Pulmonary actinomycosis – the great imitator

Abstract

Pulmonary localisation represents only 15% of all cases of actinomycosis. The clinical symptoms and radiological changes of this disease are non-specific and sometimes it can be misdiagnosed, usually as tuberculosis, lung cancer or lung abscess. In the reported case, what might look like the lung cancer, finally turned out to be actinomycosis. The interesting case is presented of lung actinomycosis in a 77-year-old farmer, admitted to the Department of Pneumonology, Oncology and Allegology in Lublin due to a massive haemoptysis. CT scan of the chest showed, apart from other changes, the spicular consolidation in the right lung which aroused oncology vigilance. The diagnostic path, which was a real medical challenge, led to the diagnosis of actinomycosis. The process of diagnosis and consequent treatment, which led to the complete regression of clinical and radiological changes, is presented.

Pulmonary Sequestration Associated with Actinomycosis: A Case Report

“…Pulmonary actinomycosis is known as “the great imitator”, where the association of the clinical symptoms and radiological findings makes us consider the diagnosis of early-stage neoplastic processes and infections [ 25 ]. Within the difficulties of microscopic examination of respiratory specimens, differentiating Nocardia from Actinomyces poses a diagnostic challenge, where among some characteristics leading to the identification of Nocardia is the absence of granule formation and the partial staining of Nocardia isolates by the Ziehl–Neelsen method [ 26 ]; but cultures are the current gold standard for differentiating these microorganisms.…”

Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview

“…No racial, seasonal, geographical, or occupational predilections are associated with the increased occurrence of actinomycoses, however, before the 1970s, an increased prevalence was noted in rural areas, compared to people living in urban environments (the observed prevalence was 10:1; cervicofacial and cutaneous actinomycosis: presumably due to poor hygiene, neglected health status, and low socioeconomic status; pelvic: in females, due to extended (>5 years) use of intrauterine devices (IUDs) and inadequate knowledge level on sexual practices), especially in people working with farm animals [5,19]. Anatomically, Actinomyces infections may be divided to cervicofacial (including central nervous system), abdominal, thoracic (including lung), pelvic, and cutaneous infections (Table 2), with cervicofacial infections (also known as ‘lumpy jaw syndrome’) being the most prevalent type in the clinical practice [1,5,11,19,21,22,23,24,25,26,27,28,29,30,31]. In addition, Actinomyces species were also described in unusual clinical presentations, such as abscesses of the breasts, groin, perianal, periaural area, and axillae; infections of knee and hip prostheses; and pericarditis [1,5,11,19,21,22,23,24,25,26,27,28,29,30,31].…”

“…Thoracic (and lung) actinomycosis is primarily caused by the aspiration of oral Actinomyces from saliva (usually presenting with pyogenic infections in the chest wall, ribs and spine), abdominal infections arise from bowel perforation or increased intestinal permeability (resulting in appendicitis and colonic or diverticular infections), pelvic actinomycosis is linked to the extensive (i.e., long term) use of IUDs, while cerebral actinomycosis is primary caused by cervicofacial surgeries or penetrative head trauma [1,5,11,19,21,22,23,24,25,26,27,28,29,32]. Adequate and prompt detection of actinomycosis should be performed, as the associated mortality is between 0 and 28% [19].…”

“…Adequate and prompt detection of actinomycosis should be performed, as the associated mortality is between 0 and 28% [19]. Initiation of therapy in cervicofacial infections is also important for the containment of the infection, as in untreated cases, the pathogens may disseminate to distant organs—such as the brain, lungs, and gastrointestinal tract—resulting in concomitant infection [19,21,22,23,24,25,26,27,28,29]. In fact, hematogenous spread of bacteria from cervicofacial infections are the second main causes of brain and lung actinomycoses [32,33,34,35,36].…”

“Holes” in the Jaw—A Report of Two Cases of Periapical Actinomycosis

“…Actinomycosis is often known as the great imitator, due to its mimicry of several clinical conditions. These conditions range from bacterial, fungal, mycobacterial and parasitic infections as well as benign and malignant neoplasms [ 1 ]. Periapical actinomycosis, a subtype of cervicofacial actinomycosis, typically presents with persistent and recurrent draining fistula in the periapical region—the area around the apex of the tooth root [ 2 ].…”