Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

Abstract

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.

Abdominal and pelvic actinomycosis due to longstanding intrauterine device: a slow and devastating infection

“…Gram staining of the pus and the histopathology of the infected tissue are more sensitive than the culture for the diagnosis. The presence of sulfur granules, which stain Gram-positive with a mycelium-like structure, is consistent with actinomycosis and may be present in 50% of the cases 2 , 12 , 14…”

“…Actinomyces spp. are very sensitive to oxygen, cultures should be processed within 15 minutes and placed immediately in anaerobic conditions and incubated for a long time to show positive growing (from 5 to 20 days, and up to 76% of the cultures are negative) 2 , 6 , 12 , 13. Gram staining of the pus and the histopathology of the infected tissue are more sensitive than the culture for the diagnosis.…”

“…The long-term antibiotic regimen is of paramount importance for the treatment. However, all the severe and complicated cases need to be treated in association with surgical intervention 12 , 14. There are no randomized controlled studies concerning antibiotic regimens;15 however, prolonged antimicrobial use is recommended and the surgical resection of infected tissue may shorten the length of therapy.…”

Treatment Options for Gram-Positive and Gram-Negative Bacteria: Focus on Ceftriaxone

“…Ceftriaxone is an alternative regimen with limited but anecdotal clinical success. 97,98 Whipple's disease is caused by Tropheryma whipplei, an Actinobacteria; the full genome sequence of T. whipplei was identified in 2003. Previously, the most common symptom of classic Whipple's disease was chronic weight loss and diarrhea with intestinal malabsorption.…”

Actinomycosis mimicking colonic neoplasia

“…Actinomyces israelli is a non-pathogenic bacteria, therefore a solution of continuity on the gastro-intestinal mucosa should occur in order to allow the infection of the organ and the proliferation of the micro-organism, causing the disease 2 . Examples of mucosal lesions that lead to the occurrence of actinomycosis are those caused by trauma, surgery, endoscopic manipulation and inflammatory bowel disease 3 . The ileocecal area is the most common site for actinomycosis in the intestine 4 , and fewer cases have been reported in the past few years.…”