Actinomycosis of the larynx represents an unusual presentation for a common bacterium comprising the oral and oropharyngeal florae. There are few cases reported in the literature of laryngeal actinomycosis occurring primarily in the immunocompromised population. Here, we present a case in a 74-year-old man that occurred in the setting of neutropenia as a result of chemotherapy. Once the diagnosis was made with biopsy of the larynx, the infection was resolved after a prolonged course of penicillin-based therapy.

OBJECTIVES:

Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis.

STUDY DESIGN:

A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature.

RESULTS:

The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 - 4 weeks, being shorter than the 3 - 52 weeks reported in the literature.

CONCLUSION:

When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 - 4 weeks is generally efficient.

La patología esofágica es común en pacientes con VIH, frecuentemente debido a Candida, citomegalovirus o virus herpes simple. Sin embargo, la actinomicosis esofágica es una infección rara, incluso en pacientes con infección VIH. Reportamos el caso en un paciente varón de 33 años, con diagnóstico reciente de VIH que acudió a consulta por fiebre, odinofagia, disfagia y dolor retroesternal. La endoscopia digestiva alta evidenció múltiples úlceras esofágicas y el informe histopatológico de la biopsia esofágica describió una esofagitis crónica con presencia de colonias de bacilos PAS positivos, compatibles con Actinomyces, iniciando tratamiento antimicrobiano con evolución favorable. Aunque es una enfermedad no común, cerca de un tercio de los casos de actinomicosis esofágica se presentan en pacientes con infección VIH, y es preciso el estudio endoscópico con toma de biopsia para definir el diagnóstico y manejo apropiado.

This paper presents the fourth case reported on the association of primary bronchial actinomycosis and foreign body. The pathogenesis of this rare association has been linked to the low respiratory tract and a foreign body (chicken bone); it depends on its characteristics and how long it has remained lodged into the bronchial tree. The diagnosis of this case was very difficult and late. Several endoscopy procedures were required in order to detect it. Our patient has been treated successfully with parenteral penicillin in association with an original bronchoscopic procedure using a laser technique to find the foreign body and take it out of the respiratory tract. We consider that it is necessary to remember this association in every patient who suffers from recurrent pneumonia, in those who are at risk of foreign body aspiration and when the presence of an endobronchial mass is suspected.

El tratamiento con anticuerpos anti-factor de necrosis tumoral (TNF) es una opción terapéutica efectiva en la enfermedad inflamatoria crónica intestinal, en casos de ineficacia a otros fármacos, pero favorece la aparición de infecciones oportunistas en sus formas graves, debido a la gran inmunodepresión de células T que produce. Entre las más frecuentes se encuentran las infecciones granulomatosas bacterianas, como las causadas por micobacterias (en la que se destaca la tuberculosis), y las fúngicas. La actinomicosis es una infección oportunista crónica, granulomatosa, supurativa e infrecuente que, en estados de inmunosupresión, como el provocado tras el tratamiento con anticuerpos monoclonales anti-TNF, puede complicarse con cuadros clínicos más graves. Se presenta el caso clínico, no descrito anteriormente, de actinomicosis cervicofacial complicada con neumonía, secundaria al tratamiento con adalimumab, en una paciente con enfermedad de Crohn.

Actimomycosis is a non opportunistic chronic infection caused by a superior bacteria that forms grains in the pus or affected organs. 54 cases have been reported in the last 50 years in the chilean literature, 51 percent were abdominal actinomycoses, 25.5 percent pelvic and 18.5 percent puñmonary. 14 cases have been treated in the last 9 years at San Borja Arriaran. Of these 7 were abdominal (1 parietal and 6 visceral forms) and 4 involved the rectosigmoid; 2 were ileocecal and occurred after an appendicectomy. The presenting picture was of a giant abdominal mass in 2 cases (1 with a colocutaneous fistula), rectal stricture in 1 case, tubo-ovarian abscess with colonic involvement in 1 case, parietal mass in 1 case and a fistula after an appendicectomy in 2 cases. Actinomuces Israelli was found in the histopathological study in three cases and in the bacteriological study in 2. All visceral forms were treated with penicillin plus tetracycline or amoxicillin during 6 to 12 months with complete and permanent recovery. 2 patients required a colonic resection due to a iatrogenic damage and an associated diverticular disease. 3 patients required a colostomy to overcome the obstruction, all of them are asymptomatic and without colostomy 18 months to 8 years later. Due to its different presentation forms, actinomycosis has been called "the great pretender" and in several ocassions the histological or bacteriological diagnosis is not achieved

La actinomicosis torácica es una infección bacteriana lentamente progresiva, producida por bacterias grampositivas anaerobias o microaerófilas que colonizan la orofaringe y el tracto gastrointestinal. Su baja frecuencia en la actualidad y sus distintas ubicaciones anatómicas constituyen un desafío diagnóstico para las distintas especialidades de la medicina. En este trabajo se presenta el caso de un paciente de 44 años de edad, con antecedentes de salud, que ingresa en el Hospital Regional de Zacapa en Guatemala por fístulas en hemitórax izquierdo y neumonía en vértice homolateral de 6 meses de evolución, interpretado inicialmente como tuberculosis pulmonar. Luego de exámenes complementarios y otros como Radiografía de Tórax, Baciloscopia, VIH y Cultivo de secreción de la lesión, se realizó Biopsia de la lesión, observándose gránulos de azufre con abundante tejido de granulación y celularidad compatible con Actinomyces israelii(AU)

Las enfermedades por hongos de localización pulmonar no han trascendido completamente en el ámbito médico. Existen a la vez, estrechas semejanzas clínicas, patogénicas e inmunológicas con otras patologías pulmonares, en particular la tuberculosis. De ahí el interés sobre el conocimiento de las micosis pulmonares por hongos patógenos primarios y por hongos oportunistas. Esta división, incluye a la histoplasmosis, coccidioidomicosis, paracoccioidomicosis y blastomicosis como micosis primarias, mientras que la actinomicosis, candidosis sistémica, criptococosis, aspergilosis, nocardiasis y zigomicosis corresponden a las micosis oportunistas. Los aspectos micológicos son fundamentales para el reconocimiento de los elementos parasitarios micósicos y la identificación de los hongos patógenos humanos, lo que garantiza un diagnóstico confiable en estos padecimientos

Resumen Las fístulas cutáneas de origen odontogénico son canales anómalos originados a partir de procesos infecciosos dentarios crónicos,que desembocan en la superficie de la mucosa de la cavidad oral o cutánea. El diagnóstico es clínico y se confirma con radiografía panorámica. Los diagnósticos diferenciales son principalmente actinomicosis, tuberculosis cutánea crónica, histoplasmosis y neoplasias. El tratamiento consiste en la extracción quirúrgica de la causa y del trayectofistuloso.