Actinomyces Meyeri Empyema Necessitatis—A Case Report and Review of the Literature

Abstract

Pleural empyema necessitatis caused by Actinomyces meyeri is a rare but severe infection. A. species predominantly A. meyeri and A. israelii represent the second most common pathogen for empyema necessitans after mycobacteria. The incidence is reported in the literature to be 1:300,000. Men are thrice more likely to be affected than women. Pathogenetically, an infection can be triggered by aspiration in immunocompromised individuals which leads to an atelectasis with pneumonitis.In two cases, a 38-year-old construction worker and a 61-year-old woman with ulcerative breast carcinoma, who presented to the local emergency department with a painful swelling of the left chest, diagnostic workup revealed a pleural empyema necessitatis of the left chest. An antibiotic treatment was initiated with piperacillin/tazobactam and sulbactam/ampicillin, respectively. Temporally vacuum-dressing therapy was initiated after surgical debridement. In the course of the procedure, a reconstruction of tissue damage was feasible. The patients were recovered completely and discharged with an oral antibiotic treatment (amoxicillin) for 6 and 12 months, respectively.Thoracic actinomycosis is a relatively uncommon and traditionally chronic, indolent infection secondary to pulmonary infection with A. species. Surgical treatment is generally reserved for cases failing to resolve with antibiotic therapy. Early diagnosis, prompt debridement, and narrow spectrum β-lactam antibiotics can result in complete resolution of infection and good prognosis.

Actinomyces meyeri pleural empyema: A case report

“…The thoracoscopic findings of septae formation, considerable pleural thickening, and multiloculated effusion in the pleural cavity, however, demonstrated that the disease was advanced already. No pulmonary tissue involvement, penetration to the chest wall, diaphragm, pericardium, mediastinum, skeletal or connective tissue, adjacent abdominal organs or fistula formation, as described in other cases [3] , [5] , [7] , [8] , were found in our patient.…”

“…Only 13 cases were published in the literature up to 2017 with men predominating (84.6% of cases) and the vast majority of cases being over 40 years of age (92.3%) [3] . In addition to the pleura, other organs, mainly the lungs, may be involved [2] , [3] , [4] , [5] . Alcoholism, as present in our patient, is a predisposing factor, favoring aspiration of the bacterium from the oral cavity into the pulmonary parenchyma.…”

Case Report: Actinomyces meyeri empyema in a COVID-19 positive patient with history of testicular mixed germ cell tumor

“…The most common treatment method was thoracotomy with or without debridement. [3][4][5][6][7][8][9][10][11][12][13][14][15] The most common antibiotic used was penicillin for a period of up to 12 months.…”

“…3 Approximately 40 cases of A. meyeri infection have been published; however, empyema is extremely rare and only 15 cases have been documented. [3][4][5][6][7][8][9][10][11][12][13][14][15] In most of the cases of actinomycosis, periodontal disease and alcoholism have been described as key risk factors.…”

A “Boil” Being the Clue to Think beyond Typical Bacterial Pathogens in Community-Acquired Pneumonia

“…In this patient, what was thought to be an isolated superficial soft tissue abscess was more likely to be an extension of his underlying indolent pneumonia. Actinomyces are fastidious, predominately anerobic Gram-positive bacilli that are challenging to culture unless under ideal conditions [ 3 ] and incubation can take up to 14 days [ 4 ]. The location of the abscess on the left chest wall directly over his area of most profound lung involvement was the clue to this.…”