ABSTRACT
Resumen La actinomicosis pélvica es una infección bacteriana supurativa crónica, producida por especies de Actinomyces, principalmente Actinomyces israelii, que afecta el aparato genital interno y las estructuras vecinas, asociada al uso prolongado de dispositivo intrauterino sin control en casi la totalidad de los casos descritos en mujeres. La actinomicosis pélvica suele presentarse como un absceso tubo-ovárico y con menor frecuencia como una actinomicosis pélvica invasiva (API). La API se propaga por contigüidad desde el aparato genital hacia las vísceras adyacentes, originando un tumor pélvico difuso, de consistencia leñosa, pseudotumoral, que a menudo se confunde con una neoplasia pélvica. La API representa un gran desafío para el ginecólogo por las dificultades en su diagnóstico y manejo. Se presentan dos casos de API y se revisan los procedimientos diagnósticos y terapéuticos recomendados actualmente para el enfrentamiento de esta patología.
Abstract Pelvic actinomycosis (PA) is a chronic suppurative bacterial infection, produced by Actinomyces, mainly Actinomyces israelii. It affects the internal genital tract, adjacent structures and is associated with a prolonged intrauterine device use with an inadequate control in almost all described cases in women. Pelvic actinomycosis usually presents as a tube ovarian abscess and less frequently as invasive pelvic actinomycosis (IPA). The IPA spreads contiguously from the genital tract to adjacent viscera, causing a diffuse, woody, pseudotumoral pelvic tumor that is frequently confused with a pelvic neoplasm. The IPA represents a great challenge for the gynecologist due to the difficulties in the diagnosis and management of this disease. Two cases of IPA are presented and the currently recommended diagnostic and therapeutic procedures for dealing with this pathology are reviewed.
Subject(s)
Humans , Female , Adult , Middle Aged , Actinomycosis/diagnosis , Actinomycosis/etiology , Pelvic Infection/diagnosis , Pelvic Infection/etiology , Intrauterine Devices/adverse effects , Actinomycosis/drug therapy , Pelvic Infection/drug therapy , Diagnosis, Differential , Anti-Bacterial Agents/therapeutic useABSTRACT
La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.
Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.
Subject(s)
Humans , Male , Child , Temporal Bone , Actinomycosis/diagnosis , Actinomycosis/surgery , Actinomycosis/therapy , MastoiditisABSTRACT
RESUMEN Se presentó el caso de una actinomicosis ósea, que se manifestó como una lesión de la piel en la zona correspondiente al segundo metatarsiano izquierdo. Por el antecedente de ser la paciente operada de un tumor de células gigantes, se pensó en una recidiva tumoral. Fue intervenida quirúrgicamente y se realizó exéresis del segundo metatarsiano y de la piel afectada. La biopsia informó actinomicosis. Se trató a la paciente con amoxicilina; evolucionando satisfactoriamente, y dando seguimiento en consulta (AU).
ABSTRACT The authors presented the case of a bone actinomycosis expressed as a skin lesion in the area of the second left metatarsals. Due to the antecedent of having undergone a surgery of a giant cell tumor, a tumor recurrence was thought. Surgical intervention was performed and the excision of the second metatarsals and affected skin was performed. The biopsy reported Actinomycosis. The patient was treated with amoxicillin. She had a satisfactory evolution and is still followed up in consultation (AU).
Subject(s)
Humans , Female , Actinomycosis/diagnosis , Forefoot, Human/pathology , Patients , Therapeutics , Biopsy/methods , Bone Diseases, Infectious/diagnosis , Actinomycosis/surgery , Actinomycosis/complications , Case ReportsABSTRACT
Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.
Subject(s)
Humans , Female , Aged , Actinomycosis/diagnosis , Abdomen/abnormalities , Liposarcoma/diagnosis , Diagnosis, DifferentialABSTRACT
INTRODUCCIÓN: La actinomicosis es una enfermedad infecciosa poco frecuente, ocasionada por una bacteria Gram positiva. La especie más común es Actinomyces israelii. Dentro de sus formas de presentación, la torácica es la menos frecuente. PRESENTACIÓN DE CASOS: Reportamos dos pacientes con actinomicosis torácica de 8 y 13 años de diferentes zonas geográficas de Perú. El primer caso tuvo empiema necessitatis y el segundo, consolidación pulmonar y hemoptisis recurrente. Ambos tuvieron cierto grado de dificultad en su diagnóstico, pero con una buena respuesta al tratamiento antibiótico y quirúrgico. El diagnóstico fue mediante estudio histopatológico. Sin embargo, no se pudo identificar la especie de Actinomyces. CONCLUSIÓN: La actinomicosis torácica es poco frecuente en niños y se presenta como una lesión parenquimal con posible fistulización a la pared torácica. Este es uno de los pocos casos reportados en la literatura peruana, constituyendo una contribución al conocimiento de esta enfermedad y su manejo en pediatría.
INTRODUCTION: Actinomycosis is a rare infectious disease caused by Gram-positive bacteria. The most common species is Actinomyces israelii. Among its forms of presentation, the thoracic is the least frequent. CASE PRESENTATION: We report two patients with thoracic actinomycosis, 8 and 13 years old, from different geographical areas of Peru. The first case had empyema necessitans and the second, lung consolidation and recurrent hemoptysis. Both had a certain degree of difficulty in their diagnosis but responded favorably to antibiotics and surgical treatment. The diagnosis was based on the histopathological study. However, we were not able to ascertain the species of actinomyces. CONCLUSION: Thoracic actinomycosis is rare in children and presents as a parenchymal lesion with possible fistulization to the chest wall. This article is one of the few in the Peruvian literature, constituting a contribution to the knowledge of the disease and its management in pediatrics.
Subject(s)
Humans , Male , Female , Child , Adolescent , Actinomyces/isolation & purification , Actinomycosis/diagnosis , Lung Diseases/diagnosis , Peru , Actinomycosis/microbiology , Actinomycosis/therapy , Lung Diseases/microbiology , Lung Diseases/therapy , Anti-Bacterial Agents/administration & dosageABSTRACT
Abstract Introduction: Actinomycosis is a rare infectious disease that affects abdominal organs and simulates oncological disease, hardly ever presents itself as a cause of intestinal obstruction. Symptoms: A 43 years old, male patient with two months of left abdominal pain associated to a growth and an 8 kg weight loss, no fever or bowel habit disruption. Interventions: A colonoscopy and an abdominal scanography. Results: A solid heterogeneous 7 × 3.8 cm mass localized in the splenic flexure of the colon with infiltration of its walls and its surrounding fat. Colon cancer was considered as the first diagnostic possibility. During hospitalization, the patient was taken to an emergency exploratory laparotomy, due to an acute abdominal pain with bowel obstruction symptoms. Histopathological diagnosis: Actinomycetoma. Conjoint continuous monitoring with the infectious disease attending, abdominal US and observation did not show new growths. Weight gain and progressive return to daily life was obtained within 8 weeks. Conclusion: In low income countries, intestinal actinomycosis should be considered in the differential diagnosis of abdominal masses and chronic inflammatory processes, patient prognosis with proper management is excellent.
Resumo Introdução: A actinomicose é uma doença infecciosa rara que acomete órgãos abdominais, simula doença oncológica e dificilmente causa de obstrução intestinal. Sintomas: Paciente do sexo masculino, 43 anos, com quadro de dor abdominal esquerda por dois meses, associado ao surgimento de massa e perda de peso de 8 kg, sem febre ou alterações dos hábitos intestinais. Intervenções: Colonoscopia e uma tomografia computadorizada abdominal. Resultados: Observou-se massa sólida heterogênea de 7 × 3,8 cm localizada na flexão esplênica do cólon, com infiltração de suas paredes e gordura adjacente. Câncer de cólon foi a primeira possibilidade diagnóstica considerada. Durante a internação, o paciente foi submetido a uma laparotomia exploradora de emergência, devido a uma dor abdominal aguda com sintomas de obstrução intestinal. Diagnóstico histopatológico: Actinomicetoma. Monitoramento contínuo em conjunto com o tratamento da infecção, ultrassom abdominal e observação; não foram observados novos crescimentos. Ganho de peso e retorno progressivo à vida diária foram observados por oito semanas. Conclusão: Em países de baixa renda, a actinomicose intestinal deve ser considerada no diagnóstico diferencial de massas abdominais e processos inflamatórios crônicos; com manejo adequado, o prognóstico é excelente.
Subject(s)
Humans , Male , Adult , Actinomycosis/diagnosis , Actinomycosis , Tomography, X-Ray Computed , ColonoscopyABSTRACT
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.
Subject(s)
Humans , Female , Middle Aged , Actinomycosis/diagnosis , Actinomycosis/surgery , Actinomycosis/pathology , Abdominal Wall/microbiology , Diagnosis, Differential , Liver Abscess/etiology , Abdominal Neoplasms/diagnosisABSTRACT
Abstract Asymptomatic female genital tract colonization with Actinomyces spp is not uncommon, particularly among intrauterine device users. Pelvic actinomycosis is an extremely rare disease. The clinical picture can resemble an advanced ovarian malignancy. We report a case of pelvic actinomycosis mimicking ovarian malignancy diagnosed postoperatively. Preoperative diagnosis is possible if there is a high index of suspicion, obviating extensive surgery and preserving fertility, since long term antibiotic treatment can be completely effective. Pelvic actinomycosis should be included in the differential diagnosis of women presenting a pelvic mass, especially if there is intrauterine device use history.
Resumo A colonização assintomática do aparelho genital feminino por Actinomyces spp não é infrequente, sobretudo em utilizadoras de dispositivo intra-uterino. A actinomicose pélvica é uma doença extremamente rara. O quadro clínico pode assemelhar-se ao de uma neoplasia maligna do ovário avançada. Relatamos um caso de actinomicose pélvica, simulando uma neoplasia maligna do ovário, com diagnóstico pós-operatório. O diagnóstico pré-operatório é possível se houver um elevado grau de suspeição, permitindo evitar cirurgias extensas e preservar a fertilidade, uma vez que o tratamento antibiótico prolongado pode ser totalmente eficaz. A actinomicose pélvica deve ser incluída no diagnóstico diferencial da mulher que apresente uma massa pélvica, sobretudo se houver história de uso de dispositivo intra-uterino.
Subject(s)
Humans , Female , Actinomyces/isolation & purification , Actinomycosis/diagnosis , Pelvic Inflammatory Disease/diagnosis , Ovarian Neoplasms/diagnosis , Actinomycosis/therapy , Actinomycosis/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Pelvic Inflammatory Disease/therapy , Pelvic Inflammatory Disease/diagnostic imaging , Diagnosis, Differential , Middle AgedABSTRACT
ABSTRACT: Actinomycosis is a bacterial infection caused by Actinomyces species, which usually affect the soft tissues of the cervicofacial region of adult males. Clinically, it's characterized by a slow-growing indurated mass, especially in the submandibular area. However, in a few cases, the jaws bones can be affected developing osteomyelitis characteristics. The aim of this paper is to report a rare clinical case of Actinomycotic Osteomyelitis affecting the maxilla of a child, involving the maxillary sinus, orbital and zygomatic areas that was treated by the association of antibiotic therapy and surgical debridement. The patient's 2 years follow-up was uneventful and no signs of the lesion recurrence.
RESUMEN: La actinomicosis es una infección bacteriana causada por la especie Actinomyces, que generalmente afecta los tejidos blandos de la región cervicofacial de los hombres adultos. Clínicamente, se caracteriza por una masa endurecida de crecimiento lento, especialmente en la zona submandibular. Sin embargo, en algunos casos, los huesos de las mandíbulas pueden ser afectados desarrollando características de osteomielitis. El objetivo de este trabajo es reportar un caso clínico poco frecuente de osteomielitis actinomicótica que afecta el maxilar de un niño, envolviendo el área del seno maxilar, y zonas orbitales y cigomáticas que fueron tratadas con la asociación de terapia con antibióticos y desbridamiento quirúrgico. El seguimiento del paciente por 2 años ocurrió sin incidentes y sin signos de recidiva de las lesiones.
Subject(s)
Humans , Female , Child , Osteomyelitis/diagnosis , Palate/microbiology , Palate/pathology , Periapical Diseases/diagnosis , Actinomycosis/diagnosis , Mouth Diseases/diagnosis , Osteomyelitis/pathology , Actinomycosis/pathology , Radiography, Panoramic , Diagnosis, Differential , Hematoxylin , Maxilla , Mouth Diseases/microbiology , Mouth Diseases/pathologySubject(s)
Humans , Actinomycosis , Actinomycosis/diagnosis , Actinomycosis/pathology , Diagnosis, DifferentialABSTRACT
Abstract Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.
Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Penicillins/administration & dosage , Actinomycosis/drug therapy , Immunosuppression Therapy , Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Actinomycosis/diagnosis , Actinomycosis/pathology , Treatment Outcome , Middle AgedABSTRACT
La actinomicosis mamaria es una infección supurativa crónica que se caracteriza por la producción de "gránulos de azufre" a partir de fístulas externas en la piel de las mamas. Por ser una enfermedad rara en esta localización y al encontrarnos con dos casos similares decidimos realizar este estudio, siendo los aspectos antes mencionados la motivación principal del mismo. Además, pretendemos despertar el interés de los médicos al estudio de tal padecimiento para el diagnóstico y conocimiento del tratamiento el cual debe ser precoz y duradero para su cura. Se hizo énfasis en la importancia del diagnóstico y tratamiento tempranos(AU)
Mammary actinomycosis is a chronic suppurative infection that is characterized by the production of sulfur granules from external fistulas in the skin of the breasts. Due to, it is a rare disease in this location. Two similar cases, are carried out in this study, the mentioned aspects being the main motivation. In addition, we intend to awaken the interest of doctors to the study of such condition for the diagnosis and knowledge of the treatment which must be early and lasting for its cure. The importance in early diagnosis and treatment is emphasized(AU)
Subject(s)
Humans , Female , Adult , Breast , Actinomycosis/diagnosis , Actinomycosis/therapy , InfectionsABSTRACT
Abstract Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.
Resumo A actinomicose periapical causada por um patógeno anaeróbio Gram positivo caracteriza uma infecção extra-radicular típica. Esse estudo determinou a frequência e correlacionou o conteúdo das colônias bacterianas com o tamanho das actinomicoses periapicais. O estudo compreendeu um total de 218 lesões periapicais (LPs) (cistos, granulomas ou abscessos). Os espécimes embebidos em parafina foram cortados em secções de 4-µm e corados com hematoxilina-eosina, Gram, ácido periódico de Schiff (PAS) e coloração de Grocott. A presença de colônias bacterianas compostas por estruturas filamentosas marcadas com os corantes histoquímicos foram descritas como Actinomyces, e para cada caso, as colônias bacterianas foram contadas e mensuradas. A correlação entre o número e tamanho das colônias bacterianas e o tamanho das LPs foi testado usando o coeficiente de correlação ajustado de Pearson. De 218 LPs, colônias bacterianas foram identificadas em 64 biópsias. Sete casos (0,3%) preencheram os critérios para o diagnóstico de actinomicose periapical. Todos os casos foram resistentes à terapia e não mostraram reparo periapical após 12 meses de acompanhamento. Cirurgia periapical ou extração dental foi realizada. O teste de correlação indicou nenhuma correlação entre o número de colônias bacterianas e o tamanho da lesão (p=0.752, r=-0.148). Entretanto, uma maior colônia bacteriana geralmente resultou em uma maior lesão periapical (p=0.000, r=0.657). A frequência de actinomicose periapical foi baixa e esta lesão deve ser incluída no diagnóstico diferencial das LPs. O tamanho das colônias de Actinomyces pareceu contribuir para o aumento no tamanho da lesão periapical.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Actinomycosis/diagnosis , Periapical Diseases/diagnosis , Actinomycosis/complications , Paraffin Embedding , Periapical Diseases/complicationsABSTRACT
Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the genus. Although pelvic inflammatory disease is an entity associated with the longstanding use of intrauterine devices (IUDs), actinomycosis is not one of the most frequent infections associated with IUDs. We present the case of a 43-year-old female patient who was referred to the emergency facility because of a 20-day history of abdominal pain with signs of peritoneal irritation. Imaging exams revealed collections confined to the pelvis, plus the presence of an IUD and evidence of sepsis, which was consistent with diffuse peritonitis. An exploratory laparotomy was undertaken, and a ruptured left tubal abscess was found along with peritonitis, and a huge amount of purulent secretion in the pelvis and abdominal cavity. Extensive lavage of the cavities with saline, a left salpingo-oophorectomy, and drainage of the cavities were performed. The histopathological examination of the surgical specimen revealed an acute salpingitis with abscesses containing sulfur granules. Therefore, the diagnosis of abdominal and pelvic actinomycosis was made. The postoperative outcome was troublesome and complicated with a colocutaneous fistula, which drained through the surgical wound. A second surgical approach was needed, requiring another extensive lavage and drainage of the recto-uterine pouch, plus the performance of a colostomy. Broad-spectrum antibiotics added to ampicillin were the first antimicrobial regimen followed by 4 weeks of amoxicillin during the outpatient follow-up. The patient satisfactorily recovered and is already scheduled for the intestinal transit reconstitution.
Subject(s)
Humans , Female , Adult , Abscess/etiology , Actinomycosis/diagnosis , Intrauterine Devices/adverse effects , Oophoritis/pathology , Salpingitis/pathology , Abdominal Cavity/pathology , Anti-Infective Agents/therapeutic use , Fistula , Intestinal Perforation , Pelvis/pathologyABSTRACT
Objectif :L'actinomycose est une infection rare due à une bactérie anaérobie à Gram positif saprophyte des cavités naturelles de l'homme. Le but de ce travail est d'illustrer les difficultés diagnostiques de cette pathologie et de montrer l'importance de l'examen anatomopathologique dans ce cadre.Matériel et méthodes :Il s'agit d'une étude rétrospective de 7 cas d'actinomycose colligés entre les années 1998 et 2015.Résultats :L'étude a intéressé 4 femmes et 3 hommes d'âge moyen de 42 ans (16 à 70 ans). Tous les patients n'avaient pas d'antécédents odontogéniques ni traumatiques. Les localisations étaient nasopharyngées dans 4 cas et sub-mandibulaires dans 3 cas. La symptomatologie était peu spécifique. Une rhinorrhée purulente était notée dans 3 cas, une obstruction nasale bilatérale dans 2 cas, une haleine fétide dans 1 cas et une anosmie dans 1 cas. Le motif de consultation était une tuméfaction submandibulaire dans 3 cas. L'échographie et le scanner n'ont pas aidé au diagnostic positif d'actinomycose. L'examen bactériologique était négatif dans tous les cas. Le diagnostic préliminaire d'actinomycose n'a été évoqué par notre équipe dans aucun cas. Le diagnostic était confirmé en postopératoire par l'examen anatomopathologique d'un prélèvement biopsique dans tous les cas. Il avait mis en évidence des grains actinomycosiques. L'évolution était dans tous les cas favorable après un traitement à base de pénicilline G associé à la chirurgie.Conclusion :L'actinomycose peut prendre des aspects trompeurs prêtant à confusion avec des affections tumorales ou infectieuses à pyogènes. Aucune imagerie ne peut fournir des informations spécifiques pour le diagnostic. Les résultats négatifs des examens bactériologiques doivent être interprétés avec prudence. L'examen anatomopathologique est d'un grand apport pour poser le diagnostic
Subject(s)
Actinomycosis/diagnosis , Actinomycosis/pathology , Case Reports , Nasopharynx , Otolaryngology , TunisiaABSTRACT
La actinomicosis es una infección poco frecuente, lentamente progresiva y de difícil diagnóstico. Se presenta el caso clínico de una mujer de 63 años en remisión total de un linfoma no Hodgkin difuso de células B grandes de amígdala. Durante su seguimiento se observó un ligero aumento de la lactato deshidrogenasa (LDH). Por la posibilidad de una recaída de su linfoma se realizó una tomografía por emisión de positrones (TEP-TC) que detectó mayor densidad y actividad en la orofaringe izquierda. Se realizó la extirpación de la lesión, cuyo diagnóstico histopatológico fue de una actinomicosis amigdalina. El género Actinomyces es comensal de la orofaringe y de la vía respiratoria y digestiva. La forma cérvico-facial es la más frecuente. La extirpación quirúrgica es a menudo esencial para un diagnóstico definitivo. Es importante incluir esta enfermedad en el diagnóstico diferencial de las lesiones tumorales de la región cérvico-facial.
Subject(s)
Humans , Female , Middle Aged , Palatine Tonsil , Actinomycosis/diagnosis , Pharyngeal Diseases/diagnosis , Lymphoma, Large B-Cell, Diffuse/diagnosis , Actinomycosis/surgery , Pharyngeal Diseases/surgery , Pharyngeal Neoplasms/diagnosis , Diagnosis, DifferentialABSTRACT
La actinomicosis es una enfermedad producida por bacterias del género Actinomyces. La forma torácica representa el 30% de los casos. La evolución es habitualmente crónica, con clínica variable. Se presenta una nina de 11 años de edad con tumefacción subescapular derecha de un mes de evolución, asociada a fiebre, hiporexia y pérdida de peso. Se diagnosticó actinomicosis torácica producida por Actinomyces meyeri. Recibió tratamiento antibiótico durante un año, con resolución completa. Aunque es poco frecuente, debe ser tenida en cuenta como diagnóstico diferencial en cuadros de tumoración torácica de larga evolución con compromiso del estado general. Debe informarse al microbiólogo la sospecha diagnóstica por lo difícil de su desarrollo en los medios de cultivo habitual.
Actinomycosis is a disease produced by bacteria of the genus Actinomyces. The thoracic form represents 30% of the cases. Signs and symptoms are generally unspecific. A previously healthy 11 year old girl was admitted with a chest mass of a month of evolution associated with fever, hyporexia and weight loss. Thoracic actinomycosis was diagnosed with the isolation of Actinomyces meyeri in the mass drainage. She received antibiotic treatment for a year with complete resolution. Although rare, it should be taken into account as a differential diagnosis in long evolution thoracic tumor affecting the general condition. The microbiologist must be warned about the suspected diagnosis because it is difficult to find it in routinely used culture media.
Subject(s)
Humans , Female , Child , Actinomyces/isolation & purification , Actinomycosis/diagnosis , Lung Diseases/diagnosisABSTRACT
La actinomicosis torácica es una infección bacteriana lentamente progresiva, producida por bacterias grampositivas anaerobias o microaerófilas que colonizan la orofaringe y el tracto gastrointestinal. Su baja frecuencia en la actualidad y sus distintas ubicaciones anatómicas constituyen un desafío diagnóstico para las distintas especialidades de la medicina. En este trabajo se presenta el caso de un paciente de 44 años de edad, con antecedentes de salud, que ingresa en el Hospital Regional de Zacapa en Guatemala por fístulas en hemitórax izquierdo y neumonía en vértice homolateral de 6 meses de evolución, interpretado inicialmente como tuberculosis pulmonar. Luego de exámenes complementarios y otros como Radiografía de Tórax, Baciloscopia, VIH y Cultivo de secreción de la lesión, se realizó Biopsia de la lesión, observándose gránulos de azufre con abundante tejido de granulación y celularidad compatible con Actinomyces israelii(AU)
Thoracic actinomycosis is a slowly progressing bacterial infection caused by gram-positive anaerobic or microaerophilic bacteria that colonize oropharynx and gastrointestinal tract. Its low frequency at present and its different anatomical locations are a diagnostic challenge for various medical specialties. The case of a 44-year-old man with health history is presented here. This patient was admitted at Zacapa Regional Hospital in Guatemala due to a fistula in left chest and pneumonia in ipsilateral vertex for six months, initially it was interpreted as pulmonary tuberculosis. After further examination and studies such as chest x-rays, smear, HIV and culture of discharge of the injury, this patient underwent a biopsy of the lesion, showing sulfur granules and abundant granulation tissue and Actinomyces israelii compatible cellularity(AU)