Although this organism was originally classified as a fungus, it is now classified as a branching bacteria. It is the source for many infections, but especially in the immunocompromised population.
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CHARACTERIZATION |
| ANAL FISTULA |
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Actinomycosis, a rare and unsuspected cause of anal fistulous abscess: report of three cases and review of the literature.
Coremans G, Margaritis V, Van Poppel HP, Christiaens MR, Gruwez J, Geboes K, Wyndaele J, Vanbeckevoort D, Janssens J.
Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
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Primary perianal actinomycosis is rare. Sporadic cases, with lesions varying in extent have been reported. The infection is caused by the bacterium Actinomyces, which often is a saprophyte. Male gender and diabetes are risk factors, but the exact pathogenic mechanism remains speculative. The diagnosis is a challenge and often delayed, with a protracted history of masses and sinuses extending into the gluteal and genital region. The treatment, a combination of surgery and antibiotics, is poorly standardized.
We report three cases and compare their characteristics to those of published cases, found by a computerized literature search (1968-2002). The lesions, a simple fistula-in-ano or a mass, were diagnosed in an early stage in all three patients. The infection always spread into the scrotum. There were no risk factors other than gender, except in one patient. The diagnosis was suspected by the observation of draining sulfur granules and promptly confirmed by histology in the three cases. All patients healed with antibiotics in addition to simple surgical procedures.
Treatment consisted of amoxicillin for two weeks in two cases and more extended antimicrobial treatment in the third. These findings are contrasting with the classic picture of perianal actinomycosis.
It is concluded that perianal actinomycosis can occur in the absence of risk factors and that early diagnosis requires a high degree of suspicion. An infection with Actinomyces should be suspected in the presence of lesions containing watery purulent material with sulfur granules. The indication for extended antibiotherapy combined with sphincter damaging surgery may need to be revised in the presence of early detection.
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| OSTEORADIONECROSIS |
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Actinomyces in infected osteoradionecrosis--underestimated?
Hansen T, Kunkel M, Kirkpatrick CJ, Weber A.
Institute of Pathology, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55101 Mainz, Germany.
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| Hum Pathol. 2006 Jan;37(1):61-7. Epub 2005 Nov 28. Abstract quote |
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Infected osteoradionecrosis (IORN) is a severe complication of radiation therapy for head and neck cancer. Infected osteoradionecrosis can lead to fracture and often requires subsequent jaw resection. It is known that irradiated bone is highly susceptible to infections, mainly with Candida species and cariogenic bacteria. Only very few data exist on Actinomyces in IORN.
The study population consisted of 31 patients (7 female, 24 male; median age, 58.3 years). All patients exhibited clinical and radiological signs of IORN (infection, mucosa or skin fistula, and sequestrated bone). To detect Actinomyces colonies, histological examination was performed using several staining procedures (hematoxylin-eosin, Gram, Grocott, periodic acid-Schiff). In addition, a semi-nested polymerase chain reaction (PCR) approach was designed targeting the 16S ribosomal RNA gene.
We found prominent Actinomyces colonies in 20 (64.5%) of 31 patients. Most of these lesions were localized in the mandible (16/20). Most interestingly, Actinomyces were almost exclusively found attached to the necrotic bone. PCR testing confirmed the presence of Actinomyces-specific DNA sequences (Actinomyces israelii).
We show that Actinomyces is considerably more frequent in IORN than previously demonstrated. We suggest that these organisms are involved in the chronic, nonhealing inflammatory processes and the purulent discharge, which are known as characteristics of IORN. It remains to be investigated whether Actinomyces could be involved in the osteolytic mechanisms. From the histopathologic perspective, detection of Actinomyces is important because these bacteria have been shown to be associated with prolonged treatment duration.
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GROSS APPEARANCE/
CLINICAL VARIANTS |
CHARACTERIZATION |
| GENERAL |
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| VARIANTS |
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| ABDOMINOPELVIC |
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Pelvic actinomycosis. Urologic perspective.
Marella VK, Hakimian O, Wise GJ, Silver DA.
Section of Urology, Maimonides Medical Center, Brooklyn, New York 11219, USA. |
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PURPOSE: Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli. This paper reviews the etiology and clinical presentation associated with Actinomycosis that often presents as a pelvic mass that mimics a pelvic malignancy.
MATERIALS AND METHODS: A combination of patients treated by the authors in the recent past and a literature review of patients with pelvic Actinomycosis were assessed for demographic, clinical and predisposing co-factors. An analysis is made of age distribution, gender, diagnostic methods and treatment concepts.
RESULTS: Thirty-three patients were included in the study that included 2 current patients and 31 obtained from literature review. There were 27 females (age range 16 - 69 years, mean 38 years) and 6 males (16 - 55 years, mean 36 years). Presenting signs and symptoms were lower abdominal mass in 28 (85%); lower abdominal pain in 21 (63%); vaginal discharge or hematuria in 7 (22%). Two patients developed fistulae (entero-vesico 1; vesico-cutaneous 1). Nineteen (70%) of the 27 female patients had intra-uterine contraceptive devices (IUD). Four patients (12.5%) (3 males and 1 female) had urachus or urachal remnants. Cystoscopy in 12 patients noted an extrinsic mass effect, bullous edema and in one patient " vegetative proliferation " proven to be a chronic inflammatory change. Exploratory laparotomy was performed in 32 of the 33 patients who had excision of mass and involved organs. Diagnosis was established by histologic examination of removed tissue. Penicillin (6 weeks) therapy was utilized to control infections.
CONCLUSION: Pelvic actinomycosis mimics pelvic malignancy and may be associated with the long-term use of intra-uterine contraceptive devices, and persistent urachal remnants. Removal of infected mass and antibiotic therapy will eradicate the inflammatory process.
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| BONE |
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Bone manifestations of actinomycosis.
Rothschild B, Naples V, Barbian L.
Arthritis Center of Northeast Ohio, Youngstown, OH 44512, USA; Department of Internal Medicine, Northeast Ohio Universities College of Medicine, Rootstown, OH 44272, USA; Department of Biomedical Engineering, University of Akron, Akron, OH 44242, USA; Department of Earth Sciences, Carnegie Museum of Natural History, Pittsburgh, PA 15213, USA.
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Actinomycosis, originally classified as a fungus, is now considered a branching bacteria. Although jaw involvement often presents with classic pathognomonic signs, postcranial disease has not been so characterized. Affected bones from individuals diagnosed in life with actinomycosis were macroscopically and radiologically examined for their macroscopic character. The bones were riddled with spheroid, occasionally coalescing defects associated with periosteal reaction. Erosion penetrated cortical bone as readily as through cortical bone or subchondral bone.
X-ray revealed circular lesions with a slight sclerotic margin. Actinomycosis apparently has unique features, which should allow it to be distinguished from multiple myeloma (because of presence of reactive new bone formation) and from fungal disease (because of lack of "fronts of resorption" and penetrating spicules).
Similarity to fungal infection is especially of interest because of the earlier phylogenetic classification question.
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| CENTRAL NERVOUS SYSTEM |
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- Cranial and intracranial actinomycosis.
Sundaram C, Purohit AK, Prasad VS, Meena AK, Reddy JJ, Murthy JM.
Pathology, Neurosurgery and Imageology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
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Five patients with central nervous system actinomycosis are presented.
There were risk factors in 2 patients like penetrating head injury and tetralogy of Fallot. All the cases were diagnosed by histopathology.
Four patients recovered after surgery and antibiotic therapy, and 1 patient died.
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| CERVICOFACIAL |
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Cervicofacial Actinomycosis: Diagnosis and Management.
Oostman O, Smego RA.
Tuberculosis Research Section, Laboratory of Immunogenetics, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Twinbrook II, Room 236, MSC 8180, 12441 Parklawn Drive, Rockville, MD 20852, USA.
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Cervicofacial actinomycosis is an uncommon but fascinating infection of the head and neck. Most cases are odontogenic in origin and occur predominantly in immunocompetent individuals.
Causative microorganisms are generally of low pathogenicity and cause disease only in the setting of antecedent tissue injury. The disease process is characterized by the formation of abscesses, fibrosis and woody induration of tissues, and draining sinuses that discharge "sulfur granules." Cultural isolation of Actinomyces species from clinical specimens, or microscopic visualization of gram-positive, non-acid-fast, thin, branching filaments in cytologic aspirates or histopathologic sections are the best methods of diagnosis of cervicofacial actinomycosis.
Penicillin is the drug of choice and is usually administered for 2 to 12 months, although short-course treatment may cure uncomplicated infection. Surgical therapy is often indicated for curettage of bone, resection of necrotic tissue, excision of sinus tracts, and drainage of soft tissue abscesses. The prognosis for treated infection is excellent.
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| LIVER |
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Hepatic actinomycosis with infiltration of the diaphragm and right lung: a case report.
Islam T, Athar MN, Athar MK, Usman MH, Misbah B.
Department of Medicine, Mercy Catholic Medical Center-Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
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Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria of the genus Actinomyces.
Actinomycosis has a myriad of clinical presentations, inducing both a suppurative and granulomatous inflammatory response. The infection spreads contiguously through anatomical barriers and frequently forms external sinuses. The most common clinical presentations are cervicofacial, thoracic, abdominal and, in females, genital.
Classic features include purulent foci surrounded by dense fibrosis that, over time, cross natural boundaries into contiguous structures, with the formation of fistulas and sinus tracts in some cases.
Hepatic actinomycosis presents as single or multiple abscesses or masses. Reported here is the unusual occurrence of actinomycosis of the liver involving the diaphragm and right lung. The present case illustrates the difficulties in diagnosing this rare and unrecognized disease.
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Primary hepatic actinomycosis.
Lakshmana Kumar YC, Javherani R, Malini A, Prasad SR.
Department of Medicine, Sri Devaraj Urs Medical College, Tamaka, Kolar 563101, Karnataka, India.
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Actinomycotic liver abscess was diagnosed in a 35-year-old alcoholic farmer from southern India with tender hepatomegaly and fever.
CT of the abdomen revealed three coalescing hypodense lesions in the liver. The causative organism could be demonstrated on direct microscopy and cultured from the pus.
Treatment with i.v. penicillin for 2 months and oral ampicillin for 5 months resulted in cure as evidenced by clinical improvement and radiological disappearance of the lesions.
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| MADURA FOOT |
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Madura foot: atypical finding and case presentation.
Foltz KD, Fallat LM.
Oakwood Healthcare System, Dearborn, MI, USA.
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Mycetomas are chronic, subcutaneous infections characterized by a clinical triad of chronic induration, draining sinuses, and discharge of granules. The granules are composed of colonies of either actinomycotic bacteria or eumycotic fungi. The infection develops after traumatic inoculation with contaminated soil and progresses to adjacent tissues or bone. The foot, hand, and lower-leg regions are the most commonly affected areas.
Treatment can be difficult and includes surgical debridement with prolonged antibiotic or antifungal treatment. Mycetomas are primarily found in tropical and subtropical areas of the world and are relatively rare in the United States. A case of indigenously obtained actinomycoses that was successfully treated with surgical resection and long-term antibiotic therapy is presented.
This case is unique because of the rarity of contracting this type of infection in the United States. Mycetomas have been reported in southern states, but there are no reported cases of obtaining this pathogen in Michigan. This case stresses the need for clinical suspicion of this rare dermatosis, especially considering the increase in immigration to the United States.
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| OVARY |
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Ovarian actinomycosis mimicking malignancy.
Atay Y, Altintas A, Tuncer I, Cennet A.
Gynecologic Oncology Clinic, Cukurova University Medical Faculty, Adana, Turkey.
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OBJECTIVE: To emphasize the importance of frozen section diagnosis in the treatment of ovarian carcinoma and to remind physicians that it may mimic ovarian carcinoma and occur in women without intrauterine contraceptive devices (IUDs).
METHODS: Three cases operated on in Adana University Hospital between the year 2001-2003 with the diagnosis of ovarian actinomycosis were reported.
CASE REPORT: Three female patients who had never used IUDs, aged 37, 45 and 47, who presented with pelvic pain and tumoral masses in the pelvis were operated on with the initial diagnosis of ovarian carcinoma between the years 2001 and 2003. Intraoperative frozen-section diagnoses of the pelvic masses were actinomycosis. In the postoperative period the patients received long-term antibiotic therapy initially intravenously (15 days), and later orally with 4 g/day for three months. They were healthy without evidence of actinomycosis infection for two years after the treatment.
DISCUSSION: Pelvic actinomycosis is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. The behavior of the disease, which mimics malignancy and urogenital manifestation, poses difficulties in diagnosis and management. Preoperative examinations could not establish the nature of the tumour. An initial diagnosis of ovarian carcinoma is usually considered in all cases. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.
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| SOFT TISSUE |
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Actinomycosis: A rare soft tissue infection.
Fazeli MS, Bateni H.
Department of Surgery , Imam Khomeini Hospital, Tehran.
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Actinomycosis is a chronic and suppurative infection caused by an endogenous Gram-positive bacterium. The usual sites of infection are the head and neck, thorax, and abdomen. Primary cutaneous actinomycosis is very rare and usually associated with external trauma and local ischemia.
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- We report on the case of a primary cutaneous actinomycosis of the thigh in a 34-year-old man. The patient was treated successfully with surgical resection and combined antibiotic therapy, and eventually cutaneous reconstructive surgical procedure.
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| TESTICLE |
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Primary testicular actinomycosis mimicking metastatic tumor.
Lin CY, Jwo SC, Lin CC.
Department of Pathology, Chang Gung Memorial Hospital, Keelung City, Taiwan, ROC.
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We report a rare case of right primary testicular actinomycosis presenting as multiple testicular lesions mimicking a metastatic tumor in a 71-year-old patient with gastric adenocarcinoma. Preoperative diagnosis is difficult. The enlarged and inflamed testis was removed by orchiectomy and testicular actinomycosis was diagnosed after pathological examination. The patient had not received any further antibiotic prescription and there was no recurrent or other site involvement after orchiectomy.
We illustrate this case, though it is rare, to alert pathologists and clinicians to the possible occurrence of primary testicular actinomycosis mimicking metastatic lesions in a cancer patient. To diagnose, extensive sampling of the tissue specimens may be needed.
We also reviewed the published literature and found that the treatment of choice for testicular actinomycosis was orchiectomy. The usage of penicillin after orchiectomy does not seem to affect the outcomes of the disease.
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