Pelvic Actinomycosis

Abstract

Introduction Actinomycosis is a chronic bacterial infection caused by Actinomyces, Gram-positive anaerobic bacteria. Its symptomatology imitates some malignant pelvic tumours, tuberculosis, or nocardiosis, causing abscesses and fistulas. Actinomycoses are opportunistic infections and require normal mucous barriers to be altered. No epidemiological studies have been conducted to determine prevalence or incidence of such infections. Objective To analyse the clinical cases of pelvic actinomycosis reported worldwide, to update the information about the disease. Methods A systematic review of worldwide pelvic actinomycosis cases between 1980 and 2014 was performed, utilising the PubMed, Scopus, and Google Scholar databases. The following information was analysed: year, country, type of study, number of cases, use of intrauterine device (IUD), final and initial diagnosis, and method of diagnosis. Results 63 articles met the search criteria, of which 55 reported clinical cases and 8 reported cross-sectional studies. Conclusions Pelvic actinomycosis is confusing to diagnose and should be considered in the differential diagnosis of pelvic chronic inflammatory lesions. It is commonly diagnosed through a histological report, obtained after a surgery subsequent to an erroneous initial diagnosis. A bacterial culture in anaerobic medium could be useful for the diagnosis but requires a controlled technique and should be performed using specialised equipment.

Pelvic Actinomycosis Mimicking Pelvic Malignancy

“…Cases of pelvic actinomycosis with LNG-IUS use were not reported, but, in the majority of cases, the type of IUD used was not disclosed. 10 In this case report, the patient had a copper IUD in place for 6 years, which had been removed 4 months before presentation. Although the development of pelvic actinomycotic abscesses in women with IUDs is exceptionally rare, the diagnosis should be considered in women of reproductive age with a pelvic mass, especially in those with an IUD in place or recently removed.…”

Actinomycotic hepatic abscess in woman with longstanding intrauterine contraceptive device

“…Typical histological findings reveal the presence of necrosis with yellow sulfur granules of 1-2 mm in diameter, representing microcolonies of bacteria surrounded by lymphocytes, plasmocytes, histiocytes, and epithelium cells [15]. Bacterial confirmation is challenging and usually is accomplished in only 50% of cases, since culturing requires immediate specimen transport, prolonged anaerobic incubation and special equipment [25,26]. Identification of Actinomyces is possible using 16S rRNA gene sequencing [27].…”

Rare cause of ovarian mass

“…Pelvic actinomycosis is almost always associated with the use of an intrauterine contraceptive device (IUD) 2. In a systematic review by Alejandra García-García et al , 12 cases of pelvic actinomycosis were reported unrelated to IUD use3 and all patients had a prior pelvic procedure 2. We present an interesting case of pelvic actinomycosis which is not associated with a prior IUD use and a pelvic procedure.…”