Abdominal actinomycosis in the last 10 years and risk factors for appendiceal actinomycosis: review of the literature

Actinomycosis as a rare cause of acute appendicitis: Case report and comprehensive literature review

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.

Appendecular actinomycosis: A case series of 14 patients

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.

Actinomyces as a rare cause of appendicitis: a case report

Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of >90%.

Appendiceal actinomycosis mimicking malignant tumor: a rare case report

Introduction

Actinomycosis is an uncommon bacterial infection caused by Actinomyces bacteria that typically progresses slowly and leads to the formation of masses. Although it commonly affects the cervicofacial area, about 20% of cases occur in the abdominopelvic region. Because the disease can be mistaken for a tumour due to its infiltrative mass-like nature on imaging, over 90% of cases are only diagnosed following surgery and histological confirmation. This report describes a case of an appendicular mass, initially suspected to be a malignant tumour, but eventually diagnosed as appendiceal actinomycosis.

Presentation of case

Upon initial presentation, a 53-year-old woman with type II diabetes mellitus and no prior surgical history, displayed abnormal appendiceal uptake during a PET-computed tomography (CT) scan conducted for a suspected spinal tumour. Colonoscopy did not indicate any notable observations, and the patient chose to defer immediate action. Several months later, a CT scan revealed an increased mass-like appearance of the appendix compared to the previous PET-CT scan. After multidisciplinary discussions, a right laparoscopic hemicolectomy was recommended due to suspected malignancy. However, histological staining on microscopy confirmed actinomycosis originating from the appendix.

Discussion

Chronic appendicitis with radiologic features similar to appendiceal carcinoma, or abdominal masses located in the ileocecal area, in patients with or without a previous surgical history should raise suspicion of actinomycosis.

Conclusion

Appendiceal actinomycosis should be considered in the differential diagnosis in the aetiology of chronic appendicitis mimicking appendiceal carcinoma. Awareness and accurate diagnosis of appendiceal actinomycosis can prevent unnecessary extended surgery as was performed in this case.

Abdominal actinomycosis mimicking malignancy: A case report

Actinomycosis is the infection caused by Actinomyces bacilli; subtypes include cervicofacial, pulmonary, and abdominal/pelvic actinomycosis. Abdominal actinomycosis can mimic intra-abdominal malignancies by causing manifestations like chronic lower abdominal pain, weight loss, and palpable mass(es). Treatment usually requires three to six months of high-dose penicillin G or amoxicillin. This report discusses an 88-year-old female who presented with chronic abdominal pain, weight loss, and other nonspecific symptoms without palpable abdominal mass. However, computed tomography (C.T.) imaging revealed multiple intra-abdominal soft tissue masses in the greater omentum, anterior abdominal wall, and small bowel mesentery. On biopsy, filamentous bacilli suspicious of Actinomyces was identified. The patient received prolonged antimicrobial treatment, underwent multiple CT-guided aspirations of recurrent abscesses, and had surgical intervention for sigmoid stricture. On subsequent imaging, the patient showed significant amelioration of omental and anterior abdominal wall masses. This case highlights the importance of prompt recognition and subsequent management of Actinomyces as an etiology of malignancy-like symptoms.

A Clinic Trial Evaluating the Effects of Aloe Vera Fermentation Gel on Recurrent Aphthous Stomatitis

Recurrent aphthous stomatitis (RAS) is the most common disorder in the oral mucosa that affects the daily quality of life of patients, and there is currently no specific treatment. In the present study, we developed aloe vera fermentation gel under the action of probiotics on aloe vera. In total, 35 patients with the history of aphthous stomatitis were enrolled to explore the potential benefits of aloe vera fermentation gel to treat RAS, and the healing-promotion effects were recorded and compared; microbial compositions in different groups were tested by high-throughput sequencing. Our results indicated that the duration of healing time of the aloe group showed potentially better effects because of the higher proportion of 4-6 day healing time (35% vs. 20%) and lower proportion of 7-10 day healing time (65% vs. 80%) compared with that of the chitosan group. Also, the use of aloe vera fermentation gel could return oral bacteria to normal levels and reduce the abundance of harmful oral bacteria including Actinomyces, Granulicatella, and Peptostreptococcus. These results suggest that aloe vera fermentation gel has the ability to treat patients with RAS and has positive prospects in clinical applications.

Abdominopelvic Actinomycosis Mimicking a Malignant Ovarian Neoplasia: Case Report and Review of Literature

Abdominal actinomycosis is a chronic, granulomatous, and indolent disease produced by Actinomyces spp., a gram-positive filamentous bacillus, anaerobic, commensal in the oral cavity, gastrointestinal tract, and pelvic mucosa. Diagnosis is usually difficult and delayed due to its insidious presentation. It can simulate different neoplastic, inflammatory as well as infectious diseases such as tuberculosis, nocardiosis, or mycosis. In most cases, the diagnosis is made postoperatively with the histopathological report, and only 10% of them are diagnosed preoperatively. We present two cases of abdominopelvic actinomycosis simulating advanced ovarian neoplasia.

Pseudotumoral Actinomycosis Mimicking Malignant Colic Disease: A Case Report and Literature Review

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.

Abdominal Actinomycosis misdiagnosed as liposarcoma

Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula’s tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient’s full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.

[Primary intestinal actinomycosis in ilium and colon. A case report and review of the literature]

Actinomycosis is a chronic, suppurative, inflammatory granulomatous disease caused by gram positive anaerobic filamentous bacteria of the genus Actinomyces, most frequently Actinomyces israelii. We report a case of a 42-year-old male presenting with abdominal pain, a 10kg weight loss and a fixed mass in the epigastrium. Tomography revealed dilatation of the intestinal loops and thickening of the colon walls; the coexistence of these two findings suggested a lymphoproliferative process. The tumour, ileum fragment and colon were surgically removed; these were adherent to the serosal fibro-adipose tissue. Microscopically, abundant polymorphonuclear infiltrate and grains of bacteria compatible with Actinomyces spp.were seen.

"Holes" in the Jaw-A Report of Two Cases of Periapical Actinomycosis

Periapical actinomycosis is a relatively rare form of cervicofacial actinomycosis, which typically involves the periapical region with subsequent potential spread to the jaw bones. We hereby present two cases of periapical actinomycosis. Both patients presented with jaw pain and "holes" in their gum and lacked the characteristic clinical features commonly seen in cervicofacial actinomycosis such as jaw mass, draining ulcers, sinuses and fistulae. The first patient was an immunocompetent host with chronic stable medical conditions but with a rather bad dentition requiring multiple recent teeth extractions. The second patient was edentulous, had refractory multiple myeloma, was on low-dose chronic steroids and pomalidomide therapy and therefore relatively immunocompromised. Both cases of actinomycosis were diagnosed by jaw bone histopathology, which showed characteristic sulfur granules and embedded Actinomyces-like organisms. The two patients had excellent clinical response to six months of penicillin therapy without any need for surgical intervention. The cases remind clinicians of including actinomycosis in the differential diagnosis of periapical lesions and illustrates the possibility of achieving cure with non-surgical treatment.