Actinomicosis ósea del antepié izquierdo. Presentación de un caso / Bone actinomycosis of the left forefoot. Presentation of a case

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).

Actinomicosis en el hueso temporal. Reporte de un caso pediátrico / Actinomycosis in temporal bone. A pediatric case report

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.

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.

Actinomicosis amigdalina imitando una recaída de un linfoma no Hodgkin / Tonsillar actinomycosis mimicking relapse of diffuse large B-cell non-Hodgkin lymphoma

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.

Tubo-ovarian Actinomycosis: A case report with brief review of literature.

Pelvic actinomycosis is an uncommon condition, often associated with the use of intrauterine contraceptive device (IUCD). Pelvic actinomycosis is rare accounting for 3% of all human actinomycotic infections. Ovarian actinomycosis is even rarer. Here, we present a 24-year-old woman using an IUCD for 3 1 / 2 years with right-sided adnexal mass, which was diagnosed postoperatively as tubo-ovarian actinomycosis. Many times, an appropriate management is overlooked or delayed due to its non-specific and variable clinical and radiological features. Sometimes, it can even mimic an advanced pelvic malignancy. Therefore, the gynecologist should consider the possibility of this infection to spare the patient from morbidity of radical surgical procedure.

Treatment of thoracic actinomycosis: a retrospective analysis of 40 patients

The aim of this study was to evaluate treatment outcomes in patients with thoracic actinomycosis and identify patient characteristics associated with unfavorable responses to antibiotic therapy. A retrospective analysis was performed on 40 patients with pathologically confirmed thoracic actinomycosis. Initial surgical treatment was performed on 17 patients to control severe symptoms such as hemoptysis or rule out lung cancer. Sixteen [94%] patients were successfully treated, including three patients who did not receive postoperative antibiotics, and one patient died of a postoperative complication. The median duration of oral antibiotic therapy after surgery was 3 months. After the diagnosis of actinomycosis, 23 patients began antibiotic therapy. The median duration of oral antibiotics therapy was 5 months. Favorable treatment outcomes were achieved in 18 of these 23 patients [78%], while five [22%] showed unfavorable response to antibiotic therapy. Surgery was successfully performed in these five patients. The patients with unfavorable responses to antibiotic therapy had a longer duration of symptoms prior to treatment [median, 10 months] as compared to patients with favorable responses [median, 2 months; P=0.012]. Medical treatment failure is possible in patients with thoracic actinomycosis, and close monitoring is necessary in those who begin antibiotic therapy, with the consideration of the age and comorbid conditions

Actinomicosis ósea y cirugía plástica / Bone actinomycosis and plastic surgery

Se describe el caso de un paciente de 18 años de edad que acudió a la consulta de Ortopedia del Hospital Windocke de la República de Namibia por presentar, desde hacía 8 años, una lesión nodular y fistulosa en el segundo dedo del pie derecho, que se extendía hasta la porción proximal y dificultaba no solo el uso del calzado, sino la ambulación. Se realizó una plastia quirúrgica que consistió en una amputación en rayo del segundo artejo y hueso metatarsiano, luego de lo cual pudo incorporarse a sus actividades sociales y laborales, así como evitar permanecer descalzo.

The case of a 18 year-old patient is described who attended the Ortopedics Department of the Windocke Hospital from the Namibia´s Republic, due to a nodular and fistulous lesion in the second right toe for 8 years that was extended into the proximal portion and made it difficult not only the use of footwear, but also the ambulation. A plastic surgery consisting in a ray amputation of the second articulus and metatarsal bone was performed, after that he could start his social and working activities, as well as avoid to be barefoot.

Actinomicosis torácicaen niños: reporte de caso / Actinomicosis torácicaen children: report of case

La actinomicosis es una infección bacteriana lentamente progresiva, cuya frecuencia en nuestro país se desconoce habiéndose publicado un número muy limitado de casos, tanto en la literatura nacional como internacional, es producida por bacterias grampositivas anaerobias o microaerófilas que colonizan la orofaringe y el tracto gastrointestinal. Su principal agente productor en humanos es actinomyces israelí. Se describe un caso clínico de un paciente de acho años de edad con cuadro clínico de tumoración en pared torácica y efusión seropurulenta, que requirió cirugía torácica diagnostica y terapeútica cuyo estudio anatomopatológico concluyó neumonía poractinomices.

Canaliculite: relato de caso e conduta / Canaliculitis: case report and management

A canaliculite é uma infecção rara do canalículo lacrimal, sendo o Actinomyces israelii o agente causal mais comum. O objetivo desse trabalho foi relatar uma doença rara, assim como seu manejo clínico e cirúrgico. Paciente feminina, 44 anos, apresentou um quadro compatível com canaliculite, sendo submetida à canaliculotomia com preservação do ponto lacrimal. A via lacrimal foi mantida intubada com tubo de silicone por 3 meses, associado a irrigações periódicas, com antibiótico, a fim de evitar complicações e a recidiva do quadro. O caso apresentado confirma os relatos da literatura nos quais o tratamento cirúrgico mostrouse superior ao conservador.

Canaliculitis is a rare infection of the lacrimal canaliculus with Actinomyces israelii as its most common etiologic agent. The objective of this paper is to report a rare pathology, as well as its clinical and surgical management. Female patient, 44 years old, presenting clinical manifestations compatible with canaliculitis, was submitted to surgical treatment preserving the lacrimal punctum. Intubation was performed into the lacrimal channel with silicone tube for three months, associated with periodical pre-programmed bathings with antibiotic, in order to avoid complications and recurrence. This case confirms the literature reports in which the surgical treatment is more effective than the conservative treatment.

An unusual presentation of actinomycosis in a young woman, after surgery

Actinomycosis is an unusual, chronic granulomatous disease. Actinomyces israelli has been found to be related to infectious processes in those patients with affected skin integrity leading to abscess formation, fistulae or mass lesions. Actinomycosis mainly presents in three forms cervicofacial (50%), abdominal (20%) and thoracic (15%). Pelvic cases have been rarely reported and are usually associated with the use of intrauterine devices. We describe a case of a 23 y/o female without history of intrauterine device use, who was admitted with an ovarian cyst following an appendectomy. An ovarian abscess was drained. The pathology showed a granuloma and focal sulfur granules like particles compatible with Actinomyces. This is a case of pelvic Actinomyces, not related to the use of an intrauterine device

Primary actinomycosis of the abdominal wall

Primary actinomycosis of the abdominal wall is a rare clinical entity. Only 7 adequately described cases have been reported in the English literature. We report a case of isolated abdominal wall actinomycosis involving the left lower quadrant of the abdominal wall in a 32-year-old diabetic male. The diagnosis was confirmed by histopathological examination. Surgical drainage of the abscess followed by long-term administration of penicillin resulted in cure. The clinicopathological spectrum of actinomycosis is reviewed and isolated involvement of the abdominal wall is characterized in light of the knowledge acquired from the available literature on this rare clinical presentation. The significance of obtaining tissues for culture and histopathology in all inflammatory lesions is emphasized

Ibn'Sina Rounds

We continue these excerpts from the case records of Dr Abubakr, current resident to that august, testy and infinitely wise consultant physician, Dr Ibn'Sina The Ibn 'Sina Rounds are presentations of actual clinical situations with a moral and teaching value

Recurrent cutaneous actinomycosis

Atinomycosis can affect any organ in the body and cutaneous variety is very uncommon. Clinical findings of painless subcutaneous nodules and discharging sinuses usually leads to diagnosis. We report a case of recurrent cutaneous actinomycosis which was treated by surgical excision and combination antimicrobial therapy including dapsone

Actinomicosis pulmonar / Pulmonary actinomycosis

Se presenta un caso de actinomicosis pulmonar en un paciente de 35 años de edad, tratado con éxito por resección pulmonar segmentaria y tratamiento antibiótico complementario con penicilina sódica endovenosa en altas dosis y luego penicilina oral durante varios meses. Se comenta el diagnóstico debido a su baja frecuencia

Actinomicosis de la pared abdominal: a propósito de un caso / Abdominal wall actinomycosis: apropos of 1 case

Se comunica el caso de un paciente portador de actinomicosis abdominal no visceral, que se manifestó por un cuadro de dolor abdominal subagudo con importante compromiso de su estado general y una masa de músculo recto abdominal abscedada y perforada hacia la cavidad peritoneal. El paciente fue sometido a taparotomía exploradora y drenaje. El diagnóstico se determinó por la biopsia del tejido muscular. Se trató por diez días con un esquema antibiótico tríasociado y posteriormente con cotrimoxazol por dos meses, presentando buena respuesta clínica y desaparición de sus lesiones. La actinomicosís es una infección poco habitual y la localización en la musculatura abdominal es excepcional, debiendo descartarse patología neoplásica especialmente sarcomas. El diagnóstico es difícil, al igual que para otras localizaciones, y en nuestro medio se obtiene sólo del estudio histopatológico. Se analizan los aspectos relevantes de la actinomicosís abdominal y se discute el rol de la cirugía en su tratamiento

Abscesso actinomicótico do cerebelo: relato de caso / Actinomycotic abscess of the cerebellum: case report

Acometimento do sistema nervoso central por actinomicetos é extremamente raro. Os autores descrevem um caso de actinomicose de cerebelo, com diagnóstico estabelecido após remoçäo cirúrgica da lesäo e tratamento com sucesso com penicilina endovenosa e oral. Breve revisäo da literatura sobre o envolvimento do sistema nervoso na actinomicose é apresentada

Actinomicose abdominal / Abdominal actinomycosis

A actinomicose é uma infecçäo crônica do homem e animais, caracterizada pela formaçäo de abscessos com múltiplos locais de drenagem, causada por um actinomiceto anaeróbio do gênero actinomices. Quando acomete o abdome, o local mais freqüente é a válvula ileocecal. Relata-se um caso de actinomicose abdominal após cirurgia por apendicite aguda. Por semelhança com neoplasia de ceco, foi efetuada uma hemicolectomia direita. Após o diagnóstico anátomo-patológico de actinomicose, foi realizado tratamento durante 6 semanas com tetraciclina

Actinomycose naso-sinusienne: a propos d'un cas

Les auteurs donnent une revue de quelques cas de mycoses du nez et des simnus paranasaux dans la litterature. Ils decrivent un tout premier cas d'actinomycose naso-sinusienne par Actinomyces Israeli au Zaire. Ils exposent les difficultes des cliniciens sur l'interet du diagnostic precoce et l'inefficacite du traitement medico-chirurgical dans les atteintes muco-osseuses avancees. Ils conseillent l'intervention chirugicale qui; pratiquee le plus tot possible et couplee a des antibiotiques tires de l'antibiogramme; peut donner de bons resultats lorsque l'infection est encore moderee