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Clinical features of actinomycosis

View Article: PubMed Central - PubMed

ABSTRACT

Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.

We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.

Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60–180), whereas the median follow-up time was 12 months (interquartile range 5.25–18). Two patients died.

This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.

No MeSH data available.


Related in: MedlinePlus

Brain abscess due to Actinomyces meyeri in patient 28. Brain MRI T1 sequence showing a 3 cm tumefaction in the right posterior temporal region, with annular homogeneous contrast enhancement and peripheral edema. MRI = magnetic resonance imaging.
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Figure 2: Brain abscess due to Actinomyces meyeri in patient 28. Brain MRI T1 sequence showing a 3 cm tumefaction in the right posterior temporal region, with annular homogeneous contrast enhancement and peripheral edema. MRI = magnetic resonance imaging.

Mentions: Patient 28 presented with a 3 cm temporal lobe abscess with peripheral edema and herniation signs (Fig. 2). Stereotaxic surgery was performed to assess diagnosis, and the patient was treated for a total duration of 120 days. Ventriculoperitoneal shunt was used to treat postinfection hydrocephalus.


Clinical features of actinomycosis
Brain abscess due to Actinomyces meyeri in patient 28. Brain MRI T1 sequence showing a 3 cm tumefaction in the right posterior temporal region, with annular homogeneous contrast enhancement and peripheral edema. MRI = magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998488&req=5

Figure 2: Brain abscess due to Actinomyces meyeri in patient 28. Brain MRI T1 sequence showing a 3 cm tumefaction in the right posterior temporal region, with annular homogeneous contrast enhancement and peripheral edema. MRI = magnetic resonance imaging.
Mentions: Patient 28 presented with a 3 cm temporal lobe abscess with peripheral edema and herniation signs (Fig. 2). Stereotaxic surgery was performed to assess diagnosis, and the patient was treated for a total duration of 120 days. Ventriculoperitoneal shunt was used to treat postinfection hydrocephalus.

View Article: PubMed Central - PubMed

ABSTRACT

Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.

We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.

Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60–180), whereas the median follow-up time was 12 months (interquartile range 5.25–18). Two patients died.

This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.

No MeSH data available.


Related in: MedlinePlus