American Federation for Medical Research

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Actinomycosis
Theo D. Trandafirescu, Mathew Trandafirescu. Medicine, Mount Sinai Services, Queens Hospital Center, Flushing, New York, United States

Purpose of Study Actinomycosis is a rarely encountered infection and technically difficult to culture, hence may pose a challenge for the clinician.
Methods Used 37 M with history of chronic alcohol abuse, presented with hemoptysis, SOB and fever.CT revealed 9 x 6 cm inflammatory-appearing cavitary opacity in the LLL with left sided loculated pleural effusion.Patient was intubated and empiric antibiotic therapy was started.2 left CT were placed for loculated pleural effusion. Sputum and pleural fluid AFB were negative. Pleural fluid was exudative and revealed Gram positive cocci and Gram positive rods, with identification of sulfur granules which was highly suggestive of Actinomyces. Intrapleural fibrinolytic agents were given with optimal drainage of empyema. Patient was extubated and improved clinically
Summary of Results Imaging studies commonly show air-space consolidation and/or cavitary or mass-like lesions. Parenchymal disease can also extend to pleural cavity and chest wall. BAL for culture is inappropriate since it may only represent colonization. Acceptable specimen include lung biopsy or pleural fluid. Gold-standard for diagnosing Actinomycosis is growth of the bacteria in culture, but is technically difficult and occurs only in a minority of cases. If the suspicion is high, the clinician should indicate this to the microbiologist to ensure appropriate processing specimen measures. Identification of sulfur granules from pleural fluid is strongly supportive of Actinomycosis and may be enough to lead the clinician into the diagnosis and appropriate management. Carbapenems or combination of a beta-lactam with beta-lactamase inhibitor is a proper empiric approach.Therapy should be targeted once Actinomycosis has been diagnosed. Intravenous therapy should be given for 2 to 6 weeks, followed by oral route.Length of the oral antibiotic depends on clinical and radiological response. Resolution or stabilization of radiographic findings may take several months, with 6 months to 1 year of oral antibiotics being recommended.
Conclusions Actinomycosis should be suspected in patients with history of aspiration and chronic alcohol abuse.High clinical index of suspicion could lead to proper usage of diagnostic tools and facilitate the rare growth of the causative pathogen in culture.Proper diagnosis should guide to targeted management and follow up, along with optimal duration of antibiotics.






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