Medical management of pulmonary actinomycosis: data from 49 consecutive cases

Kolditz, Martin; Bickhardt, J; Matthiessen, W; Holotiuk, O.; Höffken, G.; Koschel, Dirk

doi:10.1093/jac/dkp016

Cited by 44 publications

(47 citation statements)

References 5 publications

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“…The clinical features usually include low-grade inflammation with indolent advancement, which is similar to the presentation of fungal infection or lung neoplasms (8). Several reports (7,8,15) found that 25% to 49% of cases of pulmonary actinomycosis were suspected to be lung malignancy upon hospital admission, and the mean duration of illness before a definitive diagnosis was 2 to 6 months. A diagnosis of pulmonary actinomycosis is often confirmed by histological findings, which reflect chronic inflammation consisting of granulomatous change with sulfur granules (6).…”

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confidence: 96%

Multiple Lung Abscesses Caused by Actinomyces graevenitzii Mimicking Acute Pulmonary Coccidioidomycosis

Nagaoka

Izumikawa²,

Yamamoto³

et al. 2012

J Clin Microbiol

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c Actinomyces graevenitzii is a newly recognized Actinomyces species that is seldom isolated from clinical specimens. A case of multiple pulmonary abscesses mimicking acute pulmonary coccidioidomycosis is described in this study, and the findings indicate that this organism is an opportunistic human pathogen. CASE REPORTA 38-year-old apparently healthy woman complained of fever and dry cough after visiting Los Angeles, CA. Her medical history did not reveal any specific illness, including acquired immune deficiency syndrome. She did not smoke or consume alcohol. During her 3-day stay, she visited the beach in California. On her way to the beach, she encountered a dust storm and inhaled a large amount of dust. Seven days after she returned to Japan (9 days after encountering the dust storm), she was admitted to a local hospital in Nagasaki owing to a progressive dry cough (clinical day 8). On admission, the vital signs of the patient were as follows: body temperature, 37.5°C; blood pressure, 99/64 mm Hg; pulse, 72 beats/min with a regular rhythm; SpO 2 , 96% in a room air condition; and respiratory rate, 16 breaths/min. Cyanosis, cardiac murmur, and breath sounds were absent. Moreover, her liver, spleen and lymph nodes were not palpable. Her white blood cell count was 7.3 ϫ 10 3 /ml, with a shift to the left (71% neutrophils), and her C-reactive protein value was 5 mg/dl (normal range, 0 to 0.3 mg/dl). The chest computed tomography (CT) images revealed multiple round lesions located on both lobes, with diameters of 0.5 to 1 cm ( Fig. 1 and 2). The radiological findings strongly suggested metastatic tumors; hence, digestive tract endoscopy and positron emission tomography (PET) of the entire body were performed. No other lesions, except the lesions in the lungs, were found to contribute to the findings. Two weeks later (clinical day 21), the multiple pulmonary lesions had grown in size by 3-fold, with partial cavity formation ( Fig. 1 and 2). Owing to the extreme rapid progression of the lesions, the patient was transferred to our hospital for further examination and treatment. An oral antibiotic, faropenem (FRPM), at 600 mg/day was given from clinical days 21 to 24. On admission (clinical day 25), we suspected acute pulmonary coccidioidomycosis because of her travel history to the U.S. West Coast and the similarities of her CT images with those of typical pulmonary Coccidioides infection (3), and we administered liposomal amphotericin B (L-AMB) at 150 mg/day intravenously on clinical day 26. We also initiated tazobactam-piperacillin (TAZ-PIPC) therapy at 18 g/day concurrently, because the presence of other bacterial infections was not completely excluded. Before the initiation of antibiotic therapy, a transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath was performed 48 h after the cessation of FRPM treatment. The presence of antibodies against Coccidioides was also examined before the initiation of antifungal treatment (clinical day 26). After 9 days of treatment (clinical day 35),...

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confidence: 96%

Multiple Lung Abscesses Caused by Actinomyces graevenitzii Mimicking Acute Pulmonary Coccidioidomycosis

Nagaoka

Izumikawa²,

Yamamoto³

et al. 2012

J Clin Microbiol

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“…The median age of presentation in a European case series was 56. 2,4 Risk factors include poor oral hygiene, chronic respiratory disease, and alcohol excess.…”

Section: Discussionmentioning

confidence: 99%

“…The most common presenting symptoms are cough, sputum production and chest pain, followed by systemic symptoms such as fever and weight loss. 2,4 Both symptoms and examination fi ndings are usually non-specifi c, leading to potential for delayed or incorrect diagnosis. In a series of patients subsequently diagnosed with pulmonary actinomycosis, the most common initial diagnoses were malignancy, tuberculosis, and pneumonia, all of which were considered in this case.…”

Section: Discussionmentioning

confidence: 99%

A Patient with Persistent Consolidation and a Pulmonary Mass

Nwosu

Baksi

et al. 2018

Journal of the Royal College of Physicians of Edinburgh

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“…Its incidence is more frequent in males in the fourth to fifth decades but not in immunocompromised patients [3]. Risk factors include smoking, alcohol abuse, chronic pulmonary diseases, and poor dental hygiene [4,5]. The main symptoms are productive cough and hemoptysis.…”

Section: Discussionmentioning

confidence: 99%

“…Fever and weight loss may be suggestive of disseminated disease [3]. The average duration of illness before diagnosis is six months [3,4]. The characteristic findings on chest radiography and CT scan include airspace consolidation involving the upper lobe, mild enlargement of mediastinal lymph nodes, and mild pleural thickening adjacent to the airspace consolidation [6].…”

Section: Discussionmentioning

confidence: 99%

A Mass Shadow on Chest X-Ray in a 40-Year-Old Man: What’s Your Diagnosis?

Bellazreg¹,

Hachfi²,

Abdelkader³

et al. 2012

AID

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A 40-year-old man presented recurrent cough and bloody sputum for 4 months. Chest X-ray showed a large mass in the right upper lobe. Histopathologic examination of tissue from percutaneous biopsy of the lesion revealed actinomycotic granules and branching filamentous bacteria, and therefore pulmonary actinomycosis was diagnosed. These findings suggest that pulmonary actinomycosis should be included in the differential diagnosis of a mass on a chest X-ray film.

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Medical management of pulmonary actinomycosis: data from 49 consecutive cases

Cited by 44 publications

References 5 publications

Multiple Lung Abscesses Caused by Actinomyces graevenitzii Mimicking Acute Pulmonary Coccidioidomycosis

Multiple Lung Abscesses Caused by Actinomyces graevenitzii Mimicking Acute Pulmonary Coccidioidomycosis

A Patient with Persistent Consolidation and a Pulmonary Mass

A Mass Shadow on Chest X-Ray in a 40-Year-Old Man: What’s Your Diagnosis?

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