Actinomicosis torácica por actinomyces odontolyticus / Pulmonary actinomycosis by actinomyces odontolyticus. A case report and review of the literature

Introduction: Actinomycosis is an infrequent infection caused by bacteria from Actinomyces genus that manifests as a chronic, suppurative and progressive disease. Thoracic actinomycosis occurs in 18 percent of the cases, and infection by Actinomyces odontolyticus is even less frequent. The clinical presentation mimics tuberculosis or neoplastic processes. Clinical case: We report the case of a 75 years old man with COPD and Diabetes Mellitus type 2. He was referred to our clinic presenting a history of chronic cough, progressive dyspnea, fever and occasional bouts of haemoptysis. Chest radiograph showed a peripherally-located parenchymal opacity in the upper right lobe with over a year of evolution that later became a cavitary mass mimicking bronchogenic neoplasm or tuberculosis. The patient underwent bronchoscopic and CT- guided biopsy that showed necrosis and inflammatory cells. In the culture of cavitary fluids grew Actinomyces odontolyticus. We concluded that it was a thoracic actinomycosis. Penicillin 20 million units per day for six weeks was given, followed by oral amoxicillin for 6 months with good clinical and radiological response. Comments: To our knowledge this is the first report in Chile of lung infection caused by Actinomyces odontolyticus. Actinomycosis is a great masquerader, in this case we made the diagnosis with a fluid culture. This microorganism must be considered in the differential diagnostic in cavitary lung diseases.

Introducción: La actinomicosis pulmonar es una infección infrecuente causada por una bacteria del género Actinomyces, se manifiesta como un proceso crónico, supurativo de curso progresivo, el compromiso torácico ocurre aproximadamente en el 18 por ciento de los casos y la infección por Actinomyces odontolyticus es aun menos frecuente. Caso clínico: Se presenta el caso de un paciente hombre de 75 años de edad con antecedentes de EPOC y Diabetes Mellitus tipo 2, que fue derivado a nuestra clínica por cursar con una reagudización infecciosa persistente caracterizada por tos productiva, disnea progresiva,fiebre y episodios reiterados de hemoptisis de escasa cuantía. En la radiografía de tórax y tomografia computada, se detectaron opacidades mal definidas en lóbulo superior derecho de un año de evolución, que posteriormente se transforman en una masa cavitada adyacente a la pared toráxica simulando una neoplasia broncogénica o tuberculosis. El paciente fue sometido a fibrobroncoscopía realizándose biopsia y punción transbronquial. Posteriormente se efectuó biopsia por punción trans-toráxica guiada radiológicamente y en una muestra de tejido de aspecto necrótico y en líquido de la cavidad enviado a cultivo se pudo aislar Actinomyces odontolyticus. Concluyéndose que se trataba de una actinomicosis tóraco-pulmonar, se procedió a tratar con penicilina sódica 20 10(6) UI/dia por seis semanas y después se programó tratamiento por seis meses con amoxicilina vía oral, con buena respuesta clínica y radiológica. Comentarios: En nuestro conocimiento esta sería la primera comunicación en Chile de una lesión pulmonar producida por Actinomyces odontolyticus. La Actinomicosis, es un gran imitador, en este caso realizamos el diagnóstico con cultivo de líquido por punción. Este microorganismo debe ser considerado en el diagnóstico diferencial de lesiones cavitarias pulmonares.

Enfermedades pulmonares en pacientes infectados con VIH hospitalizados en el Instituto Nacional del Tórax / Lung diseases among HIV infected patients admitted to the \"Instituto Nacional del Torax\" in Santiago, Chile

Background: Pulmonary diseases are common among HIV infected patients. The prevalence of the different diseases varies greatly. Aim: To identify the different pulmonary diseases that affect a Chilean population of HIV infected patients and to identify factors associated with in hospital mortality. Material and methods: Retrospective review of the clinical records of all HIV infected patients with lung diseases discharged from our institution during a period of 3.5 years. Collection of demographic and biomedical data. Results: One hundred seventy one patients (aged 35.7 years, 86% men) had 236 episodes of lung diseases. Only 13.5% of the patients were receiving antiretroviral therapy and 18% were on pneumocystis prophylaxis. Infectious diseases accounted for 87% of the discharges, neoplasm for 5.1%. Pneumocystis jirovecii infection was responsible for 37.7% of the episodes, community acquired pneumonia was seen in 24.1% and mycobacterial diseases in 14.4%. Two or more conditions were present in 13.6%. Death during hospital stay occurred in 19.5%. Multivariate analysis identified pneumothorax as the only significant independent predictor of in-hospital mortality in patients with pneumocystis pneumonia, while nosocomial pneumonia was the only predictor of death among patients with non-pneumocystis pulmonary diseases. Conclusions: Infectious diseases were the main cause of hospitalization among Chilean HIV infected patients. Mortality among these patients remains high. Appropriate antiretroviral therapy and prophylaxis may alter pulmonary disease prevalence in the future. Every effort should be made to avoid the development of pneumothorax and nosocomial pneumonia.

Compromiso pulmonar por linfoma no Hodgkin diseminado en un paciente con SIDA / Pulmonary involvement due to disseminated non Hodgkin lymphoma in 1 patient with AIDS

Pulmonary involvement due to disseminated non Hodgkin lymphoma (LNH), is an unusual cause of lung disease in AIDS patients. We report a 38 years old male patient, with advanced AIDS, who, in the course of three weeks, developed cough, dyspnea and fever. The chest X ray film showed diffuse thickening of the peribronchovascular connective tissue with possible mediastinal lymph node enlargement. The evolution was unfavorable with hypoxemia, severe anemia, liver damage and elevated levels of lactic dehydrogenase. The presumptive initial diagnoses were Pneumocystis carinii pneumonia, pulmonary tuberculosis with hematogenous dissemination and Kaposi sarcoma. Definitive diagnosis was made through a transbronchial biopsy performed the day before his death. The pathological and inmunohistochemical report demonstrated a highly aggressive lymphoma (lymphoblastic, B precursor). This finding was confirmed by autopsy that revealed multiple organ involvement

Mucormicosis rinocerebral: comunicación de 4 casos / Rhinocerebral mucormycosis: report of 4 cases

We report four diabetic patients (one male) aged 64, 63, 61 and 77 years old with rhinocerebral mucormycosis. Three had an acute and one a chronic form of the disease. The chronic form was diagnosed with a biopsy of the nasal cavity. Three patients received amphotericin but all died. The diagnosis of the disease must be suspected in diabetics or patients with some type of immune depression

Romboencefalitis por listeria monocytogenes: caso clínico / Listeria monocytogenes rhomboencephalitis: report of 1 case

We report a previously healthy 44 years old female, that presented with mild clouding of consciousness, a left cerebellar syndrome, involvement of V, X and XII left cranial nerves and an alteration of epicritic sensitivity in the left half of the body. Cerebrospinal fluid had inflammatory features. Cerebrospinal fluid and blood cultures were positive for Listeria monocytogenes. Magnetic resonance imaging disclosed a rhomboencephalitis. Antibiotics were started and the clinical condition of the patient improved progressively. After three months of follow up, the patient is notably recovered and there is a regression of hyperintense lesions of the brainstem in the magnetic resonance imaging. The diagnosis of Listeria monocytogenes infection must be born in mind in the presence of a thromboencephalitis