Thoracic actinomycosis

Pulmonary actinomycosis

“…This mode of presentation has changed with time in line with the decrease in the disease9s prevalence [40,41]. The commonest presentation is probably now as a shadow on a chest radiograph, similar to that caused by bronchial carcinoma.…”

“…To confound matters, the disease can coexist with lung-cancer, as Actinomyces spp. have a tendency to colonise devitalised tissue, which commonly occurs within necrotic neoplasms [40]. Finding Actinomycetes filaments in sputum alone, particularly without the characteristic sulphur granules, may therefore represent simple colonisation.…”

“…Although treatment has to be tailored to the individual, generally 18-24 million units of penicillin per day are given for 2-6 weeks followed by oral therapy with penicillin V (or amoxicillin) for 6-12 months. In general, the thoracic form appears to require longer treatment courses compared to the other commoner forms [40]. Tetracyclines are the alternative especially for penicillin-allergic patients.…”

“…Secondly, the disease usually shows a peripheral and lower lobe predominance, probably reflecting the role of aspiration in its pathogenesis [19]. Finally, the disease usually shows some diminution in size within 4 weeks of starting treatment [40].…”

“…The challenge for the clinician is to obtain this in the least invasive fashion. Traditionally, excisional biopsy was the definitive diagnostic procedure [40]. In general, an attempt at establishing diagnosis by percutaneous biopsy with fine needle aspiration or core biopsy is now made before "blind" thoracotomy [58].…”