Pulmonary actinomycosis and polymicrobial empyema in a patient with ABPA and bronchocoele

Abstract

We present a 43-year-old woman, with a history of allergic bronchopulmonary aspergillosis and a chronic bronchocoele, who was admitted to hospital with an infection of the bronchocoele, progressing to a pulmonary abscess and polymicrobial empyema, following dental extraction and regular Lactobacillus probiotic ingestion. Interval chest imaging following this procedure demonstrated worsening right upper lobe opacities and a right-sided pleural effusion. Bronchoscopies identified copious mucoid secretions and an infected bronchocoele with a right upper lobe airways impaction. Oral cavity organisms including Actinomyces odontolyticus were cultured on bronchial washings. Streptococcus mitis and Lactobacillus rhamnosus were cultured in pleural fluid. Treatment with endoscopic mucoid secretion suctioning; intercostal catheter insertion and therapeutic drainage; and antibiotic, glucocorticoid and anti-IgE therapy resulted in clinical and radiological improvement. Our case illustrates the potential pulmonary complications from oral cavity organisms following tooth extraction and probiotic use in patients with chronic lung disease associated with mucoid lesions and airways obstruction.

A Case of Empyema Due to Actinomyces odontolyticus and Streptococcus Species Co-infection in an Immunocompetent Woman

“…Among these cases, tobacco and alcohol use, poor oral hygiene, and underlying pulmonary disease were the most common risk factors. The most common sources of infection found were dental disease and aspiration [7], and they were more often seen in middle-aged men [7,8]. Our patient was a young woman without any chronic medical conditions or the risk factors mentioned above.…”

“…Isolation of Actinomyces odontolyticus from the pleural fluid is uncommon, with a limited number of cases reported worldwide [6,7]. Among these cases, tobacco and alcohol use, poor oral hygiene, and underlying pulmonary disease were the most common risk factors.…”

“…Most cases of actinomycosis are not diagnosed until an advanced phase, likely due to difficulty in isolation, low suspicion of the pathogen, and, often, misleading suspicion of malignancy given its ability to invade tissues [2,3,8,9]. Delay in diagnosis and treatment increases the risk of complications, such as empyema necessitans or extensive loculations requiring management with cardiothoracic surgery [7,10]. Our patient achieved clinical improvement with appropriate antibiotic therapy and source control through the placement of chest drains, avoiding major surgical interventions.…”

Vacuum-assisted closure for chest wall reconstruction infection caused by Streptococcus mitis after surgery of lung cancer: a case report

“…Streptococcus mitis (S. mitis) has been individually identified as a part of the normal oropharyngeal flora, and has been mostly reported in cases of bacterial endocarditis and lung abscess through the bloodstream or respiratory tract [16][17][18][19]. On the other hand, there are a few rare cases of urinary tract infection, spondylodiscitis, and empyema caused by S. mitis [20][21][22]. Although the cause of infection around PTFE sheet in the present case was unclear because of no odontogenic infection and negative of the blood culture was negative, it is considered an extremely rare case.…”