Endobronchial actinomycosis in a child

Abstract

Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Pulmonary actinomycosis is very rarely seen in the paediatric population. The classic radiological presentation of thoracic involvement of actinomycosis includes lower lobe consolidation, empyema and periostitis of the ribs. We report a case of endobronchial actinomycosis in a child diagnosed on endobronchial biopsy and bronchoalveolar lavage (BAL). Bronchoscopy can be dangerous when performed on these cases, as there is a risk of severe bleeding and large airway obstruction, as was the case with this patient.

Empyema Necessitans From Actinomyces meyeri Masquerading as an SSTI

“…Actinomyces species are facultative, branching, grampositive anaerobes normally found in the oropharynx, female genitourinary (GU) tract, and gastrointestinal (GI) tract. [2][3][4][5][6][7][8][9] Aggregatibacter actinomycetemcomitans, a normal constituent of the oral flora, is so often found alongside Actinomyces that it is thought to herald its presence since it grows more readily in culture. 1,3,5,6 These organisms have been described as having a synergistic relationship through their mechanisms of weakening host defenses.…”

“…[2][3][4][5][10][11][12] Infection is most often cervicofacial in origin with abdominopelvic and thoracic disease being much less common. 2,5,7 The organism typically infects by disruption and spread through a mucosal barrier 6,7,11 ; however, hematogenous spread has been infrequently described. 9,12 Infections are often polymicrobial as seen in our case.…”

“…Risk factors for disease include dental caries, malnutrition, epilepsy, trauma, debilitation, poorly controlled diabetes mellitus, and foreign body aspiration. 2,3,[5][6][7]13 Once thought to be a disease of the immunocompromised, this does not appear to be the case in pediatrics. 2 Thoracic disease represents about 15% of cases, 7,12 and it is characterized by a chronic and progressive infection most often following an aspiration event.…”

“…2,3,[5][6][7]13 Once thought to be a disease of the immunocompromised, this does not appear to be the case in pediatrics. 2 Thoracic disease represents about 15% of cases, 7,12 and it is characterized by a chronic and progressive infection most often following an aspiration event. 2,5,13 Most cases present with cough, fever, and weight loss.…”

“…2,5,13 Most cases present with cough, fever, and weight loss. 6,7,11 Only 12% of thoracic actinomycosis extend to involve the chest wall, 2 which occurs by spread through fascial planes-a defining characteristic of this organism. [3][4][5][6][7]9 Little is known regarding the mechanism by which Actinomyces spreads through fascial planes.…”