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Actinomycosis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
In the case of actinomycosis, it has been considered that a long duration of antimicrobial therapy with high doses is necessary, with treatment extending up to 1 year (or even longer). This concept is changing, and medications are now adjusted on the basis of individual treatment needs. The same is valid for surgery, which was previously used routinely for treatment of actinomycotic lesions; however, the current trend is to limit invasive procedures and to rely on a targeted antibiotic regimen instead. Treatment of abscesses usually requires drainage, whereas surgical resection may be indicated only in cases with extensive necrotic lesions or when antimicrobial therapy fails. Actinomycosis is often a polymicrobial infection. for severe infections an initial intravenous course of two weeks is recommended, followed by an oral stepdown. Intravenous options are amoxicillin/clavulanic acid or ceftriaxone with or without metronidazole. Oral options include amoxicillin/clavulanic acid, doxycycline or a macrolide with or without metronidazole. Clindamycin or quinolones should be avoided unless in vitro susceptible.
Cervicofacial Infections
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Actinomycosis is caused by Gram-positive non-spore forming bacteria. The most common human pathogen is Actinomyces israelii but there are several other species which can rarely be pathogenic. Approximately 50% of cases are cervicofacial. Actinomyces are normal commensals in the oral cavity and infections arise from a breach of the mucosa (e.g. dental extraction). The most common presentation is a slow-growing painless mass near the mandible. Local lymph nodes may be involved and in a small number of cases metastasis of disease to liver or brain may occur. Untreated, the mass progresses to fibrosis and chronic suppuration with draining sinuses. A less common presentation is with an acute, warm, tender mass with fever. The presence of sulphur granules on pathological examination is suggestive but not diagnostic. If the diagnosis is suspected, special culture conditions increase the chance of culturing this organism. Most cases are treated by surgical excision followed by prolonged antibacterial therapy, usually penicillin for up to 6 months.
The Small Intestine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Abdominal actinomycosis is rare. It is caused by infection with Actinomyces israelii and infection usually develops several weeks after an apparently straightforward perforated appendicitis. An abscess develops and spreads to the retroperitoneal tissues and the adjacent abdominal wall, eventually becoming the seat of multiple indurated discharging sinuses. At first, the discharge from the sinuses is thin, watery and inoffensive, but it may later become thicker and malodorous. Secondary fis- tulation may occur and the tissues may become extensively indurated and woody. In contrast to tuberculosis, however, mesenteric lymph nodes are not involved and the lumen of the intestine is not narrowed. Haematogenous spread via the portal vein may lead to multiple liver abscesses.
The prediction of surgical intervention in patients with tubo-ovarian abscess
Published in Journal of Obstetrics and Gynaecology, 2022
Jong Ha Hwang, Bo Wook Kim, Soo Rim Kim, Jang Heub Kim
In the 32 patients comprising the surgical intervention group, laparoscopy and laparotomy were performed in 17 (53.1%) and 14 (43.8%) patients, respectively. One patient was treated with abscess drainage via culdotomy and pigtail insertion, 15 patients underwent unilateral salpingectomy or unilateral salpingo-oophorectomy, and 12 patients underwent bilateral salpingectomy or bilateral salpingo-oophorectomy. Four cases of total hysterectomy in addition to adnexal surgery were identified. Four patients underwent appendectomy because the TOA spread to the periappendiceal area. One patient underwent low anterior resection because the TOA resulted from colon cancer with perforation. Fistulectomy was performed in one patient with a fistula between the TOA and abdominal skin. Two patients were diagnosed with actinomycosis.
Rectal actinomycosis mimicking malignancy
Published in Acta Chirurgica Belgica, 2021
Akanksha Rajpoot, Chiranth Gowda, Vidya Monappa, Gabriel Rodrigues
Gastrointestinal actinomycosis is a chronic suppurative and granulomatous infection caused by Actinomyces species, a commensal in the colon, known to affect when there is a mucosal breach and immunocompromised patients [1]. Males have a threefold higher incidence of actinomycosis than females. Though ileo-caecal region is most commonly affected, primary anorectal actinomycosis is extremely rare. Presentation may vary from non-specific symptoms, proliferative, ulcerative lesions to strictures causing large bowel obstruction mimicking malignancy. Previous surgeries, trauma and intrauterine contraceptive devices are known to predispose rectal actinomycosis [2]. The diagnosis is established by demonstration of granulomas and filamentous Gram-positive bacteria on a tissue biopsy. A high degree of suspicion and an early diagnosis are a prerequisite for optimal treatment with minimal morbidity and a low recurrence rate.
Actinomyces lymphadenitis
Published in Baylor University Medical Center Proceedings, 2020
John Kim, Christopher Wood, Uriel Sandkovsky, Haala Rokadia
Actinomycosis is a chronic disease caused by Actinomyces, an anaerobic gram-positive bacteria that normally colonizes in the human mouth, digestive tract, and urogenital tract.1–5 Typical clinical presentations include cervicofacial actinomycosis following dental procedures, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dentition.5Actinomyces found in lymph nodes is uncommon, with only two reported cases.1,2 Due to the rarity, lymphadenopathy with Actinomyces is commonly misdiagnosed as malignancy, causing unnecessary surgical interventions when only antibiotics are warranted.2 The finding of Actinomyces in the subcarinal lymph node with concomitant cough and hemoptysis makes our case very rare.