The Incidence and Risk Factors of Chronic Pulmonary Infection after Radiotherapy in Patients with Lung Cancer

PURPOSE

This study aimed to investigate cumulative incidence and risk factors associated with chronic pulmonary infection (CPI) development after radiotherapy for lung cancer.

Materials and Methods

We retrospectively analyzed 1,872 patients with lung cancer who received radiotherapy for lung cancer from 2010-2014, had a follow-up period of ≥ 3 months after radiotherapy, and did not have CPI at the time of radiotherapy. CPI was defined as pulmonary tuberculosis, non-tuberculous mycobacterial pulmonary disease, chronic pulmonary aspergillosis, or pulmonary actinomycosis. The cumulative incidence of CPI and overall survival (OS) were estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards analysis was performed to identify risk factors associated with CPI development.

RESULTS

The median follow-up period was 2.3 years with OS rates of 55.6% and 37.6% at 2 and 5 years, respectively. CPI developed in 59 patients at a median of 1.8 years after radiotherapy, with cumulative incidence rates of 1.1%, 3.4%, 5.0%, and 6.8% at 1, 3, 5, and 7 years, respectively. A lower body mass index, interstitial lung disease, prior pulmonary tuberculosis, larger clinical target volume, history of lung cancer surgery or radiation pneumonitis, and use of inhaled corticosteroids were independent risk factors for CPI development.

CONCLUSION

The long-term survival rate of lung cancer patients receiving radiotherapy was not low, but the cumulative incidence of CPI gradually increased to 6.8% at 7 years after radiotherapy. Therefore, close monitoring of CPI development is required in surviving patients with risk factors.

Prevalence of Infectious Organisms Observed in Cervical Smears Between 1997-2014 at Mubarak Al-Kabeer Hospital, Kuwait

OBJECTIVES

This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears (CS) at a tertiary care hospital in Kuwait.

METHODS

This retrospective study analysed 121,443 satisfactory CS samples collected between 1997-2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997-2005, while modified CS were obtained between 2006-2014 following the introduction of ThinPrep® testing (Hologic Corp., Bedford, Massachusetts, USA). All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents.

RESULTS

Overall, 8,836 (7.28%) of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida species (76.05%), Trichomonas vaginalis (9.72%), human papillomavirus (HPV; 9.3%), Actinomyces-like organisms (3.23%), Chlamydia trachomatis (1.27%) and the herpes simplex virus (HSV; 0.43%). There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis, T. vaginalis and Actinomyces-like organisms detected in conventional compared to modified CS samples (P <0.050 each). However, there was no statistically significant difference in the frequency of HSV-associated changes (P = 0.938). The presence of two infectious agents in the same sample was identified in 0.87% of samples.

CONCLUSION

Among CS samples collected during an 18-year period, Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing.

Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations

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.

Can oral anaerobic bacteria cause adverse pregnancy outcomes?

AIM

Maternal periodontal infection has been recognized as a risk factor for premature and low birthweight infants. It is suspected that pathogens causing periodontal disease may translocate to the amniotic cavity and so contribute to triggering an adverse pregnancy outcome. The aim of this study was to evaluate whether the presence of specific periodontal pathogens may influence the incidence of preterm labor and premature birth.

MATERIAL AND METHODS

This study was designed as a hospital-based case-control study. A total of 70 pregnant women, aged 18-40 with single live pregnancy were recruited from the Departement of Gynecolgy and Obstetrics at a General hospital in Sibenik, Croatia, between March 2013 to March 2014. The case group: 30 pregnant women who were hospitalised with signs of premature labor.

CONTROL GROUP

40 patients with normal pregnancy post-delivery up to 48 hrs, who had given birth at term, and the baby had a weight of more than 2500 gr. These women had undergone microbiological examination at the time of recruitment, microbial samples, paper point subgingival swabs were obtained in both groups and processed by anaerobic culturing. Standard procedures were used for culture and identification of bacteria. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may have influence the premature delivery.

RESULTS

The levels of periodontal pathogens tended to be higher in the premature (case group) labor compared to the term deliveries (control group). Levels of Porphyromonas gingivalis, Fuscobacterium nucleatum, Actinomyces actinomycetecomitans were statistically significantly higher in premature births as compared to term deliveries, adjusting for baseline levels. The joint effects of red and orange microbial clusters were significantly higher in the premature group compared to the term group.

CONCLUSIONS

The study shows a significant association betwen periodontal anaerobic infection and adverse pregnancy outcome. High levels of periodontal pathogens during pregnancy are associated with an increased risk for preterm delivery. Further studies elucidating the role of the microbial load and maternal immune response as related to pregnancy outcome seem merited.

To determine of the prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp in Turkish women from Ankara, Turkey

OBJECTIVE

To determine of the prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp in Ankara, Turkey and analyze whether there is seasonal variation in these infectious agents.

METHODS

A retrospective study on the results of 23298 cervical cytology examinations of patients which were performed in Fatih University Faculty of Medicine, Pathology Laboratory in Ankara, Turkey from January 2007 to July 2011. Patients were included in the study if a Pap smear was performed for any reason.

RESULTS

The prevalence of Bacterial Vaginosis, Candida sp, mixed infections (Bacterial Vaginosis + Candida sp), Trichomonas Vaginalis, Actinomyces sp was 7.76%, 2.81%, 0.32%, 0.13%, and 0.27%, respectively A seasonal variation was not observed in the prevalence of any of the infectious agents (p>0.05).

CONCLUSION

We conclude that cervical cytology is well suited for diagnosis of cervical infections. Bacterial vaginosis appears to be the predominant cause of vaginitis.

Actinomycotic canaliculitis: resolution following surgery and short topical antibiotic treatment

PURPOSE

This study aimed to study the incidence and clinical characteristics of patients diagnosed with actinomycotic canaliculitis in Iceland.

METHODS

We present a nationwide, retrospective case series for which cases were identified by searches of hospital diagnostic registries and pathology databases. Case histories were reviewed and histopathological analysis repeated to confirm the diagnosis.

RESULTS

Nine cases of actinomycotic canaliculitis were diagnosed in Iceland during 1988-2007. Subjects included six women and three men and represented 16% of all patients diagnosed with actinomycosis in the country. The incidence was 0.16 cases/100 000 inhabitants/year. Age-specific incidence rates were 0.59 cases/100 000 inhabitants/year for the 40-59-year-old age group and 1.37 cases/100 000 inhabitants/year for individuals aged 60-79 years. All patients underwent a three-way snip procedure and 1 week of topical antibacterial therapy.

CONCLUSIONS

Actinomycotic canaliculitis is an uncommon condition which frequently eludes diagnosis. Topical antibiotics for 1 week may be sufficient following surgery, a finding which contrasts with previous reports.

Gynecologic infections seen in cervical smears in Kuwait

OBJECTIVE

To study the different gynecologic infections seen in cervical smears in Kuwait.

STUDY DESIGN

Over a 6-year period (2002-2007), a total of 42,294 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional and ThinPrep (Cytyc Corp. Boxborough, Massachusetts) smears were first screened by cytotechnicians and finally reported by cytopathologists, Smears showing inflammation were analyzed with reference to Kuwaiti women.

RESULTS

Of the 41,748 (98.7%) patients with satisfactory smears, inflammatory changes were observed in 17, 593 (42.1%). Specific infection was identified in 2,679 (15.2%) cases, of which 60.8% were Kuwaitis. The infections seen were Candida sp (73.8%), Trichomonsa vaginalis (11.9%), human papillomavirus (HPV99) (8.2%), Actinomyces-like organisms (3.4%), Chlamydia trachomatis (2.2%) and herpes simplex virus (0.5%). No significant difference was found in the proportion of infectious agents among Kuwaiti and non-Kuwaiti women except marginally higher T vaginalis (10.9% vs 13.4%, p = 0.05) among non-Kuwaitis. Candida sp was the most detectable infectious agent in both Kuwaiti (74.6%) and non-Kuwaiti women (72.4%). Chi2 for trend revealed an increasing proportion of smears from Kuwaiti women found with specific infections (p = 0.049) as compared to those of non-Kuwaitis over the years.

CONCLUSION

The prevalence of infections identified on cervical smears was found to be almost similar in Kuwaiti and non-Kuwaiti women except for T vaginalis, which was higher among non-Kuwaitis as compared to Kuwaitis (10.9% vs. 13.4%, p = 0.051). The Candida sp was the most detectable infectious agent, 74.6% in Kuwaiti and 72.4% in non-Kuwaiti women, followed by T vaginalis, the second and HPV being the third.

[Present trends in abdominal actinomycosis]

BACKGROUND

Actinomycosis is a chronic infectious disease caused by bacteria in the Actinomyces genus. The pathologic, clinic and imagistic polymorphism and the rare incidence of this disease make it so frequent misdiagnosed.

MATERIAL AND METHOD

Single unit retrospective nonrandomized clinical study on over 40 years of experience in diagnosing and treating abdominal actinomycosis.

RESULTS

First case of abdominal actinomycosis was diagnosed in our clinic in 1968. During the next 36 years, between 1968 and 2004, there were registered only 3 cases, all ileo-cecal actinomycosis. In the next 3 years interval, 5 more cases were diagnosed: 4 associated with intrauterine devices (IUDs) and 1 associated with intraperitoneal remnant calculi after laparoscopic cholecystectomy. We present these last 5 cases, the first 3 having been reported elsewhere.

CONCLUSIONS

Abdominal actinomycosis is a rare disease, with variable and deceiving clinical and imagistic characters. In Romania we witness a shift in the epidemiology of this disease as a result of the introducing of the IUDs for the first time after 1990. Confronted with a female patient carrying an IUD that has an inflammatory and a pelvic tumoral syndrome of variable intensity, one should consider also the diagnosis of abdominal actinomycosis. Preoperative establishing of this diagnosis may allow, by a long antibiotic therapy, the elimination of the need for surgery or at least the decrease of its limits. A very rare cause of intraperitoneal actinomycosis is intraperitoneal gallstones remnant after laparoscopic cholecystectomy. To our knowledge, our case is the first reported in the medical literature.

Clinical manifestations of actinomycosis in Southern Taiwan

BACKGROUND AND PURPOSE

Actinomycosis is an uncommon and frequently misdiagnosed infection that may present as an acute or indolent process. Even when clinical suspicion is high, the disease is commonly confused with other chronic inflammatory diseases and malignancy. An early diagnosis helps the clinician in deciding treatment and can avoid physical morbidity such as unwarranted surgery.

METHODS

We retrospectively evaluated the histopathology and selected clinical information on all cases of actinomycosis that occurred at Kaohsiung Veterans General Hospital in Taiwan from 1993 to 2005. Data on the demographic characteristics, predisposing conditions, clinical presentations, diagnosis and treatment were analyzed.

RESULTS

A total 36 cases of actinomycosis were identified and evaluated. The mean age of patients was 52.14 +/- 13.28 years, and the male-to-female ratio was 1:1.1. Only three types of actinomycosis were found in this study: cervicofacial, at an incidence of 31%; thoracic (33%); and pelvic (36%). The clinical manifestations depended upon the region of infection; the most frequent presentations of cervicofacial, thoracic and pelvic actinomycosis were cutaneous soft tissue swelling with drainage sinus formation (55%), hemotypsis (75%) and abnormal vaginal spotting (54%), respectively. The most common initial laboratory abnormalities were normochromic anemia (69%) and leukocytosis (25%). While most patients had no history of a foreign body, all pelvic actinomycotic patients had a history of intrauterine device use. Nineteen patients (53%) had no comorbid conditions and 11 patients (31%) had malignancy. Most patients were initially diagnosed as malignancy (56%). All patients with actinomycosis were diagnosed by histopathologic findings. Twenty two patients (61%) were treated by surgery combined with antibiotics, 11 patients (31%) by surgery only and 3 patients (8%) by antibiotics only. No recurrence or mortality occurred.

CONCLUSIONS

Actinomycosis should be included in the differential diagnosis when patients present with chronic drainage sinus, chronic hemoptysis and abnormal vaginal spotting with use of intrauterine devices.

A prospective and retrospective study of actinomycosis in last five years at Manipal Teaching Hospital, Pokhara, Nepal

OBJECTIVE

The study was carried out to determine the clinical and morphological presentation of actinomycosis and its association with malignancy and other opportunistic infections.

MATERIAL AND METHODS

A prospective and retrospective study of cases was done from January 2001 to December 2006 (5 years) in the department of pathology.

RESULT

Total 19 cases of actinomycosis were found during this period. Patients presented with discharging sinus and non-healing superficial abscess. Out of 19 cases, three cases were associated with malignancy, two cases were associated with aspergillosis while one case was clinically misdiagnosed as malignancy. All cases were diagnosed pathologically except a case of maxillary sinusitis which was initially suspected as fungal sinusitis by CT scan. Since actinomycosis is often misdiagnosed it is important to know the clinical presentation and morphological features of actinomycosis for correct management.

CONCLUSION

The clinical features and histopathological findings of actinomycosis are important to understand for its correct diagnosis and better management of patient.

Helicobacter pylori in the palatine tonsils of patients with IgA nephropathy compared with those of patients with recurrent pharyngotonsillitis

Helicobacter pylori infection is acquired by oral ingestion. However, the morphology and microscopic localization of H pylori in the human oral cavity and pharynx are unknown. In the present study, we performed immunohistochemistry, immunoelectron microscopy, in situ hybridization, and polymerase chain reaction to identify H pylori in the palatine tonsils of 32 patients with immunoglobulin A nephropathy (IgAN) and 141 patients with recurrent pharyngotonsillitis (RPT). H pylori in coccoid form was present in bacterial colonies and horny layers of the stratified squamous epithelium in tonsillar crypts. We described for the first time the morphology of H pylori in palatine tonsils. Most bacterial colonies were sulfur granules with Actinomyces israelii (A israelii), and A israelii showed significant coexistence with H pylori (P=.011). The prevalence of H pylori in palatine tonsils of the RPT group increased steeply with age, but one fourth of the patients were found not to have tonsillar H pylori in adulthood. All patients with IgAN had H pylori in palatine tonsils. The prevalence of H pylori was greater in the IgAN group than in the RPT group, and the difference was statistically significant (P<.001). In contrast, A israelii was unrelated to age and clinical diagnosis (P=.722). In conclusion, our results demonstrate that H pylori in coccoid form is present in palatine tonsils and may indicate that H pylori in palatine tonsils is among the antigens causative of IgAN.

Actinomyces in cervical smears of women using the intrauterine device in Singapore

OBJECTIVES

Reproductive tract actinomyces have been associated with the use of intrauterine contraceptive device (IUCD). Thus, there is a need to evaluate the prevalence of colonization with Actinomyces israelii in a cohort of Singaporean women using an IUCD. Second, the occurrence of actinomycosis in colonized women and the clinical need to remove the IUCD and/or possibly the need to treat asymptomatic carriers with antibiotics were evaluated.

METHODS

The study population consisted of 1,108 IUCD users attending the Fertility Control Clinic, National University Hospital, Singapore.

RESULTS

In our study, the prevalence of actinomyces-positive cervical smears among IUCD users was 13.7%; the incidence of actinomyces-positive smears was similar with Copper T (34.2%), Multiload (32.9%) and Nova T (32.9%) IUCDs. We found no association with the duration of use of IUCD and actinomyces infection. In our study, 150 out of 152 (98.7%) IUCD users with actinomyces-positive smears were asymptomatic, and only 2 out of 152 (1.3%) who had actinomyces-positive cervical smears developed pelvic inflammatory disease at 6 months.

CONCLUSIONS

Our study suggests that removal of the IUCD in asymptomatic women with actinomyces-positive cervical smear is not necessary. Moreover, we suggest that asymptomatic carriers of actinomyces do not require preemptive antibiotic treatment.

[Mass appearance of actinomycosis in a llama herd in Switzerland]

This work describes the symptoms of actinomycosis (Actinomyces bovis) in several Llamas in a herd raised in Switzerland as well as their therapy. In 5 Llamas a hematological and chemical blood examination was made where low calcium, partially low iron and copper levels were found. Various reasons are discussed which influence the bone metabolism and lead to a higher susceptibility of bone infection.

Evaluation of cervical smears at King Hussein Medical Centre, Jordan, over three and a half years

Cervical smears taken from women referred for a check-up or with vaginal itching/discharge over a period of 3.5 years were reviewed at the King Hussein Medical Centre, Jordan. All smears were fixed with 96% alcohol, stained with Papanicolaou stain and screened microscopically. Of the smears from 1176 women aged 18-70 years, 4.5% were classified as inadequate, 7.7% were normal and 79.9% showed non-specific inflammation. Abnormal vaginal flora was found in 4.8% of cases, Candida albicans in 1.2%, Trichomonas vaginalis in 0.9% and actinomycosis in 1 case. Dysphasic changes were rare: 9 cases (0.8%) were classified as atypical squamous cells of undetermined significance (ASCUS) and 2 cases (0.2%) were low-grade squamous intraepithelial lesion (LSIL). No cases of human papillomavirus infection (HPV) or cervical carcinoma were found.

[The prevalence of Actinobaculum suis in boars of breeding herds in the Omsk region (Russian Federation) by indirect immunofluorescence technique]

Actinobaculum suis (Corynebacterium suis, Eubacterium suis, Actinomyces suis) was detected in the preputial diverticulum of 64,8% of 162 boars investigated in 8 districts of the region Omsk (Russian Federation) by indirect immunofluorescent technique. Until yet no informations were available about the prevalence of Actinobaculum (A.) suis in swine herds of the Russian Federation. The study shows that A. suis, as a main aetiological factor of cystitis and pyelonephritis in sows, is widely spread among the boars of the region Omsk. Prevalence of A. suis was not influenced by housing conditions, age or breed of investigated boars. Indirect immunofluorescent technique for detection of A. suis provides a good method for screening investigations with high numbers of samples.

Pulmonary actinomycosis

Pulmonary actinomycosis is a rare but important and challenging diagnosis to make. Even when the clinical suspicion is high, the disease is commonly confused with other chronic suppurative lung diseases and with malignancy. An early, accurate diagnosis will prevent the considerable psychological and physical morbidity, including unwarranted surgery, associated with delayed diagnosis. The clinical, radiological and therapeutic characteristics of the infection are reviewed here. Respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing. This will expedite the diagnosis of an otherwise highly treatable condition with an excellent prognosis if picked up early.

Course of infection and case outcome in individuals diagnosed with microbial colonies morphologically consistent with Actinomyces species

Actinomycosis is considered to be a rare disease in the oral region. A retrospective study of files of the University of Nebraska Medical Center College of Dentistry, Department of Pathology, revealed 30 cases in which Actinomyces species were detected from the years 1982 to 2001 (28,490 specimens). Biopsy submission forms and patient records were reviewed in each of these cases with particular attention to clinical impression, subsequent treatment, and case outcome. Classic treatment for actinomycosis involves the excision of the affected area as well as long-term antibiotics. Our study indicates that antibiotics may not be necessary in treatment of the localized dental presentation of actinomycosis.

[Actinomycosis: report of 21 cases. Experience of the Anatomy and Cytopathologic Pathology Laboratory of the Rabta Hospital]

Actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. From 1994 to 1999, 21 cases of actinomycosis have been diagnosed in our laboratory. The main localisations were cervicofacial and gynecologic the diagnosis relies on histopathologic examination that shows actinomycosic granules.

Bone infection in the bovine appendicular skeleton: a clinical, radiographic, and experimental study

Four hundred and forty-five bovines with bone infection of the appendicular skeleton were selected for clinical and radiographic assessment. A distinction was made between hematogenous and post-traumatic origin (wound/fracture). Bone infection was classified into four types according to the site of infection: type 1 is metaphyseal and/or epiphyseal osteomyelitis close to the growth plate; type 2 is primary subchondral osteomyelitis mostly accompanied by septic arthritis; type 3 is infectious osteoarthritis with subchondral osteomyelitis implicating that infection in the subchondral bone originates from the infection. Type 4 summarizes bone infections which can not be categorized in the previous groups. Hematogenous osteomyelitis is 3.2 times more frequent than post-traumatic osteomyelitis. Within the different groups, the relation of hematogenous to post-traumatic infection changed significantly. In type 1 infection the ratio was 5/1, in type 2 the ratio was 8/1 and in type 3 it was 3/1. Epiphyseal or metaphyseal osteomyelitis exhibited early radiographic bone changes, whereas with infection eminating from the joint, the bone lesions were detected later, because the bone was infected as a consequence of a primary septic arthritis. In smaller bones, severe and complete bone destruction was often present. Hematogenous bone infection never involved the entire diaphysis. Actinomyces pyogenes was discovered to be the main etiologic agent, whether or not combined with anaerobes. Bone fragments from the metaphysis of young calves were subjected to the effect of pure cultures of different bacteria. Radiographic changes to the structure of the bone were not identified within 2 weeks. Rapid radiographic changes in osteomyelitis cannot be explained by the direct effect of the bacteria on bone tissue in vivo. General infections of the lungs, disorders of the intestines and other internal organs were rarely responsible for osteomyelitis or septic arthritis. Osteomyelitis and infectious osteoarthritis is probably often induced by external and internal traumatic events to joints and bones in cattle.

Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance

Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.

Eight years with the same IUD

The purpose of this study was to determine the efficacy of the TCu380A (GYNET 380 IUD) in long-term users for periods of > 5 years and to obtain the incidence of Actinomyces as related to length of use and reasons for removal. The report is a retrospective descriptive study of all the clinical cases (n = 370 patients) at the Municipal Family Planning Centre-SERGAS A Coruña, Spain, of women who had a TCu380A IUD inserted during the period 1988-1989 with a September 1997 cutoff date for data analysis. A total of 271 (73.5%) patients had been using the TCu380A IUD for > 5 years with 100% efficacy. The accumulated incidence of Actinomyces was 5.9% (CI 95%: 3.8-8.9). The highest incidence was found between the second and third year of use. There was no increase in the incidence of Actinomyces after 5 years of use. The most common reason for removal of the IUD was the duration of use of 8 years with the same device (32.3%).

Pelvic actinomycosis: a review and preliminary look at prevalence

A review of the literature on pelvic actinomycosis reveals that actinomycetes normally reside in the female genital tract. Therefore the identification of actinomycetes in the vagina or cervix by any laboratory technique, including Papanicolaou smears with specific immunofluorescence or culture, is not diagnostic of any disease and is not predictive of any disease. The evidence strongly suggests that removal of the intrauterine contraceptive device of a patient with a positive culture is not necessary and that, in the absence of evidence for pelvic infection, antibiotics are not required. Pelvic actinomycosis is a rare disease whose pathogenesis is poorly understood.

Actinomyces and nocardia infections in immunocompromised and nonimmunocompromised patients

A retrospective survey of nocardia and actinomyces infections in five local hospitals was conducted over a 3-year period in El Paso, Texas, a border city, in the southwestern United States. The medical records of 42 patients with suspected nocardiosis or actinomycosis were reviewed. One patient was diagnosed with actinomyces and 12 patients with nocardia. Microbiological data included morphologic characteristics, biochemical profile, and susceptibility testing. Predisposing factors included leukemia, renal insufficiency, renal transplant, and lymphoma. No predisposing factors were found in 67% (n = 8) of patients (including the patient with actinomycosis). Twenty-three percent (n = 3) of patients had disseminated disease without evidence of underlying disease or immunosuppression. The mortality and morbidity of these infections appeared to be low.

Thoracic actinomycosis

OBJECTIVE

Thoracic actinomycosis is a disease that is difficult to diagnose because its appearance varies from similarities with bronchogenic carcinoma to pneumonitis-like tuberculosis infections. Therefore the majority of patients undergo operations for diagnosis. We had seven patients with thoracic actinomycosis which were not diagnosed before operation.

METHODS

Between July 1990 and November 1997, seven patients with thoracic actinomycosis were diagnosed after thoracotomy in our centre. They all had non-specific symptoms and radiographic findings, so we failed to diagnose the disease during preoperative examinations. Therefore they all underwent thoracotomy for diagnosis. Four patients were operated because of suspicion of malignancy, two patients were operated because of pulmonary infiltration and abscess formation and one patient because of undiagnosed pulmonary infiltration. Lobectomy was performed in five of them because of destroyed lobes, and wedge resection was performed in two patients. In two patients the disease was diagnosed by fresh smears obtained from specimens in the course of operation and confirmed histopathologically and in the others histopathologically in the postoperative period.

RESULTS

Three major complications, acute renal failure, empyema and persistent air leakage developed in three cases after the operations. Bronchopleural fistula was found in only one of them and the patient died because of uncontrolled infection and sepsis on the 26th postoperative day. All of the other six cases are still alive. We did not observe any other problem in their long-term follow-up. All patients regularly took 20 million units/day of intravenous crystalline penicillin G when they were in the hospital. After that, antibiotic treatment was completed up to 2 months with procaine penicillin.

CONCLUSIONS

Sometimes diagnosis of the actinomycosis of the lung is very difficult although it is an infection. In that case thoracotomy is needed for the diagnosis and sometimes for the treatment. In some cases because of the irreversible parenchymal change resective surgery may be needed. Actinomyces israelii infections should be suspected of in chronic infiltrative, nodular, cavitary process and tumour-like mass lesions besides other most probable causes. After diagnosed, it is treated using penicillin chemotherapy at least for 2 months.

Seasonal fluctuations in the cervical smear detection rates for (pre)malignant changes and for infections

The detection of diseases can exhibit seasonal fluctuations. This can be studied in cervical smears. Over a 9-year observation span (January 1983-January 1992) a series of 504,093 cervical smears obtained from a routine cytology laboratory in The Netherlands were examined for infections (monilia, trichomonas, actinomyces, human papilloma virus [HPV], chlamydia, and herpes) as well as for mild, moderate, and severe dysplasias, carcinoma in situ, and squamous carcinoma. Statistical analysis (principal component analysis) demonstrates clear seasonal rhythms in the detection of infections as well as in precursor lesions. These findings suggest that we are dealing with "true" detection rhythms. For the detection of (pre)malignancy and HPV, yearly fluctuations in women being screened might be the explanation for our observations.

Incidence of tonsillar lesions caused by Tonsillophilus suis and Actinomyces sp infection in swine

The tonsils of ten fattening pigs were compared with those of ten breeding sows to determine the relative incidence of Tonsillophilus suis and Actinomyces sp lesions. Macroscopic observation revealed mildly focal upheavals on the tonsillar mucosal surfaces of two of the breeding sows. In tonsillar slices from both pig groups, tiny nodules containing sulfur granules were found. Histopathologically, the T. suis and Actinomyces sp lesions were noted as tonsillar crypt abscesses in both pig groups, and granulomas due to T. suis were seen in the breeding sows. T. suis showed larger 'club-shaped' structures than Actinomyces sp, characterized as clubs showing a broom-like structure with degenerated central thalli. Breeding sows are known to have a higher incidence of tonsillar T. suis lesions than fattening pigs, and in this study, those fattening pigs showing greater propensity to infection by Actinomyces sp also showed a mixed infection with T. suis that produced the tonsillar crypt abscesses. In addition, it is known that in breeding sows, the T. suis lesion develops from a crypt abscess into a granuloma.

Pulmonary actinomycosis: surgical considerations

Pulmonary actinomycosis is a rare disease. Of 2,247 patients presenting with a radiological pulmonary opacity, 13 (0.6%) were identified with pulmonary actinomycosis in a 13 year period. Twelve of the 13 patients underwent thoracotomy and one had clinical diagnosis and subsequent medical treatment alone. Neither mortality nor major complications were observed. One patient had recurrent disease after surgery. The other surgical patients are well and free from disease at a minimum 6 month follow-up. Diagnosis of actinomycosis is frequently difficult because it often infects pre-existing cavitary disease in the lung. As a consequence, the infection may progress to stages which will not respond to medical treatment alone. Surgery then provides the best method to achieve diagnosis and ultimate treatment.

[Clinical, diagnostic laboratory and therapeutic studies of mastitis in a large sheep breeding flock]

During two lambing seasons, 6500 ewes of a large sheep breeding unit were investigated. Within this period, 467 ewes suffered from mastitis. The morbidity was 3.8% and the lethality 4.7%. In 84% of the investigated animals udder-pathogenic bacteria were detected. Mostly, Pasteurella haemolytica and Staphylococcus aureus were isolated as agents of ovine mastitis. Before and during the antibiotic therapy the clinical symptoms (general condition, temperature, milk appearance, consistency of the udder tissue) were recorded. The combined antibiotic therapy, which consisted of parenteral and local intracisternal applications, was mostly satisfactory concerning recovery from mastitis and survival of the ewes. Only 17 ewes died from mastitis; most deaths caused by Staphylococcus aureus.

Intrauterine bacterial findings in postpartum cows with retained fetal membranes

Eleven Swedish postpartum cows with retained fetal membranes (RFM) were studied to determine the intrauterine bacterial flora. Bacteriological examination was performed from twice weekly uterine biopsies. A total of 161 biopsies were collected during the first 8 weeks postpartum of which 82 (50.9%) were found with bacterial growth. Seventy-one of the 82 bacteria-positive biopsies (86.6%) showed mixed infections whereas the remaining 11 (13.4%) were pure cultures. Generally, a total of 322 isolates belonging to 12 different genera of bacteria, 6 facultative and 6 obligate anaerobic pathogens were identified. Mixed infections were most frequent for Actinomyces pyogenes together with obligate anaerobic bacteria, especially Bacteroides levii/spp. and Fusobacterium necrophorum. All of the studied cows had an infection that involved the first two genera of bacteria, whereas F. necrophorum was found in 8 of the 11 animals. The present work suggests that a possible pathogenic synergism between A. pyogenes and the two main Gram-negative anaerobes might have caused early endometritis and/or persistent infection.

Incidence of actinomycosis associated with intrauterine devices

The incidence of intrauterine device (IUD)-associated cervicovaginal actinomycosis was evaluated. Papanicolaou-stained cervicovaginal smears from 1,520 women with IUDs were reviewed for the presence of Actinomyces-like organisms. The overall colonization rate was 11.4%. The colonization rates for the Progestasert, plastic IUDs and copper IUDs were 14.3%, 10.8% and 6.69%, respectively. The colonization rate appeared to increase with the duration of IUD use. The relatively high cervicovaginal Actinomyces colonization rate suggests that all patients with IUDs should undergo annual cytologic smears, with specific attention given to the presence of Actinomyces-like organisms.

Mastitis in heifers

Udder health is typically overlooked but critically important in heifers. Mastitis pathogens of the contagious as well as environmental groups have been implicated in mastitis in heifers. Procedures considered for control of heifer mastitis include prepartum treatment in primigravid heifers, separating preweaned calves to prevent suckling, fly control, and segregation of pregnant heifers from dry cows. Further investigation is needed before general recommendations can be made relative to prepartum treatment of primigravid heifers. An improved understanding of the epidemiology and pathogenesis of heifer mastitis will aid in expanding and improving control measures.

[Thoracic actinomycosis]

BACKGROUND

Thoracic actinomycosis is an rare disease in our medium. This fact, together with the variability of its forms of presentation and the difficulty in isolating its etiologic agent, make its diagnosis, particularly difficult.

METHODS

A series of 8 cases diagnosed in the years 1988, 1989 and 1990 in two centers (Hospital de Bellvitge-Prínceps d'Espanya and Hospital de l'Esperança) is described with evaluation of the clinical and analytical data and the therapy applied.

RESULTS

Species were only identified in 3 cases with Actinomyces israelii in two and Actinomyces odontolyticus in the third. The proven association with Mycobacterium tuberculosis, the presence of distant septic metastasis and eosinophilic pleuritis as forms of presentation are of note. Medical treatment was penicillin or derivatives in all the cases except one which was treated with diagnostic/therapeutic segmentectomy.

CONCLUSIONS

It is concluded that when any subacute involvement of the thoracic and/or pleuropulmonary wall specific cultures should be carried out to discard eventual thoracic actinomycosis.

The incidence and role of actinomyces in recurrent acute tonsillitis

Although actinomyces has been identified in between 1.77% and 37% of resected tonsils its possible role in recurrent acute tonsillitis has received little attention. A histological and bacteriological study of 129 pairs of tonsils from patients with recurrent acute tonsillitis showed actinomyces to be present in 29.5%. The organism, however, was also present in 40% of tonsils from 10 patients with no history of tonsillar disease. In neither of these groups was there any specific evidence of tissue reaction to actinomyces nor was there a male preponderance as in clinical actinomycosis. The presence of actinomyces in the tonsil was not favoured by the concurrence of beta-lactamase producing bacteria. These data indicate that actinomyces does not have a causal role in recurrent acute tonsillitis.

An investigation into the use of restriction endonuclease analysis for the study of transmission of Actinomyces

DNA fingerprints of 28 reference strains of Actinomyces, comprising representatives of different species and serotypes, and 19 isolates recovered from 16 periodontal patients was performed. The aim was to determine the potential of the method for detecting strain differences in terms of discriminatory power and to evaluate its usefulness in the typing of Actinomyces strains for eco-epidemiological studies. Among the 17 restriction endonucleases tested, Bst EII, Pvu II and Sma I proved to be the most suitable for the genus Actinomyces restriction digest analysis. Visual comparisons of Bst EII, Pvu II and Sma I digest patterns of chromosomal DNA revealed clear differences within species but also within serotypes of Actinomyces that are otherwise identical. The method offers the qualities for use as an epidemiological tool for identifying sources and tracing routes of transmission of Actinomyces: stability, reproducibility, ease of preparation and interpretation and enough sensitivity for detection of differences between morphologically and serologically similar strains of Actinomyces.

Summer mastitis in heifers: studies on the seasonal occurrence of Actinomyces pyogenes, Peptostreptococcus indolicus and Bacteroidaceae in clinically healthy cattle in Denmark

With the aim of investigating the seasonal occurrence of Actinomyces pyogenes, Peptostreptococcus indolicus, Bacteroides melaninogenicus ss. levii and Fusobacterium necrophorum, and thus the potential for development of summer mastitis, clinically healthy Danish Holstein-Friesian heifers due to calve in the autumn were sampled from the teat tip, the conjunctiva and the oral cavity at 2-6 week intervals from 1979 to 1981. The overall isolation rates of F. necrophorum, P. indolicus and B. melaninogenicus ss. levii, in order of significance, were significantly higher during the pasture period whereas no differences in isolation rates of A. pyogenes between housed and pastured animals were detected. F. necrophorum was recovered almost exclusively from the oral cavity, P. indolicus and A. pyogenes occurred most frequently in samples from the teat skin, whereas isolates of B. melaninogenicus ss. levii were evenly distributed between conjunctiva and teat tip samples. A distinct seasonal pattern of the isolation rates of summer mastitis pathogens was recorded, which corresponded closely to the seasonal activity of symbovine insects, in particular the headfly Hydrotaea irritans (Fallén). However, the high proportion of clinically healthy bacterial carriers as compared with the incidence of clinical disease strongly suggests that as yet unknown contributing or triggering factors, apart from the mere presence of the relevant bacterial species, are required for the establishment and development of clinical summer mastitis.

Paraurethral actinomycosis

Actinomycosis of the genitourinary tract is rare. Herein we report a case of actinomycosis of the urethra following staged hypospadia repair. Pathophysiology and treatment options of this rare lesion are discussed.

Epidemiologic features of an intracranial abscessation/suppurative meningoencephalitis complex in white-tailed deer

Case records of 683 white-tailed deer (Odocoileus virginianus) submitted to the Southeastern Cooperative Wildlife Disease Study (Georgia, USA) for diagnostic purposes from 1971 to 1989 were reviewed for the occurrence of pyogenic infections of the central nervous system, specifically intracranial abscessation or suppurative meningoencephalitis. These conditions, either alone or in combination, were diagnosed in 24 of 683 (4%) deer. Thirteen genera of bacteria were isolated; the most frequent species was Actinomyces pyogenes. The disease was strongly sex biased (P less than 0.01); 88% of the cases occurred in males. Cases were more prevalent (P less than 0.05) in older bucks; the median age of infected bucks was 3.2 yr, and 71% of these were greater than or equal to 2.5-yr-old. Intracranial abscessation/suppurative meningoencephalitis cases accounted for 20% of the diagnoses among 56 bucks greater than or equal to 3-yr-old. Cases were seasonal, occurring only from October to April. Characteristic necrosis, erosion, and pitting of skull bones were common, and this bone damage may be useful in determining cause of death when only skeletal remains are found. Males, especially older bucks, apparently are predisposed to intracranial abscessation/suppurative meningoencephalitis because of the cycle of antler development and behavioral traits associated with reproduction. The strong bias toward prime age bucks suggests that these infections could specifically hinder management strategies designed to produce populations with older buck age structures.

[Actinomyces and other bacteria isolated from cervical cultures of women using IUDs]

In this study we performed endocervical cultures from 517 patients with infection. In 75 of these 517 cultures (14.5%) Actinomyces has been grown. The incidence of Actinomyces has increased in correlation with IUD period, but the type of IUD has not affected the incidence of Actinomyces. Actinomycosis of uterus is usually superficial. It rarely spreads and causes pelvic actinomycosis. Even it can change to systemic infection. For this reason, in women who have used IUDs for long period Actinomyces infection should be kept in mind. Clinicians should be in corporation with the laboratories, this is important for identification of the microorganism and for the right therapy.

Incidence of actinomycetes infection in women using intrauterine contraceptive devices

Pancervicovaginal smears taken from 350 women using an intrauterine contraceptive device (IUD) were screened for the presence of actinomycetes organisms. Of the 12 cases in which actinomycetes-like organisms were seen in Papanicolaou-stained smears, the presence of actinomycetes organisms was confirmed by immunofluorescence in 10 cases. The prevalence of actinomycetes infection was thus 2.8% (10 of 350 cases) in the IUD users. Eight (4.3%) of 173 symptomatic subjects had actinomycetes infections. Two of the positive cases were asymptomatic. Eight of the ten patients with confirmed actinomycetes infection were using the Cu T device while two were wearing the Lippes Loop IUD. Seven of the ten patients had been using an IUD for more than two years. The time of insertion of the IUD (postpuerperal, postmenstrual or after medical termination of pregnancy) did not show any correlation with the presence of actinomycetes infection. Actinomyces israelii was responsible for the infection in eight cases while Arachnia propionica was seen in two cases. The organisms could not be grown in culture.