Pulmonary Actinomycosis in a 65-Year-Old Female with Poor Oral Dentition.

Pulmonary actinomycosis is an uncommon clinical entity that can be challenging to diagnose due to its non-specific symptomatology. Misdiagnosis and delayed treatment may result in invasive procedures and extended antimicrobial treatment courses. We report a case involving a 65-year-old female with poor oral dentition admitted for acute respiratory failure subsequently found to have a left-sided pleural effusion and perihepatic abscess formation. Cytopathology examination and microbiology studies confirmed the diagnosis of pulmonary actinomycosis.

A rare case of brain abscess caused by Actinomyces meyeri.

BACKGROUND: Brain abscesses are the rare and most severe form of actinomycosis, which usually manifests as abscesses of the occipital or parietal lobe due to direct expansion from an adjacent area, the oral cavity. In the medical literature, there are only a few reported cases of brain abscess caused by Actinomyces meyeri. In this report, we present a 35-year-old male patient who experienced an insidious headache and left-sided weakness and was diagnosed with an Actinomyces meyeri brain abscess. CASE PRESENTATION: A 35-year-old Nepalese man came to our institute with the primary complaint of insidious onset of headache and left-sided weakness. His physical examination was remarkable for the left-sided weakness with power 2/5 on both upper and lower limbs, hypertonia, hyperreflexia and positive Babinski sign, with intact sensory function. Cardiac examination revealed systolic murmur with regular S1 and S2, and lung examination was normal. The patient had poor dental hygiene. Biochemistry and haematology panel were normal. Urinalysis, chest X-ray and electrocardiogram revealed no abnormality. A transthoracic echocardiogram revealed mitral regurgitation. However, there was no evidence of valvular vegetation. A magnetic resonance imaging (MRI) of the brain was performed, which showed a bi-lobed rim enhancing lesion with a conglomeration of two adjoining round lesions in the right parietal parasagittal region. Perilesional oedema resulting in mass effect over the right lateral ventricle and mid-right uncal herniation with midline shift was noted. Craniotomy was performed, and the lesion was excised. Gram staining of the extracted sample revealed gram variable filamentous rods. Creamy white, moist, confluent colonies were observed after performing anaerobic culture in chocolate agar. On the gram staining, they showed gram-positive filamentous rods. Actinomyces meyeri was identified based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Based on the susceptibilities, he was successfully treated with ampicillin-sulbactam. CONCLUSIONS: In conclusion, Actinomyces should be considered in the differential diagnosis of brain abscess in patients with poor dental hygiene, and early diagnosis and appropriate treatment can lead to better results.

Health improvement for disadvantaged people in Nepal - an evaluation.

BACKGROUND: An evaluation of progress with participatory approaches for improvement of health knowledge and health experiences of disadvantaged people in eight Districts of Eastern Nepal has been undertaken. METHODS: A random selection of Village Development Committees and households, within the eight Districts where participation and a Rights-based Approach had been promoted specifically by local NGOs were compared with similar villages and households in eight Districts where this approach had not been promoted. Information was sought by structured interview and observation by experienced enumerators from both groups of householders. Health knowledge and experiences were compared between the two sets of households. Adjustments were made for demographic confounders. RESULTS: Complete data sets were available for 628 of the 640 households. Health knowledge and experiences were low for both sets of households. However, health knowledge and experiences were greater in the participatory households compared with the non-participatory households. These differences remained after adjustment for confounders. CONCLUSIONS: The study was designed to evaluate progress with participatory processes delivered by non-governmental organisations over a five year period. Improvements in health knowledge and experiences of disadvantaged people were demonstrated in a consistent and robust manner where interventions had taken place.