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Abdominal Actinomycosis

Actinomycosis is an infection caused by gram-positive anaerobic bacteria Actinomyces spp., a commensal microorganism of our respiratory and gastrointestinal tract. Abdominal actinomycosis is one of the main subtypes, involving either the intestines or the genitourinary system. Previous mucosal injury is almost a prerequisite for this infection to occur. The diagnosis can be made after a thorough clinical, laboratory, and imaging workup, but conventional microbiological studies are of limited efficacy.


Presentation

Abdominal actinomycosis is one of the clinical subtypes of Actinomyces spp. infection, a commensal microorganism of our gastrointestinal, respiratory, but also genitourinary tracts [1] [2]. Actinomyces (principally A. israelii) seems to cause an infection in the gastrointestinal tract only after a significant injury to the intestinal mucosa, as seen in diverticulitis, appendicitis, abdominal trauma, and following gastrointestinal surgery [1] [3] [4] [5]. Despite the fact that a large number of cases is now being associated with the use of intrauterine devices (IUDs), the infection is encountered almost three times more frequently in males than females [1] [2] [5] [6]. In the abdomen, Actinomyces can cause an infection of the gastrointestinal, biliary, and genitourinary tracts, whereas pelvic actinomycosis might also be encountered, often as a complication of abdominal infection [2] [5] [6]. In the GI tract, the appendix, the cecum, and the large intestine are the predominant sites of infection, and abdominal pain accompanied by a firm and or even hard palpable mass is the main presenting feature [2] [5] [6]. Other reported complaints are fever, right lower or right upper quadrant pain (in colonic or hepatic actinomycosis, respectively), and alterations in bowel habits [5] [7] [8]. Similar to the GI tract, the infection of the genitourinary tract will manifest as a palpable mass as well, with fever and other organ-related complaints [2].

Fever
  • Symptoms included intermittent fever, abdominal pain and significant weight loss. Hepatic and renal tumor masses were suspected on sonography and computerized tomography. XGP and actinomycosis were proven by pathology.[ncbi.nlm.nih.gov]
  • Similar to the GI tract, the infection of the genitourinary tract will manifest as a palpable mass as well, with fever and other organ-related complaints.[symptoma.com]
  • Actinomycosis must be considered in the differential diagnosis of patients who present with abdominal pain, fever, leucocytosis and intestinal wall thickness and/or abdominal mass.[ncbi.nlm.nih.gov]
  • Although nonspecific, actinomycosis should be included in the differential diagnosis when CT scans show an infiltrative mass with unusual aggressiveness and dense inhomogeneous contrast enhancement, especially in patients with fever, leukocytosis, or[ncbi.nlm.nih.gov]
  • A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy.[ncbi.nlm.nih.gov]
Sulfur Granules
  • A 46-year-old woman with intra-abdominal actinomycosis is described in whom the condition was first suspected when sulfur granules were found in her urine. The infection had involved her bladder but not her kidneys.[ncbi.nlm.nih.gov]
  • The diagnosis is confirmed by the presence of "sulfur granules" in the fistulous tracts.[ncbi.nlm.nih.gov]
  • Exploratory laparotomy was performed and actinomycosis was confirmed by the presence of sulfur granules and filamentous bacteria. Postoperatively, the patient was successfully treated with long-term penicillin and recovered completely.[ncbi.nlm.nih.gov]
  • Postoperatively, pathologic examination confirmed the diagnosis of abdominal actinomycosis in which the characteristic finding of sulfur granules in the resected specimen was demonstrated.[ncbi.nlm.nih.gov]
  • The postoperative pathologic study showed sulfur granules in the resected specimen compatible with abdominal actinomycosis. No signs of recurrence were seen throughout the 6-month follow-up.[ncbi.nlm.nih.gov]
Weight Loss
  • Symptoms included intermittent fever, abdominal pain and significant weight loss. Hepatic and renal tumor masses were suspected on sonography and computerized tomography. XGP and actinomycosis were proven by pathology.[ncbi.nlm.nih.gov]
  • A 46-year-old female presenting with intermittent abdominal pain, nausea, vomiting, transient bowel obstruction, weight loss (18 kg), anemia, and hypoalbuminemia was evaluated in our clinic.[ncbi.nlm.nih.gov]
  • He reported a 25lb weight loss over the past the month. He denied abdominal pain, decreased appetite, change in bowel or bladder habits, or recent travel.[shmabstracts.com]
  • It usually presents with a history of prolonged use ( 2 years) and symptoms of fever, vaginal discharge, pelvic or abdominal pain, and weight loss.[patient.info]
Anemia
  • A 46-year-old female presenting with intermittent abdominal pain, nausea, vomiting, transient bowel obstruction, weight loss (18 kg), anemia, and hypoalbuminemia was evaluated in our clinic.[ncbi.nlm.nih.gov]
  • Similarly, common lab abnormalities including anemia and leukocytosis, were seen.[shmabstracts.com]
  • Among the findings are normochromic anemia, leukocytosis, and increased globular sedimentation velocity. 2,7 Macroscopic examination of the surgical specimen of this case revealed inflammation at the level of the appendix.[revistagastroenterologiamexico.org]
  • The laboratory results of the patient showed anemia.[panafrican-med-journal.com]
  • BRONȘITA INFECȚIOASĂ AVIARĂ 68 GASTROENTERITA TRANSMISIBILĂ A PORCULUI 73 DIAREEA EPIZOOTICĂ PORCINĂ 77 BOALA VOMITĂRII ȘI DESHIDRATĂRII 78 (ENCEFALOMIELITA CU VIRUS HEMAGLUTINANT) 78 PERITONITA INFECȚIOASĂ FELINĂ 79 CIRCOVIROZE 81 CIRCOVIROZA PORCINĂ 81 ANEMIA[biblioteca.regielive.ro]
Pseudotumor
  • We report the case of a 6-y-old boy with actinomycosis, presenting as xanthogranulomatous pyelonephritis (XGP), hepatic pseudotumor and abdominal abscess. Symptoms included intermittent fever, abdominal pain and significant weight loss.[ncbi.nlm.nih.gov]
  • Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD.[ncbi.nlm.nih.gov]
  • Actinomycosis is a chronic suppurative disease that presents with the formation of fistula, sinus, inflammatory pseudotumor, or abscess.[revistagastroenterologiamexico.org]
Abdominal Pain
  • Symptoms included intermittent fever, abdominal pain and significant weight loss. Hepatic and renal tumor masses were suspected on sonography and computerized tomography. XGP and actinomycosis were proven by pathology.[ncbi.nlm.nih.gov]
  • We describe a previously healthy 11-year-old girl who presented with right lower quadrant abdominal pain and drainage. Computed tomography scan showed an abdominal wall mass. Surgical debridement cultures grew Actinomyces meyeri.[ncbi.nlm.nih.gov]
  • A 27- year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago.[ncbi.nlm.nih.gov]
  • We report a 16-year-old boy with abdominal actinomycosis who presented with a 2-week history of intermittent abdominal pain. He complained of oliguria during the 3 days prior to admission.[ncbi.nlm.nih.gov]
  • Actinomycosis must be considered in the differential diagnosis of patients who present with abdominal pain, fever, leucocytosis and intestinal wall thickness and/or abdominal mass.[ncbi.nlm.nih.gov]
Abdominal Mass
  • As a pathogen it causes fistulas, sinuses, and may appear as an abdominal mass and/or abscess. The abdominal mass can masquerade as a malignant process that is very difficult to differentiate, often requiring surgical intervention with resection.[ncbi.nlm.nih.gov]
  • The symptoms persisted, however, and the decision was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed.[ncbi.nlm.nih.gov]
  • Two 11-year-old boys had similar clinical courses of abdominal actinomycosis complicating ruptured appendicitis and manifesting as abdominal masses causing hydronephrosis. Cure was effected by surgery and prolonged penicillin therapy.[ncbi.nlm.nih.gov]
  • A 26 year old woman who had had an intrauterine contraceptive device had an abdominal mass due to actinomycosis excised three months after routine laparoscopy. The aetiology and possible association with laparoscopy is discussed.[ncbi.nlm.nih.gov]
  • We report a case of a 48-yr-old woman with a large abdominal mass secondary to actinomycosis.[ncbi.nlm.nih.gov]
Vomiting
  • A 46-year-old female presenting with intermittent abdominal pain, nausea, vomiting, transient bowel obstruction, weight loss (18 kg), anemia, and hypoalbuminemia was evaluated in our clinic.[ncbi.nlm.nih.gov]
  • She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver.[ncbi.nlm.nih.gov]
  • He denied high fever, vomiting or bowel movement disturbances. He did not have a history of any chronic disease.[omicsonline.org]
  • […] symptoms of abdominal actinomycosis may include: mild fever – usually a temperature that's no higher than 38C (100.4F) weight loss tiredness (fatigue) a change in your bowel habits, such as constipation or diarrhoea abdominal (tummy) pain nausea and vomiting[beaconmedicalgroup.nhs.uk]
  • She denied diarrhea, melena, nausea, vomiting, or hematochezia. She had been having night sweats but denied any weight loss.[karger.com]
Nausea
  • A 46-year-old female presenting with intermittent abdominal pain, nausea, vomiting, transient bowel obstruction, weight loss (18 kg), anemia, and hypoalbuminemia was evaluated in our clinic.[ncbi.nlm.nih.gov]
  • Since these bacteria can grow without oxygen, they can thrive in such environments, resulting in infection Digestive Tract Actinomycosis can occur as a consequence of infections, surgery, or ingestion of a foreign object, causing chronic pain, nausea,[dovemed.com]
  • Side effects of these antibiotics include: diarrhoea nausea (feeling sick) skin rash increased vulnerability to fungal infections, such as oral thrush (a fungal infection that occurs in the mouth) If you're allergic to penicillin, alternative antibiotics[beaconmedicalgroup.nhs.uk]
  • She denied diarrhea, melena, nausea, vomiting, or hematochezia. She had been having night sweats but denied any weight loss.[karger.com]
Hypogastric Mass
  • A 48-year-old female, presented as a case of acute abdomen with a small-bowel obstruction and a palpable hypogastric mass, was urgently operated.[ncbi.nlm.nih.gov]
  • A 46-year-old woman presented with a hypogastric mass. The preoperative diagnosis was a malignant ovarian tumor involving multiple organs, including the urinary bladder.[ncbi.nlm.nih.gov]
Oliguria
  • He complained of oliguria during the 3 days prior to admission. Abdominal computed tomography revealed a large inflammatory mass obstructing the ureter, which led to hydronephrosis of the right kidney.[ncbi.nlm.nih.gov]

Workup

The indolent course of the infection, a frequent misdiagnosis (as tumors, autoimmune bowel disease, etc.), the nonspecific clinical presentation, and the need for strict conditions for bacterial growth through standard microbiological methods are the challenges faced by the physician in making the diagnosis of all types of actinomycosis, including abdominal [1] [2] [3] [4]. For this reason, a detailed patient assessment through history taking may be crucial in raising clinical suspicion. Physicians should inquire about recent abdominal trauma, gastrointestinal surgery, appendicitis, or the use of an IUD [3] [4]. Furthermore, the role of the physical examination is equally important, since the detection of a palpable mass is a key step in allowing a more thorough investigation. Imaging studies should be employed, and ultrasonography (US), regarded as a first-line study, is able to visualize a solid mass that is often misidentified as a tumor [1] [2]. If, however, macroscopic features suggest an abscess, percutaneous drainage or biopsy of the mass, assisted by either computed tomography (CT) or endoscopic US, might be indicated [1] [5] [9]. Once appropriate samples are obtained, cultivation and gram-staining of Actinomyces are recommended strategies to confirm the diagnosis, but the very long incubation period (> 10 days) and strict anaerobic conditions impede the effectiveness of these procedures [2] [5] [6]. More advanced studies, on the other hand, such as polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF), are showing very high success rates in detecting Actinomyces [2] [5], but their cost is a significant limitation.

Gram-Positive Bacteria
  • Pelvic actinomycosis infection is rare but serious infection caused by Actinomyces sp , an opportunistic gram-positive bacteria usually introduced by foreign bodies specially IUCDs, surgery, or trauma.[radiopaedia.org]
  • Both Gram-positive bacteria and Gram-negative bacteria pick up the counterstain, the counterstain, however, is unseen on Gram-positive bacteria because of the darker crystal violet stain.[wikivisually.com]
  • Characters that differentiate these four genera from each other and from other anaerobically growing nonsporulating gram-positive bacteria are derived from cell wall or whole-cell analysis, acid end-product analysis, and certain physiological tests.[antimicrobe.org]
Gram-Positive Rods
  • The differential included nocardiosis which is also identified as beading gram positive rods on gram stain. However nocardia bacteremia is rare and not commonly found as commensal bacteria.[shmabstracts.com]
  • TAXONOMY OF THE ANAEROBIC ACTINOMYCTES• Anaerobic non - sporulating gram- positive rods consist of two groups based on guanosine (G) plus cytosine (C) DNA content: Low mole percent (30- 53%) and high mole percent (49-68%)• Actinomyctes species member[slideshare.net]

Treatment

  • Both simulated a malignant process and required operations for diagnosis and treatment. As reported, actinomycotic abdominal masses and strictures can be treated by penicillin alone.[ncbi.nlm.nih.gov]
  • Long term oral antibiotic treatment (mean 4.2 months; range, 0.5-7.0 months) were administered to all patients.[ncbi.nlm.nih.gov]
  • Treatment with high doses of penicillin resulted in rapid and complete recovery. This is one of the most misdiagnosed diseases because of its variety of clinical presentation.[ncbi.nlm.nih.gov]
  • After treatment with antibiotics and surgery, the patient's condition improved.[ncbi.nlm.nih.gov]
  • After surgery, the patients continued antibiotic treatment with ampicillin for 2 months at our OPD and had no signs of recurrence 1 year after surgery.[ncbi.nlm.nih.gov]

Prognosis

  • Assertive removal of necrotic tissue with surgical drainage and long term antibiotic treatment provide a good prognosis in patients with actinomycosis.[ncbi.nlm.nih.gov]
  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.com]
  • Other findings: indurated pelvic fat pelvic free fluid pelvic abscess hydronephrosis wider Intra-abdominal extension: mainly through contiguous spread formation of tubo-ovarian abscesses 2 subsequent infertility Treatment and prognosis Treatment is usually[radiopaedia.org]
  • In such cases, the recovery can be prolonged Please find comprehensive information on Digestive Tract Actinomycosis regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis,[dovemed.com]
  • Prognosis When actinomycosis is diagnosed early and treated with appropriate antibiotic therapy, the prognosis is excellent.[emedicine.medscape.com]

Etiology

  • This type of infection can be treated successfully with drugs if the etiology is identified in a timely manner. However, in the case of our patient, the manner of presentation made diagnosis more difficult prior to surgical trauma.[ncbi.nlm.nih.gov]
  • Histological analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued for 6 months.[ncbi.nlm.nih.gov]
  • Actinomyces israelii is the most common etiologic agent; however, at least five other species are implicated in human disease Using comparative 16s ribosomal RNA, some bacteria traditionally associated with actinomycotic disease have been reclassified[pathologyoutlines.com]
  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.com]
  • Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-97. PMid:25045274. 15. Bonnefond S, Catroux M, Melenotte C, et al.[autopsyandcasereports.org]

Epidemiology

  • This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis.[ncbi.nlm.nih.gov]
  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.com]
  • […] actinomycosis, but some sources do not discriminate between actinomycosis of abdomen and pelvis Other common sites are oral cervicofacial actinomycosis ("lumpy jaw", see secondary chronic osteomyelitis ), skin , thoracic and pelvic ( cervix , kidney , ovary ) Epidemiology[pathologyoutlines.com]
  • Epidemiology [ 1 ] Actinomycosis is rare.[patient.info]
  • Epidemiology Frequency United States Actinomycosis is rare. During the 1970s, the reported annual incidence of actinomycosis in the Cleveland area was 1 case per 300,000 persons.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis.[ncbi.nlm.nih.gov]
  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.com]
  • […] abdominal actinomycosis comprises 15 - 20% of actinomycosis in humans Males are more commonly affected Sites Most common site is cecum, most often with concurrent ileal disease Some cases are secondary to disease in appendix or female genital tract Pathophysiology[pathologyoutlines.com]
  • PATHOPHYSIOLOGY• In general, Actinomyces species, being members of the normal flora, are agents of low pathogenicity and require disruption of the mucosal barrier to cause disease.[slideshare.net]
  • This review of the literature offers us an update of this disease in epidemiology, pathophysiology and its clinical features. Key words : Actinomycosis, abdominal, abscess, malignant, neoplasms, appendicitis, abdominal mass, penicillin.[academiapublishing.org]

Prevention

  • The patient's antibiotic treatment was changed to a penicillin-series oral antibiotic to prevent recurrence of the actinomycosis.[ncbi.nlm.nih.gov]
  • The patient had an intensive antibiotic therapy prescribed in order to prevent a disease relapse because it was not sure whether the remaining part of omentum was affected by microscopic Actinomycosis.[pjms.com.pk]
  • The orbital actinomycosis; diagnosis of visceral actinomycosis; ano-rectal actinomycosis; and prevention of actinomycosis are also elaborated.[books.google.com]
  • One of the best ways to prevent actinomycosis is to practice good oral hygiene. Schedule regular visits with your dentist so that they can spot potential problems.[healthline.com]
  • Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health[books.google.com]

References

Article

  1. Garner JP, Macdonald M, Kumar PK. Abdominal actinomycosis. Int J Surg. 2007;5(6):441-448.
  2. Valour F, Sénéchal A, Dupieux C, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-197.
  3. Karagulle E, Turan H, Turk E, Kiyici H, Yildirim E, Moray G. Abdominal actinomycosis mimicking acute appendicitis. Can J Surg. 2008;51(5):E109-E110.
  4. Wong JJ, Kinney TB, Miller FJ, Rivera-Sanfeliz G. Hepatic actinomycotic abscesses: diagnosis and management. AJR Am J Roentgenol. 2006;186:174–176.
  5. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
  6. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.
  7. Hayashi M, Asakuma M, Tsunemi S, et al. Surgical treatment for abdominal actinomycosis: A report of two cases. World J Gastrointest Surg. 2010;2(12):405-408.
  8. Sung HY, Lee IS, Kim SI, et al. Clinical features of abdominal actinomycosis: a 15-year experience of a single institute. J Korean Med Sci. 2011;26:932-937.
  9. Abela J, Sciberras J, Meilak M, et al. Omental actinomycosis presenting with right lower quadrant abdominal pain. J Clin Pathol 2004;57:671.

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Last updated: 2018-06-21 23:42