Analysis of the diagnosis and treatment experience and etiological characteristics of 119 cases of primary canaliculitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the clinical features, diagnosis and treatment experience and the distribution characteristics of pathogenic microorganisms of primary canaliculitis, and provide reference for its diagnosis and treatment. METHODS: Retrospective clinical study. A total of 119 cases(120 eyes)diagnosed as primary canaliculitis in the department of ophthalmology of Wuxi No.2 People's Hospital from June 2019 to February 2023 were included. The treatment methods were mainly divided into conservative treatment(removing canaliculus stones through lacrimal punctum combined with injecting antibiotic eye ointment into the tube)and surgical treatment. The inspection methods of pathogenic microorganisms included secretion smear microscopy and microbial culture.RESULTS: Primary canaliculitis was more common in middle-aged and older female, mainly manifested by long-term red eye and increased secretion; however, the majority was not accompanied by tearing. Totally, 118 cases(99.2%)had monocular disease, while 63 cases(63 eyes; 52.5%)had inferior lacrimal canaliculus disease. Laboratory examination: Among 119 cases(120 eyes), 4 cases(4 eyes)did not undergo laboratory examination, and the other 115 cases(116 eyes)were as follows: Gram staining microscopy of secretion smear showed that Actinomyces were detected in 102 cases(103 eyes; 88.8%), while no fungus was detected; Microbial culture: 85 cases(86 eyes; 74.1%)were positive for bacterial culture. A total of 111 bacterial strains were cultured, which contained 26 types of bacteria. Among them, 32 strains were aerobic(28.8%); 26 strains were anaerobic(23.4%); and 53 strains were facultative anaerobic(47.7%). The most common bacteria were streptococcus(20 strains), staphylococcus(13 strains), Propionibacterium(10 strains), and capnocytophaga(10 strains). Only 4 cases(4 eyes; 3.4%)of microbial cultures were positive for Actinomyces. Fungus was negative in all microbial cultures. Treatment: Of the 119 cases(120 eyes), 114 cases(115 eyes; 95.8%)were cured by conservative treatment of removing lacrimal canaliculus stones through lacrimal punctum and intracanalicular ointment infiltration(IOI), while 5 cases(5 eyes)were not effective in conservative treatment; however, all of them were cured after surgical treatment, and the cure rate for primary canaliculitis was 100.0%.CONCLUSION: The incidence of primary canaliculitis is low, and it is prevalent in middle-aged and older female. Single lacrimal canaliculus is more common, which could be missed and misdiagnosed in clinic. Actinomyces is the major pathogen observed mostly in mixed infections, with heterogeneous strains, mainly anaerobic or facultative anaerobic bacteria. Streptococcus and Staphylococcus are the most common whereas fungal canaliculitis is rare. The cure rate of primary canaliculitis is high after diagnosis, and IOI method is recommended as the initial treatment of canaliculitis.

Chronic Bi-Maxillary Osteomyelitis Caused by Actinomycetes in a Patient with Severe COVID-19 / Osteomyelitis bi-maxilar crónica causada por Actinomycetes en un paciente con COVID-19 severo

Abstract Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow- up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.

Resumen La osteomielitis se define como la inflamación del hueso medular, cortical o esponjoso, incluyendo nervios y vasos sanguíneos, causando necrosis y formación de secuestro óseo; esta condición es una patología rara, y las infecciones odontogénicas son consideradas como el factor causal más frecuente. En este caso, se muestra un paciente con osteomielitis bi-maxilar causada por Actinomyces spp, la cual empeoró por la infección de COVID-19 severo. El paciente fue sometido a una cirugía, maxilectomía bilateral total amplificada, a través de la técnica quirúrgica de Weber- Fergusson, y el uso prolongado de una combinación de antibióticos, logrando una buena recuperación. A los 2 años de seguimiento, el paciente no mostró evidencia clínica o imagenológica de la infección de osteomielitis. El presente caso muestra una interesante relación entre una infección rara y su asociación con COVID-19.

Actinomyces europaeus (Gleimia europaea) asociado con absceso cerebral: comunicación de tres casos / Actinomyces europaeus (Gleimia europaea) associated with brain abscess: A reportof three cases

Resumen El absceso cerebral es una infección focal caracterizada por acumulación de pus enel parénquima cerebral; su diagnóstico es de urgencia debido a la alta mortalidad que acarrea.Presentamos tres casos de pacientes con abscesos cerebrales con foco otogénico de origen poli-microbiano, que presentaron en común el aislamiento de Actinomyces europaeus, agente nodescrito hasta el momento en esta localización. A. europaeus fue identificado por la metodo-logía convencional, por espectrometría de masas por desorción/ionización asistida por matriz(MALDI-TOF MS) y por secuenciación del gen ARNr 16S. La sensibilidad antibiótica se evaluó porel método epsilométrico. Todos los aislados presentaron sensibilidad a penicilina, vancomicinay linezolid, mientras que la sensibilidad a clindamicina y eritromicina fue variable. La iden-tificación por MALDI-TOF MS permitió arribar a nivel de especie de forma rápida y confiabley dar una respuesta oportuna y efectiva, evitando el retraso en el tratamiento, lo que sueleincrementar la morbimortalidad del cuadro clínico.

Distribution and function of cariogenic bacteria in supragingival plaque in patients with type 2 diabetes mellitus / 口腔疾病防治

Objective@#To investigate the distribution characteristics and functional genes of cariogenic bacteria in oral microorganisms of patients with type 2 diabetes mellitus and to improve the understanding of the relationship between type 2 diabetes mellitus and dental caries.@*Methods@#The experimental group included 10 patients with type 2 diabetes treated in the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University. The normal control group included healthy oral subjects without type 2 diabetes in the community population (10 cases). Samples of supragingival plaque from patients with type 2 diabetes mellitus and normal controls were collected and sequenced. Bioinformatics and statistical analysis of cariogenic bacteria such as Streptococcus mutans, Lactobacillus, Actinomyces viscosus and Candida albicans were carried out.@*Results@#There were slightly fewer cariogenic bacteria such as Streptococcus mutans, Lactobacillus, Actinomyces viscosus and Candida albicans in supragingival plaque samples of type 2 diabetic patients than in normal controls, but the difference was not statistically significant (P>0.05). The results of KEGG pathway functional metabolic differences showed that the metabolic pathways of D-arginine and D-ornithine metabolism, biofilm formation-Escherichia coli, carolactam degradation and arginine biosynthesis were more abundant in the T2DM group than in the normal control group, while metabolic pathways such as tyrosine metabolism, selenocompound metabolism and pyruvate metabolism showed the opposite trend. @*Conclusion @#There was no significant difference in the content of cariogenic microorganisms between type 2 diabetic patients and normal control group. The differential metabolic pathways of the functional genes indicated that an increase in the arginine metabolic pathway was beneficial to the maintenance of acid-base balance in the oral microecological environment.

Actinomycotic Osteomyelitis and Myiasis in Oroantral Communication: Clinicopathological and Tomographic Findings

Actinomycotic osteomyelitis of the maxilla presenting with oroantral communication is very rare, herein we report the first case of this condition in association with myiasis. A 50-year-old man reported chronic sinusopathy and a non-healing maxillary lesion, with 30 years of evolution, presenting occasional nasal and intraoral purulent discharge, with foul smell, and recurrent episodes of larvae presence. Cone beam computed tomography showed a large hyperdense image inside the left maxillary sinus, with focal areas with soft tissue density, and extensive discontinuity of the maxillary sinus floor, confirming the oroantral fistula. The necrotic tissue curetted during surgery presented hard consistency, and dark greenish color, and was submitted for histopathological analysis. Microscopically, necrotic bone, masses of filamentous bacteria colonie s, compatible with actinomycosis, and large rhomboidal structures surrounded by eosinophilic capsule - suggestive of larvae, were observed. The diagnosis of actinomycotic osteomyelitis with presence of structures compatible with larvae was established.

La osteomielitis actinomicótica del maxilar que se presenta con comunicación oroantral es poco frequente. En este trabajo reportamos el primer caso de esta condición en asociación con miasis. Un hombre de 50 años que refiere sinusopatía crónica y lesión maxilar que no cicatriza, de 30 años de evolución, presenta secreción ocasional purulenta nasal e intraoral, con mal olor y episodios recurrentes de presencia de larvas. La tomografía computarizada de haz cónico mostró una gran imagen hiperdensa en el interior del seno maxilar izquierdo, con áreas focales con densidad de partes blandas y una extensa discontinuidad del piso del seno maxilar, lo que confirma la fístula oroantral. El tejido necrótico legrado durante la cirugía presentó consistencia dura, coloración verdosa oscura, y fue remitido para análisis histopatológico. Microscópicamente se observó hueso necrótico, masas de colonias de bacterias filamentosas compatibles con actinomicosis y grandes estructuras romboidales rodeadas de cápsula eosinofílica sugestiva de larvas. Se estableció el diagnóstico de osteomielitis actinomicótica con presencia de estructuras compatibles con larvas.

Actinomyces y síndrome de Kartagener: Reporte de caso y revisión de la literatura / Actinomyces and Kartagener syndrome: Case report and literature review

RESUMEN El síndrome de Kartagener, el cual hace parte del subgrupo de las discinesias ciliares primarias predispone a infecciones respiratorias recurrentes del tracto respiratorio por Haemophilus influenzae, Staphylococcus aureus y Streptococcus pneumoniae. Se describe a continuación el caso de un paciente con diagnóstico de síndrome de Kartagener en quien se documentó colonización por Pseudomonas fluorescens y neumonía con empiema asociado por Actinomyces spp, una asociación poco frecuente en la literatura.

ABSTRACT Kartagener syndrome, which is part of the subgroup of the primary ciliary dyskinesias, predisposes to recurrent respiratory tract infections due to Haemophilus influenzae, Staphylococcus aureus and Streptococcus pneumoniae. The case of a patient with a diagnosis of Kartagener syndrome in whom colonization by Pseudomonas fluorescens and pneumonia complicated with empyema by Actinomyces spp is a rare association in the literature, which is described below.

Infecciones abdominales por Actinomyces odontolyticus: comunicación de dos casos

Resumen Actinomyces spp es una familia de bacilos grampositivos saprofíticos que rara vez producen infecciones en el ser humano. Actinomyces odontolyticus forma parte de la microbiota oral y existen escasos reportes de casos de infecciones asociadas a este microorganismo, principalmente de localización oral, torácica, pélvica y bacteremias. Estas infecciones se caracterizan por ser recidivantes y causar abscesos y trayectos fistulosos. Su aislamiento microbiológico es difícil ya que la mayoría de los equipos automatizados no identifican la especie de Actinomyces, por lo que técnicas como MALDI-TOF MS resulta de gran ayuda en el diagnóstico definitivo. Finalmente, el tratamiento antibacteriano debe ser prolongado, acompañado del drenaje quirúrgico de las colecciones. Presentamos dos casos de infección abdominal recurrente por A. odontolyticus, en pacientes inmunocompetentes, con tratamiento exitoso.

Abstract Actinomyces spp is a family of saprophytic gram-positive rods that rarely cause infections in humans. Actinomyces odontolyticus is part of the oral microbiota and there are few case reports of infections associated, mainly oral, thoracic, pelvic involvement and bacteremia. These infections are characterized by being recurrent and causing abscesses and fistulous tracts. Microbiological isolation of the microorganism is difficult because most of the automated identification equipment does not detect the Actinomyces species. The use of identification techniques such as MALDI-TOF MS is a great help in the definitive diagnosis. Finally, antibacterial treatment should be prolonged, and accompanied by surgical drainage of the collections. We report two cases of recurrent abdominal infection by A. odontolyticus, in immunocompetent patients, with successful treatment.

Aplicação do plasma de baixa temperatura sob pressão atmosférica no controle de biofilmes cariogênicos / Application of low temperature plasma under atmospheric pressure in the control cariogenic biofilms

O objetivo geral do presente estudo foi avaliar a aplicação dos jatos de plasma de baixa temperatura sob pressão atmosférica (PBTPA) produzidos por gás de argônio e hélio como gases de trabalho, no controle de biofilmes cariogênicos. Para tanto, foram estabelecidos os parâmetros físicos dos PBTPA gerados com argônio e hélio que se mostraram efetivos frente a biofilmes mono, dual e polimicrobianos compostos por combinações das espécies Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguinis, Lactobacillus casei, Lactobacillus acidophilus, Candida albicans e Actinomyces naeslundii. Os biofilmes mono, dual e multi-espécies foram submetidos ao tratamento com PBTPA produzidos por dois dispositivos diferentes, um obtido comercialmente (kINPen09®) que usou argônio como gás de trabalho, e outro protótipo desenvolvido pela FEG-UNESP (Faculdade de Engenharia de Guaratinguetá) que usou hélio. Análises quantitativas e microscópicas (confocal, microscopia eletrônica de varredura) foram realizadas. Foi incluído controle negativo (sem tratamento), positivo (clorexidina 0,12%) e controle de gás, utilizando apenas fluxo de gás, sem produzir plasma. Além disso, os efeitos celulares do PBTPAargônio e hélio sobre biofilme dual e multi-espécies também foram analisados em microscopia eletrônica de varredura e microscopia de varredura a laser confocal. Todos os ensaios foram realizados em triplicata em três experimentos independentes. Os resultados foram tabulados e analisados quanto à distribuição. A seguir, os testes estatísticos mais adequados foram selecionados. O nível de significância foi de 5%. Os resultados obtidos para os tratamentos dos biofilmes mono, dual ou multi-espécies com PBTPA-argônio e hélio foram todos significativos em comparação ao controle negativo em todos os tempos analisados. Para PBTPA-argônio, não houve recuperação de S. gordonii e S. sanguinis em todos tempos analisados. Para PBTPA-hélio, os melhores resultados foram obtidos em 5 e 7 minutos de exposição dos biofilmes ao PBTPA. Finalmente, tanto o dispositivo gerador de PBTPA que trabalhou com gás argônio quanto o dispositivo que trabalhou com gás hélio, demonstraram resultados promissores e poderão contribuir para o desenvolvimento de novos protocolos de Odontologia de Intervenção Mínima. (AU) The general objective of this study was to evaluate the application of lowtemperature plasma under atmospheric pressure (PBTPA) of argon and helium flow, in the control of cariogenic biofilms. For this, the effective physical parameters of PBTPA-argon and helium in mono, dual and polymicrobial biofilms composed of combinations of the species Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguinis, Lactobacillus casei, Lactobacillus acidophilus, Candida albicans and Actinomyces naeslundii were established. The multi-species biofilms were treated by different PBTPA generating devices, one obtained commercially (kINPen09®) that used argon as working gas, and another prototype developed by FEG-UNESP (Faculdade de Engenharia de Guaratinguetá) that used helium as working gas. Quantitative and microscopic analyzes (confocal, scanning electron microscopy) were performed. Negative control (no treatment), positive control (chlorhexidine 2%) and gas control (argon) were included. Besides that, cellular effects of PBTPA-argon and helium on dual and multi-species biofilms were analyzed by scanning electron microscopy (SEM) and confocal laser scanning microscopy. The results obtained for the treatments of mono, dual or multispecies biofilms with both PBTPA-argon and helium were all significant when compared to the negative control at all times analyzed. For PBTPA-argon, there was no recovery of S. gordonii and S. sanguinis at all analyzed times. For PBTPA-helium, the best results were obtained at 5 and 7 min of exposure of biofilms to PBTPA. All the tests were carried out in triplicate in three independent experiments. The results are tabulated and analyzed in terms of distribution. Next, the most suitable statistical tests were selected. The level of significance was 5%. The results obtained for the treatments of mono, dual or multi-species biofilms with PBTPA-argon and helium were all significant compared to the negative control at all analyzed times. Finally, both PBTPA generating could contribute to the development of new protocols for Minimal Intervention Dentistry (AU)

O objetivo geral do presente estudo foi avaliar a aplicação dos jatos de plasma de baixa temperatura sob pressão atmosférica (PBTPA) produzidos por gás de argônio e hélio como gases de trabalho, no controle de biofilmes cariogênicos. Para tanto, foram estabelecidos os parâmetros físicos dos PBTPA gerados com argônio e hélio que se mostraram efetivos frente a biofilmes mono, dual e polimicrobianos compostos por combinações das espécies Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguinis, Lactobacillus casei, Lactobacillus acidophilus, Candida albicans e Actinomyces naeslundii. Os biofilmes mono, dual e multi-espécies foram submetidos ao tratamento com PBTPA produzidos por dois dispositivos diferentes, um obtido comercialmente (kINPen09®) que usou argônio como gás de trabalho, e outro protótipo desenvolvido pela FEG-UNESP (Faculdade de Engenharia de Guaratinguetá) que usou hélio. Análises quantitativas e microscópicas (confocal, microscopia eletrônica de varredura) foram realizadas. Foi incluído controle negativo (sem tratamento), positivo (clorexidina 0,12%) e controle de gás, utilizando apenas fluxo de gás, sem produzir plasma. Além disso, os efeitos celulares do PBTPAargônio e hélio sobre biofilme dual e multi-espécies também foram analisados em microscopia eletrônica de varredura e microscopia de varredura a laser confocal. Todos os ensaios foram realizados em triplicata em três experimentos independentes. Os resultados foram tabulados e analisados quanto à distribuição. A seguir, os testes estatísticos mais adequados foram selecionados. O nível de significância foi de 5%. Os resultados obtidos para os tratamentos dos biofilmes mono, dual ou multi-espécies com PBTPA-argônio e hélio foram todos significativos em comparação ao controle negativo em todos os tempos analisados. Para PBTPA-argônio, não houve recuperação de S. gordonii e S. sanguinis em todos tempos analisados. Para PBTPA-hélio, os melhores resultados foram obtidos em 5 e 7 minutos de exposição dos biofilmes ao PBTPA. Finalmente, tanto o dispositivo gerador de PBTPA que trabalhou com gás argônio quanto o dispositivo que trabalhou com gás hélio, demonstraram resultados promissores e poderão contribuir para o desenvolvimento de novos protocolos de Odontologia de Intervenção Mínima. (AU)

Pseudomicosis por oportunistas: desconocimiento y retos diagnósticos / Pseudomycosis due to opportunists: Lack of knowedge and diagnostic challenges

Resumen Se denominan pseudomicosis a las infecciones generadas por microorganismos que parecen hongos pero que no lo son. En esta revisión se abordan desde una perspectiva etiológica, epidemiológica y clínica algunas de las pseudomicosis por oportunistas más frecuentes: actinomicosis, botriomicosis, nocardiosis y prototecosis. Adicionalmente, se revisan las herramientas clínicas y paraclínicas para facilitar su diagnóstico y se actualizan las pautas de tratamiento.

Abstract Infections generated by microorganisms that look like fungi but are not fungal are called pseudomycosis. This review addresses pseudomycosis by more frequent opportunists: actinomicosis, botryomycosis, nocardiosis and prototechosis, from an etiological, epidemiological and clinical perspective. In addition, clinical and paraclinical tools are reviewed to facilitate diagnosis, and and treatment guides are updated.

Cervicofacial actinomycosis: important considerations on a mimicking disease / Actinomicosis cervicofacial: consideraciones importantes sobre una enfermedad imitadora

SUMMARY Actinomycosis is a rare chronic suppurative infection that affects upper airways and the gastrointestinal tract. The aim of this work was to review important information regarding the etiopathogenesis, clinical features and treatment of cervicofacial actinomycosis. According to the anatomic site affected, it is classified into three clinical forms: cervicofacial (50%), thoracic (30%) and abdominal (20%). We present here a literature review focusing on important aspects of cervicofacial actinomycosis. Despite the name comprising the term mycosis, the disease is caused by Gram-positive bacteria of the genus Actinomyces, mainly Actinomyces israelii, which are commensals of the oral microbiota. Nevertheless, when the integrity of the oral mucosa is compromised, they can become pathogenic. Actinomycosis evolves slowly and it often mimics other clinical conditions such as malignancies. Treatment consists in antibiotic therapy and can last up to 12 months in severe cases. Health care professionals' knowledge about the disease is crucial in a way to promote its prevention, early diagnosis and proper treatment.

RESUMEN La actinomicosis es una enfermedad infecciosa muy infrecuente de tipo crónico y supurativo que afecta al área cervicofacial e el tracto gastrointestinal. El presente trabajo tuvo como objetivo, revisar informaciones importantes en cuanto etiopatogenia, presentación clínica y tratamiento de la actinomicosis cervicofacial. Se puede clasificar de tres maneras a depender del sitio anatómico: cervicofacial (50%), torácica (30%) y abdominal (20%). Presentamos una revisión de la literatura con foco en aspectos importantes de la actinomicosis cervicofacial. Aunque se le denomine micosis, la enfermedad es causada por bacterias grampositivas del género Actinomyces, siendo que A. israelli es el agente etiológico más frecuente, cuales son microorganismos comensales de la boca. Sin embargo, si la integridad de la mucosa es violada, ellos se tornan patogénicos. La actinomicosis es lentamente progresiva y frecuentemente imita otras condiciones clínicas como malignidades. El tratamiento consiste en terapia antibiótica y puede durar 12 meses en casos más graves. El conocimiento de los profesionales de salud acerca de esa enfermedad es fundamental para promover su prevención, diagnóstico precoz y tratamiento correcto.

Actinomicosis mandibular

RESUMEN Mujer de 46 años, tiroidectomizada por bocio hiperfuncionante, con bicitopenia (anemia y leucopenia) en estudio, acude por tumoración y dolor del maxilar inferior y secreción purulenta, de 4 meses de evolución, con fiebre intermitente. Presentó disminución de ingesta de alimentos con pérdida de 20 kg de peso aproximadamente. Ya recibió varios esquemas de tratamiento entre los que se incluye antimicrobianos, sin mejoría. Muestras de secreción con cultivo: negativos. Tomografía del macizo facial con lesiones osteolíticas y fractura del maxilar inferior. La biopsia muestra inflamación crónica inespecífica y presencia de Actinomyces sp. Biopsia osteomedular: probable efecto tóxico medular. Recibió tratamiento prolongado con antimicrobiano, mejorando. Actualmente en planes de reconstrucción de maxilar inferior.

ABSTRACT A 46-year-old woman, thyroidectomized by hyperfunctional goiter, with bicytopenia (anemia and leukopenia) under study, consults because of a tumor, pain of the lower jaw and purulent secretion of 4 months of evolution, with intermittent fever. She presented decrease in food intake with loss of approximately 20 kg of weight. She has already received several treatment schemes, including antimicrobials, without improvement. Culture secretion samples: negative. Tomography of the facial massif showed osteolytic lesions and fracture of the lower jaw. The biopsy shows nonspecific chronic inflammation and the presence of Actinomyces sp. Osteomedullary biopsy: probable spinal toxic effect. She received prolonged treatment with antimicrobial, improving. Currently she is in reconstruction plans of the lower jaw.

Pelvic inflammatory disease by actinomyces: report of 1 case and review of the literature

Actinomycosis is a chronic disease that is characterized by the formation of abscesses, fistulas and dense fibrous tissue at the site of involvement. Its distribution is worldwide. However, pelvic actinomycosis has increased in frequency and has been associated with abdominal surgery, intestinal perforation or trauma, due to the destruction of the muscular barrier. The clinical elements of suspicion are the latency of months and even years of symptoms and the history of being a carrier of an intrauterine device. Actinomyces israelli is a rare etiological agent of pelvic inflammatory disease, so it is difficult to reach the diagnosis. A case report is made of a 48-year-old patient with an intrauterine device older than 5 years, who entered the emergency department with abdominal pain syndrome and 7-day evolutionary fever accompanied by dyspareunia. She was hospitalized for antibiotic treatment, presenting an unsatisfactory evolution, with increased leukocytosis and persistent abdominal pain. An exploratory laparotomy with abdominal hysterectomy was performed. The histopathological diagnosis was pelvic inflammatory disease due to actinomyces. We must always suspect in the presence of a pelvic inflammatory disease in any of its clinical forms, the presence of actinomyces as one of the possible causative germs, especially in patients with intrauterine device for more than 5 years.

Growth and antioxidant response of juvenile oysters Crassostrea sikamea and Crassostrea corteziensis treated with Streptomyces strains / Crescimento e resposta oxidative de ostras jovens Crassostrea sikamea e Crassostrea corteziensis tratadas com cultura Streptomyces

The effect of three Streptomyces strains (N7, RL8 and V4) and a mixture of Bacillus (BMix) on the growth (Weight, Size) and superoxide dismutase activity (SOD) in hatchery-reared juvenile oysters Crassostrea corteziensis and Crassostrea sikamea was investigated to determine their probiotic potential. Microorganisms were added to culture water at 1×106 CFU/ml once a day during 30 days and all oysters fed daily a microalgae mix. Juveniles of C. sikamea treated with strains N7, RL8 and V4 had a significant weight gain compared to the control group. C. corteziensis juveniles treated with strains RL8 and BMix showed a significantly higher weight gain than the control group. No significant size increase was observed in any treated group for both oyster species. SOD activity significantly increased in C. sikamea treated with RL8 and with RL8, N7 and BMix in C. corteziensis. Streptomyces strains RL8 and N7 emerge as promising probiotic agents to cultivate C. sikamea and C. corteziensis and may also be useful to other molluscs and marine invertebrates .(AU)

O efeito de três culturas Streptomyces (N7, RL8 e V4) e uma mistura de Bacillus (BMix) sobre o cresimento (Peso, Tamanho) e atividade superóxido dismutase (SOD) em ostras jovens Crassostrea corteziensis e Crassostrea sikamea cultivadas artificalmente foi investigado para determinar seu potencial probiótico. Microorganismos foram adicionados à água de cultura a 1×10 6 CFU/ml uma vez por dia durante 30 dias e todas as ostras foram alimentadas diariamente com uma mistura de microalgas. Jovens C. sikamea tratados com culturas N7, RL8 e V4 tiveram ganho de peso significativo quando comparado ao grupo de controle. Jovens C. corteziensis tratados com culturas RL8 e BMix demonstraram peso significativamente mais algo que o grupo de controle. Nenhum aumento em tamanho foi observado em grupos tratados em ambas espécies. A atividade SOD foi significamente aumentada em C. sikamea treatado com RL8 e com RL8, N7 e BMix em C. corteziensis. Culturas Streptomyces RL8 e N7 surgem como agentes probióticos promissores para o cultivo de C. sikamea e C. corteziensis e podem ser úteis para outros moluscos animais marinhos invertebrados.(AU)

Actinomicosis de pared abdominal con infiltración hepática simulando una neoplasia maligna: reporte de un caso / Abdominal wall actinomycosis with hepatic infiltration mimicking a malignant neoplasm: case report

La infección por Actinomices (actinomicosis), es una entidad poco frecuente y que puede crear dificultades diagnósticas y terapéuticas; principalmente cuando por su presentación se asemeja a neoplasias malignas. El objetivo de este estudio fue reportar un caso de actinomicosis de pared abdominal con infiltración hepática y revisar la evidencia existente. Se trata de una paciente sexo femenino, de 33 años de edad, sin antecedentes quirúrgicos ni de utilización de dispositivos intra-uterinos. Consultó por dolor abdominal y masa palpable a nivel epigástrico. Se estudió con imágenes, las que permitieron verificar una masa de pared abdominal con trayecto fistuloso al hígado. Se realizó una exéresis amplia de la lesión antes descrita. Una vez extirpado el espécimen, se fue a estudio histopatológico, que reveló gránulos de azufre consistentes con actinomices. La paciente evolució de forma satisfactoria, sin inconvenientes. Presentamos un caso poco común de actinomicosis de pared abdominal con infiltración hepática. Cuando se encuentra una gran masa intraperitoneal, la actinomicosis debe incluirse en el proceso de diagnóstico diferencial.

Actinomyces infection (actinomycosis) may create diagnostic conflicts and be confused with malignant neoplasms, especially in the abdomen. The objective of this study was to report a case of abdominal wall actinomycosis with hepatic infiltration, and review the existing evidence. Female patient, 33 years of age, with no surgical history or use of intra-uterine devices. She consulted for abdominal pain and palpable mass at the epigastrium. It was studied with images, which allowed verifying an abdominal wall mass with hepatic fistulae. A broad extirpation of the lesion was performed. The histological study revealed sulfur granules consistent with actinomyces. The patient has evolved satisfactorily, without problems; and is currently in treatment with amoxicillin. We present an unusual case of abdominal wall actinomycosis with hepatic infiltration that resulted in a difficult diagnosis. When a large intraperitoneal mass is found, actinomycosis needs to be included as a differential diagnoses.

Actinomycotic lacrimal canaliculitis: a rare case report

Actinomyces israelii is a gram-positive anaerobic organism commonly associated with canaliculitis in adults. Actinomyces are normal commensal bacteria in humans and primarily cause opportunistic infections during immunosuppressive state or when loss of continuity of epithelial lining in mucosa occurs. Lacrimal canaliculitis is a relatively rare condition and is undiagnosed for long periods of time. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem and Actinomycosis may form in up to 2% of all lacrimal disease. Here present study reports a case of lacrimal canaliculitis caused by Actinomyces israelii.

Invasive Actinomycosis of Maxilla-An Unusual Case Report

Cervicofacial actinomycosis is an unusual infectioncaused by Actinomyces species. It rarely involves themaxilla. We present a case of an elderly female with aleft sided maxillary swelling which was diagnosed asleft maxillary actinomycosis invading the adjacentstructures suspected to be secondary to a bone neoplasmon the basis of histopathology. The organism grew inculture in our laboratory and hence this case is adeviation from the common feature that cultures aremost of the times of little help in detecting thisorganism. The classical growth of this organism onculture in addition to the histopathology report highlyempowered the diagnosis of this case. Also, our findingsthat it can permeate the surrounding structures and canproduce a conundrum for the diagnosis are noteworthy

Actinomicosis esofágica en pacientes con infección por VIH / Esophageal actinomycosis in patients with HIV infection

La patología esofágica es común en pacientes con VIH, frecuentemente debido a Candida, citomegalovirus o virus herpes simple. Sin embargo, la actinomicosis esofágica es una infección rara, incluso en pacientes con infección VIH. Reportamos el caso en un paciente varón de 33 años, con diagnóstico reciente de VIH que acudió a consulta por fiebre, odinofagia, disfagia y dolor retroesternal. La endoscopia digestiva alta evidenció múltiples úlceras esofágicas y el informe histopatológico de la biopsia esofágica describió una esofagitis crónica con presencia de colonias de bacilos PAS positivos, compatibles con Actinomyces, iniciando tratamiento antimicrobiano con evolución favorable. Aunque es una enfermedad no común, cerca de un tercio de los casos de actinomicosis esofágica se presentan en pacientes con infección VIH, y es preciso el estudio endoscópico con toma de biopsia para definir el diagnóstico y manejo apropiado.

Esophageal pathology is common in patients with HIV, frequently due to Candida, cytomegalovirus or herpes virus. However, esophageal actinomycosis is a rare infection, even in patients with HIV. We report the case of a 33-year-old male patient, with a recent diagnosis of HIV who was admitted for fever, odynophagia, dysphagia and retrosternal pain. Upper gastrointestinal endoscopy evidenced multiple esophageal ulcers and the histopathological report of the esophageal biopsy described a chronic esophagitis with colonies of PAS positive bacilli, compatible with Actinomyces, initiating favorable antimicrobial therapy. Although it is an uncommon disease, about one-third of cases of esophageal actinomycosis occur in patients with HIV infection, and endoscopic biopsies are required to define diagnosis and appropriate treatment.

Long-term Outcome of Incision and Curettage Treatment in Patients with Lacrimal Gland Ductulitis

PURPOSE: To describe the effects and long-term outcomes of incision and curettage treatment in patients with lacrimal gland ductulitis.METHODS: Twenty-four patients (24 eyes) with lacrimal gland ductulitis who were treated at Saevit Eye Hospital from June 2010 to November 2016. All patients underwent incision and curettage through the lacrimal ductule, and granules or concretions were removed. After the procedure, oral and topical antibiotics, oral anti-inflammatory agent were used for a week. Clinical presentations of the patients were analyzed. The resolution of symptoms and inflammatory signs and recurrence were evaluated more than 12 months after the procedure including telephone follow-up by a specialist nurse.RESULTS: Common symptoms were a painful, swelling mass with mucous discharge (17 eyes) and conjunctival injection (7 eyes) at the lateral canthal area. During the procedure, 22 patients (91.7%) had typical sulfur granule of Actinomyces, and 10 patients (41.7%) had many cilia in the expressed debris from the ductule. Twenty-three of 24 patients had resolution of symptoms after the procedure and all but one patient (95.8%) showed no recurrence.CONCLUSIONS: Incision and curettage is a simple and less invasive procedure that may be considered as a first treatment option for lacrimal gland ductulitis. Furthermore, incision and curettage of the affected lacrimal ductule has been shown to be effective at minimizing long-term recurrence of lacrimal ductulitis.

Identification and biological characteristics of an Actinomyces europaeus strain / 中华微生物学和免疫学杂志

Objective To investigate the methods for identifying Actinomyces europaeus and to analyze its biological characteristics in order to provide a basis for the diagnosis of actinomycosis. Methods Pus speci-mens collected from patients were used for bacterial culture and then analyzed with Gram staining. VITEK 2 Compact automatic microbiological analyzer was used for species identification. Drug susceptibility test was per-formed with E-test. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry ( MALDI-TOF MS) was used to identify the isolated strain. The common primers of 16S rRNA were used for amplification fol-lowing DNA extraction, and the product of PCR was sequenced after recovery and purification. Homology analy-sis was conducted using the sequence in GenBank database. Results The drug susceptibility test showed that the strain was sensitive to penicillin, piperazolin/taclobatan, and ceftriaxone, but resistant to ciprofloxacin. MALDI-TOF MS and 16S rRNA gene assay identified the strain as Actinomyces europaeus. Conclusions MALDI-TOFMS and 16S rRNA could be used to identify Actinomyces europaeus and are of great significance for the diagnosis of actinomycosis.

Actinomicosis orofaríngea como diagnóstico diferencial de carcinoma de cavum: Reporte de un caso / Cervicofacial actinomycosis as differential diagnosis of cavum carcinoma: case report

La actinomicosis es una enfermedad infrecuente en pediatría que implica, habitualmente, un desafío diagnóstico. Es producida por bacterias del género Actinomyces. La forma cervicofacial suele originarse tras la disrupción de la mucosa oral secundaria a alteraciones odontógenas. Se presenta el caso de una adolescente que, tras la colocación de un piercing en la lengua, comenzó con odinofagia y cambios del tono de voz. Luego de ocho meses de persistencia de los síntomas y habiendo realizado múltiples tratamientos antibióticos con leve mejoría, se efectuó una biopsia y se diagnosticó carcinoma de cavum, por lo que se derivó a este Hospital para su tratamiento. Al analizar nuevamente la biopsia, se descartó la patología oncológica y se diagnosticó actinomicosis orofaríngea. Cumplió 6 meses totales de tratamiento antibiótico, con buena evolución. Si bien la colocación de piercings orales no ha sido descrita hasta el momento como factor de riesgo, la disrupción mucosa generada podría favorecer el inicio del cuadro.

Paediatric actinomycosis is an infrequent infectious disease caused by Actinomyces spp. Cervicofacial infections are usually related to disruption in oral mucosal membranes. We discuss the case of a 15-year-old girl who refers an 8-month history of odynophagia and changes in her tone of voice after getting a tongue piercing. She received multiple antibiotic treatments with slight improvement. Nasopharyngeal carcinoma was diagnosed by endoscopic biopsy. The patient was referred to our Hospital for treatment but, when the biopsy was analyzed again, oncological pathology was excluded and oropharyngeal actinomycosis was diagnosed. She received a total of 6 months of antibiotic treatment with favorable evolution.