A rare case of co-infection with pulmonary tuberculosis and oronasal actinomycosis

Abstract

A 48-year-old white male, a construction worker, was admitted to the ER with complaints of fever and productive cough, together with night sweats, for two days. He had a history of diabetes, alcohol abuse and was a current smoker with an 80 pack-year smoking history. In addition, his dental health and hygiene were very poor.He was acyanotic and presented normal respiration. The chest X-ray (Figure 1) revealed an infiltrative consolidation in the middle and upper lobes of the right lung, suggestive of cavitation. The sputum smear microscopy showed IntroductionActinomycosis is a chronic suppurative bacterial infection characterized by multiple abscesses, fistulous pathways and fibrosis involving the face, neck, chest and abdomen. It is caused by Actinomyces spp., a group of anaerobic gram-positive saprophytic bacteria.(1) We presentt a rare case of co-infection with pulmonary tuberculosis, confirmed by sputum culture. During hospitalization, the patient presented complaints of dysphagia and nasal regurgitation of food after eating. The examination of the oral cavity revealed a large fistula of the palate due to Actinomyces spp. infection. AbstractOronasal actinomycosis is an infection seldom described in the literature, especially in the form of a co-infection with pulmonary tuberculosis. We report the case of a 48-year-old male admitted to the isolation ward due to active pulmonary tuberculosis, with a history of diabetes and alcohol abuse. While hospitalized, the patient complained of dysphagia and nasal regurgitation of food. The examination of the oral cavity revealed an oronasal fistula. The infecting agent was identified, and the treatment was successful. We also present a brief review of the literature, as well as a full description and discussion of the process of investigating this rare clinical case.Keywords: Actinomycosis, cervicofacial; Tuberculosis, pulmonary; Oral fistula. ResumoA actinomicose oronasal é uma infecção raramente descrita na literatura, especialmente na forma de coinfecção com tuberculose pulmonar. Descrevemos o caso de um paciente de 48 anos de idade, admitido em enfermaria de isolamento por tuberculose pulmonar bacilífera, com história de diabetes e alcoolismo. Durante a internação, o paciente referiu queixas de disfagia e regurgitação alimentar por via nasal. O exame da cavidade oral revelou uma fístula oronasal. O agente infeccioso foi identificado, e o tratamento foi realizado com sucesso. Apresentamos também uma breve revisão da literatura e uma descrição e discussão completa do processo de investigação deste raro caso clínico.Descritores: Actinomicose cervicofacial; Tuberculose pulmonar; Fístula bucal. Case ReportA rare case of co-infection with pulmonary tuberculosis and oronasal actinomycosis

An unusual case of rapidly forming severe oral lesions involving bacterial infection in a dog

“…In humans, certain chemicals/drugs [4] and rhinoliths [5] have also been described to cause oronasal fi stulae. Fungal and actinomycotic infections of the oropharynx may also result in subacute, invasive infl ammatory processes with extensive tissue necrosis and oronasal fi stulation in humans [6,7]. None of such possible causes for an oronasal fi stula formation has been identifi ed in the case presented here.…”

Actinomycose pulmonaire disséminée avec atteinte hépatique : une forme trompeuse mimant un tableau polymétastatique

“…Les diagnostics différentiels principaux de cette pathologie sont le cancer bronchopulmonaire et la tuberculose pulmonaire. Mais une association tuberculose-actinomycose ou cancer-actinomycose a été décrite [14][15][16]. Des cas d'actinomycose endobronchique induit par un corps étranger imitant un carcinome bronchique et des cas de culture positive d'actinomycose sur des masses parenchymateuses de cancer bronchique ont égale-ment été décrits [1,12,17,18].…”