Surgical Implications of Actinomycosis

Wohlgemuth, Stephen D.; Gaddy, M C

doi:10.1097/00007611-198612000-00024

Cited by 17 publications

(8 citation statements)

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“…As the organism cannot penetrate healthy tissue, underlying trauma, disease, or surgery usually precedes infection [1,2,4,5]. Cervicofacial involvement is most often associated with poor oral hygiene or oral trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracic actinomycosis follows aspiration of infected material from the teeth, tongue, or tonsils [6]. Abdominal actinomycosis is usually preceded by surgery or perforation of a viscus [1,2,4,5]. Pelvic involvement is associated with intrauterine contraceptive devices [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Spread to other sites is typically by direct extension. Hematogenous or lymphatic spread is unusual [2]. Retroperitoneal involvement without intraabdominal disease is rare [2][3][4]7].…”

Section: Discussionmentioning

confidence: 99%

“…Although the cervicofacial region is the most common site of primary involvement, the abdomen and thorax are often involved [1][2][3][4]. Disease in an extremity is usually secondary.…”

Section: Introductionmentioning

confidence: 99%

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Actinomycosis of the retroperitoneum and an extremity: CT features

1993

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Abstract.A patient presenting with thigh and flank masses and back pain for 3 months proved to have actinomycosis involving the retroperitoneum and quadriceps muscle. Retroperitoneal involvement without intraperitoneal disease is rare. Computed tomography (CT), however, showed disease transgressing adjacent anatomic compartments with direct extension through the body wall and involvement of adjacent bony structures which is characteristic of actinomycosis.Key words: Actinomycosis, retroperitoneum--Actinomycosis, kidney extremity--CT.Actinomycosis is a chronic, suppurative infectious disease characterized by multiple abscesses, draining sinuses, and the formation of dense fibrous granulation tissue. Although the cervicofacial region is the most common site of primary involvement, the abdomen and thorax are often involved [1][2][3][4]. Disease in an extremity is usually secondary. This patient had actinomycosis concomitantly involving the retroperitoneum and an extremity, without history of prior trauma or surgery of either region. Retroperitoneal involvement without intraperitoneal disease is rare. Case ReportA 3 l-year-old woman had lower back pain for 3 months and developed tender, enlarging masses in the left flank and the right thigh. Additionally, she had fatigue, fevers, chills, and a 50-pound weight loss. Three months prior to admission, painless gross hematuria led to an intravenous urogram and cystoscopy which were normal. On physical examination, she had an 11 x 10 cm left paraspinal soft tissue mass at the lower costal margin and a 10 x 8 cm mass of the right upper thigh. The masses were warm, tender, and firm. There was hypochromic microcytic anemia, an elevated sedimentation rate, and a white blood cell count of 25,400 without a significant left shift. Chest radiographs showed a left pleural effusion. Fine-needle aspiration of the paraspinal mass yielded less than 5 ml of cloudy aspirate. Routine Gram stain and culture were negative. Ampicillin, ctindamycin, and gentamicin were started.Computed tomography (CT) showed a soft tissue mass in the retroperitoneum displacing the left kidney laterally (Fig. 1A). The mass involved the paraspinous muscles with destruction of the cortex of T11, and periostitis of the 1 lth and 12th ribs (Fig. 1B). The left kidney was enlarged and the calyces splayed. CT of the thigh showed enlargement and decreased density of the quadriceps muscle with infiltration of the subcutaneous fat (Fig. 1C). The thigh mass was incised and drained and the retroperitoneal mass biopsied in the operating room. A diagnosis of organizing abscess due to actinomycosis was made when organisms were cultured from biopsy material from both sites. Ampicillin was given intravenously for 6 weeks. Prior to discharge, a CT study showed nearly complete resolution of the thigh lesion. The left flank findings were unchanged, but there were now no symptoms. The patient was discharged with a 4-week course of oral ampicillin. She was subsequently lost to recall.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Spread to other sites is typically by direct extension. Hematogenous or lymphatic spread is unusual [2]. Retroperitoneal involvement without intraabdominal disease is rare [2][3][4]7].…”

Section: Discussionmentioning

confidence: 99%

“…Although the cervicofacial region is the most common site of primary involvement, the abdomen and thorax are often involved [1][2][3][4]. Disease in an extremity is usually secondary.…”

Section: Introductionmentioning

confidence: 99%

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Actinomycosis of the retroperitoneum and an extremity: CT features

1993

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“…This bacterium is universally distributed and is not very virulent; it is rarely related to abdominal disease. Primary bowel involvement is rare, but it has increased in frequency over the last few years [2][3][4][5][6][7][8].…”

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confidence: 99%

Actinomycosis simulating malignant large bowel obstruction

Bittencourt¹,

Andreis²,

Lima³

et al. 2004

Braz J Infect Dis

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Actinomyces

Schaal¹,

Yassin²

2015

Bergey's Manual of Systematics of Archaea and Bacteria

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Ac.ti.no.my'ces. Gr. fem. n. aktis, aktinos ray; Gr. masc. n. mukês fungus; N.L. masc. n. Actinomyces ray fungus referring to the radial arrangement of filaments in Actinomyces bovis sulfur granules. Actinobacteria / Actinobacteria / Actinomycetales / Actinomycetaceae / Actinomyces Straight or slightly curved rods , 0.2–1.0 µm in diameter, which vary considerably in shape and size, and slender filaments , 1 µm or less in width and 10–50 µm or more in length, with true branching. Short rods (0.5–5.0 µm in length) with or without clubbed ends are frequently seen and may occur singly, in pairs with diphtheroidal arrangements (Y, V, T forms and palisades), in short chains or in small clusters. Longer (5.0–10.0 µm in length) branched rods are also common. Several members of the genus appear chiefly or exclusively as coccobacillary or even coccoid elements. Filaments which may predominate in certain species are either straight or wavy , show varying degrees of branching and may have swollen, clubbed, or clavate ends. Gram‐stain‐positive , but irregular staining giving rise to a beaded or barred appearance frequently occurs, and two species may be Gram‐stain‐variable. Non‐acid‐fast, nonmotile, and non‐endospore‐forming. Conidia are not produced. DNA G+C content (mol%) : 55–71 ( T m , HPLC). Type species : Actinomyces bovis Harz 1877, 133 AL .

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Surgical Implications of Actinomycosis

Cited by 17 publications

References 0 publications

Actinomycosis of the retroperitoneum and an extremity: CT features

Actinomycosis of the retroperitoneum and an extremity: CT features

Actinomycosis simulating malignant large bowel obstruction

Actinomyces

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