ABSTRACT
BACKGROUND: Actinomycosis is a rare indolent infectious disease caused by Actinomyces. Although pulmonary actinomycosis is thought to be more prevalent in developing countries, data from developing countries are scanty. This study was to reveal the current situation of pulmonary actinomycosis in developing countries and the difference from that in developed countries. METHODS: Patients fulfilling the inclusion criteria for pulmonary actinomycosis from Peking Union Medical College Hospital in China between January 2003 and December 2014 were retrospectively analyzed. Baseline characteristics, clinical symptoms, underlying diseases, diagnostic methods, pulmonary function test results, chest computed tomography (CT) tests, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) tests, initial diagnosis, treatment and prognosis were retrieved from medical records and analyzed. RESULTS: Twenty-six patients were included in this study (mean age 52.0 + 13.1 years). The ratio of male to female was 1.17:1. Most common clinical symptoms were cough (15/26), sputum (12/26) and hemoptysis (12/26). Chest CT findings presented as masses (13/26), nodules (10/26) and infiltrates (3/26). FDG-PET had an increased standardized uptake value and 4/6 patients were misdiagnosed as malignancy. Many kinds of antibiotics were used in the treatment of pulmonary actonomycosis and all got favorable results. Five patients receiving complete resection of the lesion were cured without postoperative use of antibiotic. CONCLUSIONS: Pulmonary actinomycosis is a rare disease even in developing countries, and both misdiagnosis and missed diagnosis are common. FDG-PET seems useless in the differential diagnosis, and complete resection of the pulmonary lesion without postoperative antibiotic therapy might be enough to achieve cure.
Subject(s)
Actinomycosis/diagnosis , Lung Diseases/diagnosis , Actinomycosis/diagnostic imaging , Actinomycosis/metabolism , Adult , Aged , China , Female , Fluorodeoxyglucose F18 , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/metabolism , Male , Middle Aged , Positron-Emission Tomography , Radiography , Retrospective Studies , Treatment OutcomeABSTRACT
ExtraMedullary Plasmacytoma (EMP) is a rare plasma cell tumor. It can occur in the upper aerodigestive tract and presents as a large nodule causing local compressive symptoms. A 79-year old woman presented to Otorhinolaryngology Department with progressive hearing loss and no other symptoms. Following PET/TC examination due to the suspicion of a lymphoproliferative disease, the patient underwent tonsillectomy and the diagnosis of solitary EMP was formulated. In addition to that, the histological examination of the tonsillar tissue revealed large colonies of filamentous bacteria, showing abundant sulphur granules and Splendore-Hoeppli phenomenon; these evidences indicating the presence of a chronic Actinomyces infection. Immunohistochemical analysis demonstrated a marked IL-6 immunoreactivity of the neoplastic plasma cells. Interestingly, a marked IL-6 immunoreactivity was also found in the tissue surrounding the Actinomyces colonies. In the present study we report for the first time a solitary EMP associated with Actinomycosis. It is tempting to speculate that the unsuspected and untreated Actinomyces infection, through chronic IL-6 production, could contribute to the neoplastic transformation of plasma cells.
Subject(s)
Actinomyces , Actinomycosis , Cell Transformation, Neoplastic , Interleukin-6/metabolism , Plasmacytoma , Tonsillar Neoplasms , Actinomycosis/complications , Actinomycosis/metabolism , Actinomycosis/microbiology , Actinomycosis/pathology , Aged , Cell Transformation, Neoplastic/metabolism , Cell Transformation, Neoplastic/pathology , Humans , Plasma Cells/metabolism , Plasma Cells/microbiology , Plasma Cells/pathology , Plasmacytoma/etiology , Plasmacytoma/metabolism , Plasmacytoma/microbiology , Plasmacytoma/pathology , Tonsillar Neoplasms/etiology , Tonsillar Neoplasms/metabolism , Tonsillar Neoplasms/microbiology , Tonsillar Neoplasms/pathologyABSTRACT
A 32-year-old woman carried a copper intrauterine contraceptive device (IUCD) or intrauterine pessar (IAP) for more than 5 years. She had acyclic menstrual bleedings and underwent a corpus abrasio after explantation of IUCD. The histological study of paraffin sections showed an actinomycotic endometritis with brown to black deposits in or around typical actinomyces druses, but there was no carcinoma. The electron microscopic study of these accumulations by electron energy loss spectroscopy (EELS) in TEM demonstrated copper deposits in the shell and matrix of these druses as well as inside the bacteria. With scanning electron microscopy (SEM) and Energy Dispersive X-Ray Analysis (EDX), the electron-dense accumulations revealed high signals for copper and sulfur, but also of phosphorus and oxygen in a lower extent. This copper accumulation is discussed as an active uptake and concentration by these actinomyces bacteria.
Subject(s)
Actinomyces/metabolism , Actinomycosis/metabolism , Copper/metabolism , Endometritis/metabolism , Intrauterine Devices, Copper , Actinomyces/ultrastructure , Actinomycosis/pathology , Adult , Copper/analysis , Electron Probe Microanalysis , Endometritis/etiology , Endometritis/pathology , Female , Humans , Microscopy, Electron, Scanning , PregnancyABSTRACT
Five patients, each with a brain abscess, were examined by means of 1H MR spectroscopic imaging in vivo. The aspirated pus was analyzed in vitro by means of 1D and 2D COSY 1H MRS. In addition to resonance lines from compounds (lactate, alanine and lipids) often found in the spectra from intracranial tumors, resonance lines were detected from a number of markers of infectious involvement (acetate, succinate, and various amino acids). These results suggest that 1H MRS in vivo might contribute in establishing noninvasively a differential diagnosis between brain abscess and tumor.
Subject(s)
Brain Abscess/diagnosis , Magnetic Resonance Spectroscopy , Acetates/analysis , Actinomycosis/diagnosis , Actinomycosis/metabolism , Adult , Alanine/analysis , Amino Acids/analysis , Brain Abscess/metabolism , Brain Neoplasms/diagnosis , Brain Neoplasms/metabolism , Diagnosis, Differential , Eikenella corrodens , Fatty Acids/analysis , Female , Fusobacterium Infections/diagnosis , Fusobacterium Infections/metabolism , Fusobacterium nucleatum , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/metabolism , Humans , Hydrogen , In Vitro Techniques , Lactates/analysis , Male , Streptococcal Infections/diagnosis , Streptococcal Infections/metabolism , Succinates/analysis , SuppurationABSTRACT
A patient with pulmonary actinomycosis who unexpectedly showed focal uptake of technetium-99m-hexakis-2-methoxy isobutyl isonitrile and thallium-201 is presented. The appearance of the lesion on the chest radiograph and x-ray CT scan resembled a mediastinal tumor. The diagnosis of pulmonary actinomycosis was achieved by histopathologic examination of the surgically removed mass.
Subject(s)
Actinomycosis/metabolism , Lung Diseases/metabolism , Nitriles/pharmacokinetics , Organotechnetium Compounds/pharmacokinetics , Thallium Radioisotopes/pharmacokinetics , Actinomycosis/diagnostic imaging , Child , Humans , Lung Diseases/diagnostic imaging , Male , Radionuclide Imaging , Technetium Tc 99m SestamibiABSTRACT
Primary actinomycoma of the third ventricle has been reported to be a very rare form of central nervous system actinomycosis. Others have demonstrated actinomycotic-like colonies in colloid cysts of the third ventricle. We have confirmed these structures (HLS) in five colloid cysts and have demonstrated by various histochemical stains that they consist of desoxyribose nucleic acid, base protein and phospholipid. Ultrastructurally, they consist of amorphous to granular electron dense material, probably deposited on a lamellar substructure. On the basis of the available information, we believe that the lesions, previously reported as primary actinomycomas, are actually colloid cysts containing degenerative HLS. The possible origin of the hyphal-like structures is discussed.
