Human actinomycosis: A study of 181 subjects

doi:10.1016/S0046-8177(73)80097-8

Human Pathology

Volume 4, Issue 3, September 1973, Pages 319-330

https://doi.org/10.1016/S0046-8177(73)80097-8 Get rights and content

Abstract

The clinical and pathologic features of 181 cases of human actinomycosis are reviewed. Actinomycosis is a chronic, sometimes fatal infection caused by species of Actinomyces and involves any part of the body. The abscesses produced contain soft tiny granules in thick pus. These granules contain gram-positive branching bacilli and a radiating eosinophilic fringe. Actinomycosis is not characterized by draining sinuses or hard yellow grains, and the organism is seldom identified by culture. The clinical diagnosis of actinomycosis is seldom made. The infection responds best to a combination of surgical and antibiotic treatment.

References (15)

PratherJ.R.
Actinomycosis of the thorax. Diagnosis and treatment
Ann. Thorac. Surg.
(1970)
PeabodyJ.W. et al.
Actinomycosis and nocardiosis
J. Chron. Dis.
(1957)
KapsimalisP. et al.
Actinomycosis of the periapical tissues
Oral Surg.
(1968)
LurieH.I. et al.
Opportunistic infections of the lungs
Hum. Path.
(1970)
WeedL.A. et al.
Actinomycosis. A pathologic and bacteriologic study of twenty-one fatal cases
Amer. J. Clin. Path.
(1949)
McQuarrieD.G. et al.
Actinomycosis of the lung and chest wall
Surgery
(1968)
McQuownA.L.
Actinomycosis and nocardiosis
Amer. J. Clin. Path.
(1955)

There are more references available in the full text version of this article.

Cited by (444)

The diagnosis and management of pulmonary actinomycosis
2023, Journal of Infection and Public Health
Pulmonary actinomycosis is a rare infection caused by the bacterial species actinomyces. This paper aims to provide a comprehensive review of pulmonary actinomycosis to improve awareness and knowledge. The literature was analysed using databases including Pubmed, Medline and Embase from 1974 to 2021. After inclusion and exclusion, a total of 142 papers were reviewed. Pulmonary actinomycosis is a rare disease occurring in approximately 1 per 3,000,000 people annually. Historically, pulmonary actinomycosis was a common infection with high mortality; however, the infection has become rarer since the widespread use of penicillins. Actinomycosis is known as "the great masquerade"; however, it can be differentiated from other diseases with acid-fast negative ray-like bacilli and sulphur granules being pathognomonic. Complications of the infection include empyema, endocarditis, pericarditis, pericardial effusion, and sepsis. The mainstay of treatment is prolonged antibiotic therapy, with adjuvant surgery in severe cases. Future research should focus on multiple areas, including the potential risk secondary to immunosuppression from newer immunotherapies, the utility of newer diagnostic techniques and ongoing surveillance post-therapy.
Nocardia and Actinomyces
2023, Molecular Medical Microbiology, Third Edition
Nocardiosis is an opportunistic infectious disease caused by a ubiquitous aerobic bacterium of the genus Nocardia that can be found in the environment. These bacteria are held responsible for many infections affecting the lungs, the brain or the skin—especially in immunocompromised patients. The taxonomy of this bacterium is complex, and a multilocus sequence analysis may be sometimes necessary for a correct identification when the 16S rRNA gene does not yield discriminative enough results. Nowadays, the matrix-assisted laser desorption ionization time-of-flight mass spectrometry system offers an interesting possibility to this genus as it allows to rapidly identify with a low error rate the four most common clinical species or species complexes: Nocardia farcinica, Nocardia abscessus, Nocardia nova, and Nocardia cyriacigeorgica. The next-generation sequencing system allows researchers to easily obtain genomic sequences at an affordable cost, thereby facilitating taxonomic analyses and even enhancing the accuracy of identifications. Actinomyces belong to the normal indigenous microflora, therefore they are considered as facultative pathogens. Actinomycosis is usually associated with the breakdown of normal physical barriers, such as disruption of mucosal membranes. Actinomycosis and nocardiosis are distinct diseases that respond to very different forms of therapy. Actinomyces can be readily distinguished from Nocardia by their different—anaerobic versus aerobic—patterns of growth after isolation from a clinical sample.
Laryngeal and pharyngeal actinomycosis: a systematic review and report of 3 cases
2022, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Actinomycosis is a granulomatous infection that rarely involves the larynx or pharynx. Three cases of actinomycosis of the larynx or pharynx from our institution were reviewed and a systematic literature review was performed to better define surgical management, antibiotic therapy, risk factors, and incidence of recurrence or complications.
PubMed/Medline, Cochrane, Embase, and Google Scholar were searched on November 30, 2021 using the terms “laryngeal actinomycosis”, “pharyngeal actinomycosis”, “actinomycosis AND larynx”, and “actinomycosis AND pharynx.” Articles which did not describe appropriate sites or were non-English were excluded. Results were collected for demographic information, site(s) of infection, comorbidities, lesion characteristics and treatments.
Along with three cases reported from our institution, 40 unique cases were reviewed from 37 studies for a total of 43 patients (Table 1). 34 (81.0 %) of the patients were male with the highest incidence of infection in the seventh decade (54.8 %). The most common site for the infection was the larynx (69.0 %) followed by the pharynx (16.7 %). Risk factors included a history of radiation therapy, immunosuppression, inhalational irritant, and diabetes (Table 3). The duration of antibiotic therapy varied greatly, from one month to one year and total follow up ranged from 1 month to 2.5 years (Table 1).
A comprehensive review of the literature on pharyngolaryngeal actinomycosis shows that this infection has increased prevalence within the head and neck cancer patient population. Similar to cervicofacial actinomycosis, these atypical sites have shown favorable responses to extended antibiotic therapy and generally do not require aggressive surgical management.
Paediatric pulmonary actinomycosis: A forgotten disease
2022, Paediatric Respiratory Reviews
Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Actinomycosis develops when there is disruption of the mucosal barrier, and invasion and systemic spread of the organism, which can lead to endogenous infection affecting numerous organs. It is known to spread in tissue through fascial planes and most often involves the cervicofacial (55%), abdominopelvic (20%) and thoracic (15%) soft tissue. Pulmonary actinomycosis is rare in patients under the age of five years, with the median reported age in the fifth decade. Clinical findings include chest wall mass (49%), cough (40%), pain (back, chest, shoulders) (36%), weight loss (19%), fever (19%), Draining sinuses (15%) and hemoptysis (9%). Chest x-ray findings in pulmonary actinomycosis are mostly nonspecific and can overlap with pulmonary tuberculosis, foreign body aspiration and malignancy. Endobronchial tissue aggregates may show sulphur granules, with yellow to white conglomerate areas of gram positive Actinomyces. Removal or biopsy of these large endobronchial masses must be done with care, because of the risk of bleeding and large airway obstruction. The cytology on bronchoalveolar lavage fluid may show Periodic acid–Schiff (PAS) positive stain, ZN negative and Gram-positive filamentous bacilli which is morphologically suggestive of Actinomycosis. Actinomyces spp is highly susceptible to beta lactam antibiotics, penicillin G, and amoxicillin. A minimum of 3–6 months is needed but up to 20 months of treatment may be needed. Early diagnosis and correct treatment can lead to a good prognosis with a low mortality.
Acute disseminated actinomycosis presenting as pneumonia with bilateral pulmonary nodules and pelvic osteomyelitis in an immunocompetent patient
2022, IDCases
Actinomycosis is an indolent human infectious disease caused by gram-positive anaerobic filamentous bacteria Actinomyces. Despite its sluggish growth, clinical manifestations can be acute or chronic. Over the last five decades, a significant incidence decline in the western world is due to the discovery of effective antimicrobials and improved oral hygiene. Actinomycosis is now rarely encountered and often misdiagnosed as its manifestations mimic malignancy and other infectious diseases. Due to prior use of antimicrobials, laboratory diagnostic processes often fail to isolate the organism making it arduous to establish the diagnosis. Clinical classification is based on the geographical distribution of the disease as oro-cervicofacial, thoracic, abdominopelvic, neurologic, musculoskeletal, and disseminated. Disseminated and pulmonary actinomycosis in an immunocompetent individual is extremely rare. Here we present a 53-year-old healthy male presenting with acute disseminated actinomycosis with bilateral pulmonary nodules, right upper lobe pneumonia, and pelvic osteomyelitis from Actinomyces odontolyticus infection.
Microstructural analysis of bony alterations in a historic case of actinomycosis
2020, International Journal of Paleopathology
Actinomycosis infection of bone is rare and its diagnosis challenging. Here, we aim to identify and verify its microstructural features and the potential value for differential diagnosis.
We investigated the dry preparation of the lumbar vertebrae and pelvic ring of a purported case of actinomycosis documented by a post-mortem examination in 1891.
Macroscopic inspection, conventional radiology, μCT, 3D reconstruction, and histological examination were employed.
All approaches revealed new periosteal bone deposition with increased vascularisation of the os coxa, vertebrae, and sacrum. The μCT revealed cortical loss underneath the new bone formation; the 3D reconstruction and histological examination revealed plexiform bone and granular structures.
The plexiform bone is the result of reactive rapid growth and remodelling processes, and is consistent with pathomorphological findings summarised in the autopsy report (soft tissue abscesses and formation of fistulas caused by “Actinomycosis intestine et ossis ilei sin.”).
This is the first case of a historically documented case of actinomycosis infection investigated by μCT and histology. Different degrees of tissue damage and inflammatory reaction in form of plexiform bone, which has not been reported previously, was identified.
The noted bone tissue modifications are not solely pathognomic of actinomycosis; they characterise other diseases, as well. Histological evaluation is not appropriate for identifying the aetiology of the granular structures observed here; but clinically such aggregations appear in tissue affected by actinomycosis.
Histochemical and molecular-genetic analyses are obligatory to affirm the diagnosis based on micromorphological features.

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^*: This investigation was supported in part by a research contract, Project Number 3A061102B71Q, from the Medical Research and Development Command, U.S. Army, Washington, D.C. The opinions or assertions contained herein are the private views of the author and are not to be construed as offcial or as reflecting the views of the Department of the Air Force of the Department of Defense.

^†: Associate Pathologist, Beverly Hospital, Beverly, and Hunt Memorial Hospital, Danvers, Massachusetts. Formerly Staff Pathologist, Infectious Diseases Branch, Geographic Pathology Division, Armed Forces Institute of Pathology, Washington, D.C.

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Human actinomycosis: A study of 181 subjects*

Abstract

Ann. Thorac. Surg.

J. Chron. Dis.

Oral Surg.

Hum. Path.

Actinomycosis. A pathologic and bacteriologic study of twenty-one fatal cases

Amer. J. Clin. Path.

Actinomycosis of the lung and chest wall

Surgery

Actinomycosis and nocardiosis

Amer. J. Clin. Path.