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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Actinomyces israelii is the most commonly implicated pathogen. The characteristic cause is progressive and indolent; patients present with pain, fever, weight loss, and a palpable mass – as a result, actinomycosis is commonly misdiagnosed as malignancy. Tissue injury precedes development to actinomycosis (e.g., dental procedures leading to cervical actinomycosis; aspiration leading to pulmonary actinomycosis; the intrauterine contraceptive device has been implicated in the development of genital actinomycosis). Diagnosis is based on clinical diagnosis, accompanied with fine-needle aspiration – serology is not useful. ‘Sulphur granules’ are seen in less than 50 per cent of cases at surgery. Although characteristic of the infection they are not pathognomonic as they may also be seen in other infections such as those caused by Nocardia.
Infections of the Eye
Published in Keith Struthers, Clinical Microbiology, 2017
Dacrocystitis is infection of the lachrymal gland, and canaliculitis is infection of the nasolachrymal duct (Figure 15.5). While common pathogens such as pneumococcus and Streptococcus pyogenes are usually responsible, chronic infections can be caused by Actinomyces israelii. Inflammation in the duct produces a nodule, consisting of an outer layer of fibrous tissue enclosing a purulent collection of neutrophils, which themselves surround ‘sulphur granules’. These granules contain conglomerations of the actinomycete bacteria, and their presence in an excised nodule is diagnostic.
Miscellaneous Respiratory Infections
Published in Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace, Pulmonary Infection, 2004
Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace
Gram stain microscopy shows characteristic filamentous, branching Gram-positive bacilli in samples of pus or tissues (particularly crushed sulphur granules). Acid-fast stains are negative. Specific stains using flourescein-labelled antibodies may distinguish Actinomyces israelii from other commensal bacteria with similar morphology. A photomicrograph from the patient in 7.14A is shown in 7.14B, demonstrating a colony of Actinomyces growing within a micro-abscess. Figure 7.15 presents a photomicrograph of a colony of Actinomyces within a micro-abscess, showing the
Chronic canaliculitis with canaliculoliths due to Providencia stuartii infection
Published in Orbit, 2023
Jenny Lin, Victoria S. North, Christopher Starr, Kyle J. Godfrey
Canaliculitis is inflammation of the lacrimal canaliculus, with primary canaliculitis the result of infection of the canaliculus and secondary canaliculitis most related to punctal and intracanalicular plug placement.1 The classic presenting symptoms of canaliculitis include epiphora, medial canthal swelling, nonresolving or recurrent conjunctivitis, a swollen, pouting punctum, and punctal discharge or concretions.1 It is often misdiagnosed as conjunctivitis, leading to delayed therapeutic and surgical management.1 Although Actinomyces israelii is the most common causative microorganism, an increasing number of studies describe additional responsible bacteria including Streptococcus and Staphylococcus species.2–4 The authors present a case of chronic canaliculitis with canaliculoliths due to Providencia stuartii, which has not been reported as a canaliculitis or canaliculolith causing pathogen. Collection and evaluation of protected patient health information were compliant with the Health Insurance Portability and Accountability Act and the Declaration of Helsinki.
Actinomycosis infection causing a utero-cutaneous fistula
Published in Journal of Obstetrics and Gynaecology, 2022
Mohamed Okba, Shereen Ibrahim, Alaa Alsadik Jaly, Abha Govind
Pelvic actinomycosis occurs most commonly as a result of prolonged use of an IUD (Jones et al. 2020). Usually, the disease is caused by Actinomyces israelii, an anaerobic gram-positive organism that enters the tissue through a break in the mucosa. It can be misdiagnosed as a malignant process. Pelvic actinomycosis can lead to sequelae such as an abscess, fistula formation and infertility. Removal of the IUD and a prolonged course (6–12 months) of antibiotic treatment form the cornerstone of management of pelvic infection. Surgery may be required in selected cases.
Plug-related canaliculitis: a rare or underdiagnosed disease?
Published in Clinical and Experimental Optometry, 2022
Tsai-Chu Yeh, Tzu-Yu Hou, Yu-Yun Huang, Wei-Kuang Yu, Chieh-Chih Tsai
Greater awareness of canaliculitis among optometrists, opticians and ophthalmologists would likely prevent misdiagnosis and delays in referral for effective treatment. Liyanage et al. reported a case of lacrimal canaliculitis initially diagnosed as bacterial conjunctivitis, but there was a poor response to various topical antibiotics. The microbiological culture of the discharge yielded Actinomyces israelii. The case was successfully treated by canaliculotomy with no further recurrences noted.3