayed or inappropriate treatment. CLINICAL CASE Male 41 years old, with no previous history, with abdominal pain of one month onset, as well as weight loss, intermittent fever and diarrhoea. He developed acute abdomen and underwent surgery, finding a tumour in the distal ileum with necrosis and punctiform perforations. A resection was performed on the affected part of the ileum and colon, as well as an ileostomy using Hartmann's procedure. CONCLUSIONS Actinomycosis is a disease that must be considered by the surgeon when faced with a clinical picture of subacute onset with intermittent fever, weight loss, abdominal pain, and even anaemia in patients with abdominal and retroperitoneal abscesses or previous history of surgery.
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Affiliation(s)
- Beatriz García-Zúñiga
- Servicio de Cirugía General, Hospital de Alta Especialidad Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Puebla, Puebla, México.
| | - Marco Tulio Jiménez-Pastrana
- Servicio de Cirugía General, Hospital de Alta Especialidad Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Puebla, Puebla, México
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25
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Al-Obaidy K, Alruwaii F, Al Nemer A, Alsulaiman R, Alruwaii Z, Shawarby MA. Primary gastric actinomycosis: report of a case diagnosed in a gastroscopic biopsy. BMC Clin Pathol 2015; 15:2. [PMID: 25774092 PMCID: PMC4359583 DOI: 10.1186/s12907-015-0002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background Primary gastric actinomycosis is extremely rare, the appendix and ileocecal region being the most commonly involved sites in abdominopelvic actinomycosis. Herein, we report a case of primary gastric actinomycosis. The diagnosis was made on microscopic evaluation of gastroscopic biopsy specimens. To the best of our knowledge, this is the third case to be reported in the literature, in which the diagnosis was made in a gastroscopic biopsy rather than a resection specimen. Case presentation An 87-year-old Saudi male on medication for cardiomyopathy, premature ventricular contractions, renal impairment, hypertension, and dyslipidemia, presented to the emergency department with acute diffuse abdominal pain, abdominal distension, constipation and vomiting for two days, with no history of fever, abdominal surgery or trauma. The patient was admitted to the hospital with an impression of gastric outlet obstruction. Based on radiologic and gastroscopic findings, a non-infectious etiology was suspected, possibly adenocarcinoma or lymphoma. Gastroscopic biopsies showed an actively inflamed, focally ulcerated atrophic fundic mucosa along with fragments of a fibrinopurulent exudate containing brownish, iron negative pigment and abundant filamentous bacteria, morphologically consistent with Actinomyces. Conclusion Althuogh extremely rare, primary gastric actinomycosis should be considered in the differential diagnosis of radiologic and gastroscopic diffuse gastric wall thickening and submucosal tumor-like or infiltrative lesions, particularly in patients with history of abdominal surgery or trauma, or those receiving extensive medication. A high level of suspicion is required by the pathologist to achieve diagnosis in gastroscopic biopsies. Subtle changes such as the presence of a pigmented inflammatory exudate should alert the pathologist to perform appropriate special stains to reveal the causative organism.
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Affiliation(s)
- Khaleel Al-Obaidy
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Fatimah Alruwaii
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Areej Al Nemer
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Raed Alsulaiman
- Department of Internal Medicine, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Zainab Alruwaii
- King Fahd Hospital of the University, University of Dammam, P.O. Box 2208, Al-Khobar, 31952 Saudi Arabia
| | - Mohamed A Shawarby
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
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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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Blanco-Vela C, Luna-Ayala V, Perez-Aguirre J. Colonic mass secondary to actinomycosis: A case report and literature review. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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[Colonic mass secondary to actinomycosis: a case report and literature review]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:206-8. [PMID: 24880530 DOI: 10.1016/j.rgmx.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/04/2014] [Accepted: 04/02/2014] [Indexed: 11/24/2022]
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Arif Manish M, Roy N. Isolated abdominal wall actinomycosis after hysterectomy. Surg Infect (Larchmt) 2014; 15:347-8. [PMID: 24810683 DOI: 10.1089/sur.2013.036] [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)
- M Arif Manish
- Department of Surgery, Katihar Medical College , Katihar, India
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KHODAVAISY S, ZIBAFAR E, HASHEMI SJ, NARENJI H, DAIE GHAZVINI R. Actinomycosis in Iran: Short Narrative Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:556-60. [PMID: 26060757 PMCID: PMC4449403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/11/2014] [Indexed: 11/16/2022]
Abstract
Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily of genus Actinomyces, which colonize the mouth, colon and vagina. Mucosal disruption may lead to infection virtually at any sites in the body. The aim of this study was to underline different features of actinomycosis and to represent total data about etiologic agents, clinical, diagnostic and therapeutic approaches these infections. From a total of 38 case reports or series, ninety one cases were obtained by using of relevant articles reported as recorded cases in Iran (1972 to 2012). Analyzed data represented 21 cases of oral-servicofacial (23.1%), 7 cases of thoracic (7.7%), 17 cases of abdominal (18.7%), 21 cases of disseminated forms (23.1%) and 25 cases of others (27.5%). Findings indicated more common of these infections in men (61.5%). Actinomyces naeslundii (21 cases) was found as the most common causative agents in comparison with A. Israeli (15 cases), A. viscosus (3 cases) and A. bovis (1 case). The most patients had been successfully treated with penicillin although some cases needed surgery along with antibiotic therapy. Since some clinical features of actinomycosis are similar to malignancies, so the differential diagnosis of invasive forms must be considered. This report emphasizes on the importance of differential diagnosis of actinomycosis from similar diseases by clinicians.
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Affiliation(s)
- Sadegh KHODAVAISY
- 1. Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,2. Dept. of Medical Microbiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ensieh ZIBAFAR
- 1. Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal HASHEMI
- 1. Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,3. Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanar NARENJI
- 2. Dept. of Medical Microbiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Roshanak DAIE GHAZVINI
- 1. Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,* Corresponding Author:
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Abstract
We present a single case of abdominal actinomycosis occurring in a 74-year-old female with a history of cholecystectomy 42 months before presentation. In a review of the literature, we present risk factors, clinical characteristics, diagnosis, and treatment of this infection. Abdominal actinomycosis is a rare, chronic, granulomatous infection characterized by the release of 'sulphur granules'. Actinomyces species should always be part of the differential diagnosis of patients presenting with a history of surgical or invasive procedures, presenting with an abdominal mass. Computed tomography (CT)-guided aspiration with or without core biopsy of this mass is a useful investigation. Diagnosis is often difficult: In less than 10% of cases, the diagnosis is made pre-operatively. Definitive diagnosis is often based on histochemical, macroscopic, and microscopic examination of tissue specimens. The disease should be treated with high doses of intravenous penicillin for 2-6 weeks followed by oral therapy for at least 6-12 months.
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Triantopoulou C, der Molen AV, Es ACMGV, Giannila M. Abdominopelvic actinomycosis: spectrum of imaging findings and common mimickers. Acta Radiol Short Rep 2014; 3:2047981614524570. [PMID: 24778807 PMCID: PMC4001438 DOI: 10.1177/2047981614524570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/09/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Actinomycosis is a rare suppurative disease that may mimic other inflammatory conditions on imaging. Its invasive nature may lead to mass formation and atypical presentation thus making accurate diagnosis quite difficult. PURPOSE To describe the different aspects of abdominopelvic actinomycosis on cross-sectional imaging and indicate discriminative findings from other inflammatory or neoplastic diseases. MATERIAL AND METHODS In our study we analyzed 18 patients (15 women, 3 men; age range, 25-75 years; mean age, 50 years) with pathologically proved abdominopelvic actinomycosis. Contrast-enhanced abdominal computed tomography (CT) had been performed in all patients. Eleven patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness and enhancement degree, inflammatory infiltration, and features of peritoneal or pelvic mass were evaluated at CT. RESULTS The sigmoid colon was most commonly involved. Most patients showed concentric bowel wall-thickening, enhancing homogenously and inflammatory infiltration of pericolonic fat was mostly diffuse. In 11 patients, one or more pelvic abscesses were revealed, while a peritoneal or pelvic mass adjacent to the involved bowel segment was seen in three cases. Infiltration into the abdominal wall was seen in three cases while in one case there was thoracic dissemination. CONCLUSION Actinomycosis is related not only to long-term use of intrauterine contraceptive devices and should be included in the differential diagnosis when cross-sectional imaging studies show concentric bowel wall-thickening, intense contrast enhancement, regional pelvic or peritoneal masses, and extensive inflammatory fat infiltration with abscess formation.
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Affiliation(s)
| | | | - Ad CMG Van Es
- Radiology Department, Leiden University Medical Center, the Netherlands
| | - Maria Giannila
- Radiology Department, Konstantopouleio General Hospital, Athens, Greece
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Heo SH, Shin SS, Kim JW, Lim HS, Seon HJ, Jung SI, Jeong YY, Kang HK. Imaging of Actinomycosis in Various Organs: A Comprehensive Review. Radiographics 2014; 34:19-33. [DOI: 10.1148/rg.341135077] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Kaya D, Demirezen Ş, Hasçelik G, Gülmez Kıvanç D, Beksaç MS. Comparison of PCR, culturing and Pap smear microscopy for accurate diagnosis of genital Actinomyces. J Med Microbiol 2013; 62:727-733. [PMID: 23378560 DOI: 10.1099/jmm.0.053165-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Dilek Kaya
- Hacettepe University, Faculty of Science, Department of Biology, 06800 Beytepe, Ankara, Turkey
| | - Şayeste Demirezen
- Hacettepe University, Faculty of Science, Department of Biology, 06800 Beytepe, Ankara, Turkey
| | - Gülşen Hasçelik
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, 06100 Sıhhiye, Ankara, Turkey
| | - Dolunay Gülmez Kıvanç
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, 06100 Sıhhiye, Ankara, Turkey
| | - Mehmet Sinan Beksaç
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, 06100 Sıhhiye, Ankara, Turkey
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Yilmaz M, Akbulut S, Samdanci ET, Yilmaz S. Abdominopelvic actinomycosis associated with an intrauterine device and presenting with a rectal mass and hydronephrosis: a troublesome condition for the clinician. Int Surg 2012; 97:254-9. [PMID: 23113856 PMCID: PMC3723221 DOI: 10.9738/cc121.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Surgery, Division of Liver Transplantation Inonu, University Faculty of Medicine, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Division of Liver Transplantation Inonu, University Faculty of Medicine, 44280, Malatya, Turkey
- Reprint requests: Sami Akbulut, MD, Department of Surgery, Division of liver Transplantation, Inonu University Faculty of Medicine, 44280, Malatya, Turkey. Tel.: +90422 3410660, Fax: +90422 3410036; E-mail:
| | | | - Sezai Yilmaz
- Department of Surgery, Division of Liver Transplantation Inonu, University Faculty of Medicine, 44280, Malatya, Turkey
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Kuesters S, Timme S, Keck T. Uncommon cause of an inflammatory pancreatic head tumor. Diagnosis: Purulent actinomycosis and incidental T1-carcinoid of the pancreatic head. Gastroenterology 2011; 141:e9-10. [PMID: 21888907 DOI: 10.1053/j.gastro.2010.08.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 08/02/2010] [Accepted: 08/23/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Simon Kuesters
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
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Menahem B, Alkofer B, Chiche L. Abdominal actinomycosis. Clin Gastroenterol Hepatol 2010; 8:e121-2. [PMID: 20601135 DOI: 10.1016/j.cgh.2010.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 06/04/2010] [Accepted: 06/11/2010] [Indexed: 02/07/2023]
Affiliation(s)
- Benjamin Menahem
- Department of Digestive Surgery, Centre Hospitalier Universitaire Caen, France
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Actinomycoses abdominales à forme tumorale : une série rétrospective de sept observations. Rev Med Interne 2010; 31:735-41. [DOI: 10.1016/j.revmed.2010.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 03/13/2010] [Accepted: 06/07/2010] [Indexed: 11/30/2022]
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40
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Omental Actinomycosis With Abdominal Wall Invasion. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181c755c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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