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

  Occasionally fever and elevated white cell count or ESR are found [8]. However all of our 3 patients have leucocytosis and elevated erythrocyte sedimentation rates, fever and abdominal pain. [scielo.br]

  People have chronic chest pain and fever. They lose weight and cough, sometimes bringing up sputum. People probably become infected when they inhale fluids that contain bacteria from their mouth. [merckmanuals.com]

  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]

  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]

• Sulfur Granules

  The majority of actinomycosis infections are diagnosed histopathologically (sulfur granules). [onlinelibrary.wiley.com]

  Histopathologic examination of the infected tissue should include a search for characteristic appearances of sulfur granules (Figure 2). The granules measure 40-400 ìm and stain Gram-positive with a mycelium-like structure. [scielo.br]

  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]

• 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]

  He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. [hindawi.com]

  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]

  Other possible side effects include C. difficile associated diarrhea, hemolytic anemia, gall bladder disease and it is not recommended in those who have had anaphylaxis to penicillin but may be used in those who have had milder reactions. [wikivisually.com]

• Malaise

  The presenting symptoms are usually non-specific including pain, malaise, fever, weight loss and the pressure effect of the granuloma on adjacent structures. [academic.oup.com]

  Symptoms may include pelvic pain, leukorrhea, menorrhagia, and amenorrhea, associated with fever, malaise, weakness, and weight loss, in any combination. [antimicrobe.org]

• Abdominal Pain

  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]

  Conclusion Abdominal actinomycosis is an uncommon infectious disease that can mimic multiple disease processes. It may present as a malignant disease, with symptoms of abdominal pain, asthenia, and weight loss. [hindawi.com]

• 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]

  We report a case of a 48‐yr‐old woman with a LARNE abdominal mass secondary to actinomycosis. [mayoclinic.pure.elsevier.com]

• 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]

  Chronic abdominal pain, fever, vomiting, diarrhea or constipation, and severe weight loss are common symptoms. Fistulas may form from the interior of the abdomen to the skin above it and between the intestine and other organs. [merckmanuals.com]

  He denied high fever, vomiting or bowel movement disturbances. He did not have a history of any chronic disease. [omicsonline.org]

  CASE REPORT An 81-year-old male was admitted to hospital with a 1-day history of faeculent vomiting and a 3-week history of a change in his bowel habit. [academic.oup.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]

• Loss of Appetite

  […] of appetite, and weight loss. [dovemed.com]

  Thoracic actinomycosis The symptoms of thoracic actinomycosis may include: a high temperature (fever) of 38C (100.4F) or above weight loss tiredness (fatigue) loss of appetite shortness of breath chest pain the appearance of sinus tracts on the surface [beaconmedicalgroup.nhs.uk]

  Patient reported that the abdominal pain was dull, aching, nonradiating, 7/10 in severity, aggravated by movement, alleviated by rest, and associated with loss of appetite and 20 pounds’ weight loss in 2 months. He denied any associated fever. [hindawi.com]

• Dental Caries

  The risk factors for cervicofacial infections include poor dental hygiene, recent dental extraction, dental caries, oromaxillofacial trauma, chronic tonsillitis, otitis, and mastoiditis ( 2, 6 ). [pubs.rsna.org]

• Asthenia

  It may present as a malignant disease, with symptoms of abdominal pain, asthenia, and weight loss. High index of suspicion is needed to avoid delay in diagnosis. [hindawi.com]

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]

  […] wall of Gram-positive bacteria. [wikivisually.com]

  Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). [hindawi.com]

  Actinomyces israeli is an anaerobic, gram-positive bacteria that forms part of the normal flor of the human mouth and gastrointestinal tract. Cervicofacial, thoracic, and abdominal actinomycosis are the three most common forms of the disease. [iss.ndl.go.jp]

  MICROBIOLOGY Actinomycosis is an uncommon, indolent, progressively invasive bacterial infection caused by organisms of the Actinomyces species, which are non-motile, filamentous, branching, gram-positive and predominantly anaerobic bacteria. [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]

  The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. [hindawi.com]

  SEVERAL SPECIES CAN CAUSE ACTINOMYCOSIS AND CAN BE POLYMICROBIAL INFECTION• Actinomyces is a gram positive, non-spore- forming anaerobic or microaerophilic bacterial rod. [slideshare.net]

An outpatient treatment strategy would be cost effective and a good choice for patients. [scielo.br]

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]

Although the surgical treatment facilitates recovery, it is usually not curative. Antibiotic treatment should be given for prolonged periods of 2 to 12 months. [omicsonline.org]

Surgery may be a valid option for patients who do not respond to medical treatment. [patient.info]

Assertive removal of necrotic tissue with surgical drainage and long term antibiotic treatment provide a good prognosis in patients with actinomycosis. KEYWORDS: Abdominal Actinomycosis; Unusual Abdominal Mass [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]

Nevertheless it was concluded that the judgment of the pathogenicity of Actinomyces naeslundii and of the other members of the heterogenous group of etiological agents of human actinomycosis still remains a matter of delicacy in any actual case of their [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

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]

This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis. [Indexed for MEDLINE] Free full text [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]

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]

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]

This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis. [Indexed for MEDLINE] Free full text [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]

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]

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]

The patient's antibiotic treatment was changed to a penicillin-series oral antibiotic to prevent recurrence of the actinomycosis. [ncbi.nlm.nih.gov]

Preventing actinomycosis Most cases of oral actinomycosis occur as a result of poor dental hygiene. This means practising good dental hygiene is the best way to prevent actinomycosis. [your.md]

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]

The orbital actinomycosis; diagnosis of visceral actinomycosis; ano-rectal actinomycosis; and prevention of actinomycosis are also elaborated. [books.google.com]

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]

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