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The isolation of
Actinomyces spp
. from sterile clinical samples is traditionally regarded as significant. We reviewed the demographics, clinical risk factors and outcomes of patients with
Actinomyces spp
. isolated from blood culture in our NHS Hospital Trust and found that this is not necessarily the case.
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Similar publications
Background:
Recently, it is reported that Actinomyces meyeri is the most common species causing actinomycosis. However, to our knowledge, there was no report about pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade.
Case presentation:
Hereby we describe a case of pulmonary actinomycosis attributable to A. meyeri pr...
Actinomycosis is an infrequent chronic infection regarded as the most misdiagnosed disease by experienced clinicians. The Office of Rare Diseases at the National Institute of Health has also listed this disease as a "rare disease." This article presents a case report of actinomycosis of the alveolus with unusual clinical features but a successful r...
Cases of actinomycosis with atypical presentation are described in two oxen. In both cases there was a hard irregular and extensive lesions in the maxilla. The maxilla of both cattle became enlarged and honeycombed as a result of destructive rarefaction and regenerative bone proliferation. The cut surface of the lesions consisted of white glistenin...
Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily from the genus Actinomyces. Thoracic involvement is observed in approximately 15% of cases of infection with actinomycosis. Here, we present a case of a 61-year-old male who presented with recurrent endobronchial actinomycosis. The...
Pulmonary actinomycosis is a chronic, suppurative, granulomatous disease caused by Actinomyces israelii, an obligate anaerobe. The clinical manifestations and imaging characteristics of pulmonary actinomycosis lack specificity and can lead to confusion with tuberculosis and lung cancer. The present study reported a case of pulmonary actinomycosis d...
Citations
... The authors underlined the potential impact of commensal bacteria in specific types of infections and recommended a species-level identification of Actinomyces isolates. In a study from London, UK, clinical significance of Actinomyces found in blood specimens was evaluated retrospectively from NHS Trust records between October 2009 and December 2014 [20]. Most blood isolates from 60 patients were S. odontolytica. ...
... No apparent negative impact on clinical outcomes was observed between the treated and untreated groups. The authors speculated whether Actinomyces could be blood culture contaminants or represent transient bacteremia by commensals translocated from their habitats to blood [20]. Moreover, Lynch et al. [21] examined 115 invasive infections with involvement of Actinomyces, diagnosed in a Canadian health care region between 2011 and 2014. ...
Actinomyces organisms reside on mucosal surfaces of the oropharynx and the genitourinary tract. Polymicrobial infections with Actinomyces organisms are increasingly being reported in the literature. Since these infections differ from classical actinomycosis, lacking of specific clinical and imaging findings, slow-growing Actinomyces organisms can be regarded as contaminants or insignificant findings. In addition, only limited knowledge is available about novel Actinomyces species and their clinical relevance. The recent reclassifications have resulted in the transfer of several Actinomyces species to novel genera Bowdeniella, Gleimia, Pauljensenia, Schaalia, or Winkia. The spectrum of diseases associated with specific members of Actinomyces and these related genera varies. In human infections, the most common species are Actinomyces israelii, Schaalia meyeri, and Schaalia odontolytica, which are typical inhabitants of the mouth, and Gleimia europaea, Schaalia turicensis, and Winkia neuii. In this narrative review, the purpose was to gather information on the emerging role of specific organisms within the Actinomyces and related genera in polymicrobial infections. These include Actinomyces graevenitzii in pulmonary infections, S. meyeri in brain abscesses and infections in the lower respiratory tract, S. turicensis in skin-related infections, G. europaea in necrotizing fasciitis and skin abscesses, and W. neuii in infected tissues around prostheses and devices. Increased understanding of the role of Actinomyces and related species in polymicrobial infections could provide improved outcomes for patient care.
Key messages
Due to the reclassification of the genus, many former Actinomyces species belong to novel genera Bowdeniella, Gleimia, Pauljensenia, Schaalia, or Winkia.
Some of the species play emerging roles in specific infection types in humans.
Increasing awareness of their clinical relevance as an established or a putative pathogen in polymicrobial infections brings about improved outcomes for patient care.
... Actinomyces species are susceptible to several antimicrobials, including penicillin, macrolide, and tetracyclines. Treatment of actinomycosis involves the combination of surgical drainage and prolonged courses of antibiotic therapy which most likely penicillin as a treatment of choice [7]. ...
Introduction and importance
Manifestations of infection by A. odontolyticus include thoracic, abdominal, pelvic, and central nervous system disease. In the four decades following its isolation, more than 20 cases of invasive infections were reported in multiple geographic locations including the United States and Europe. As such, A. odontolyticus is an emerging bacterium and related research is encouraged for further characterization of its prevalence and clinical significance. Our case series represents the first case series about A. odontolyticus bacteremia in the state of Qatar.
Methods
We are reporting 15 cases with isolated A. odontolyticus positive blood cultures at Hamad Medical Corporation, State of Qatar from 1/Jan/2016 to 1/Nov/2020. Electronic health records (EHR) of patients who were identified to have positive blood cultures were accessed and the demographics and other clinically related data were collected and mentioned in this manuscript, after obtaining the appropriate approval from the Corporation Medical Research Council (MRC).
Outcomes
We are reporting 15 cases with isolated A. odontolyticus positive blood cultures at Hamad Medical Corporation, State of Qatar from 1/Jan/2016 to 1/Nov/2020.
Conclusion
12 of the 15 reported cases were considered significant and received a complete course of antimicrobial therapy. The patients presented with a wide variety of clinical pictures and were of variable age.
... Cutaneous actinomycosis is uncommon in clinical practice [19] and is usually a secondary infectious process with an underlying focus in deeper tissues [20], or it may appear as a result of hematogenous spread from an actinomycotic lesion elsewhere in the body [4]. In cutaneous actinomycosis, the commonly found causative organisms were A. meyeri and A. viscosus according to previous reports [4,12]. ...
... According to the literature review of original clinical studies on Actinomyces, this species can become pathological when superadded by periodontal disease and poor oral hygiene, leading to the development of infections. The mucosal barrier is disrupted by triggering factors such as plaque, tooth cavities, and periodontitis in the case of oral infections [19,63,64]. ...
Background and Objectives: Actinomyces species are part of the normal flora of humans and rarely cause disease. It is an uncommon cause of disease in humans. The clinical features of actinomycosis have been described, and various anatomical sites (such as face, bones and joints, respiratory tract, genitourinary tract, digestive tract, central nervous system, skin, and soft tissue structures) can be affected. It is not easy to identify actinomycosis because it sometimes mimics cancer due to under-recognition. As new diagnostic methods have been applied, Actinomyces can now more easily be identified at the species level. Recent studies have also highlighted differences among Actinomyces species. We report a case of Actinomyces viscosus bacteremia with cutaneous actinomycosis. Materials and Methods: A 66 years old male developed fever for a day with progressive right lower-leg erythematous swelling. Blood culture isolates yielded Actinomyces species, which was identified as Actinomyces viscosus by sequencing of the 16S rRNA gene. In addition, we searched for the term Actinomyces or actinomycosis cross-referenced with bacteremia or “blood culture” or “blood stream” from January 2010 to July 2020. The infectious diseases caused by species of A. viscosus from January 1977 to July 2020 were also reviewed. Results: The patient recovered well after intravenous ampicillin treatment. Poor oral hygiene was confirmed by dental examination. There were no disease relapses during the following period. Most cases of actinomycosis can be treated with penicillin. However, clinical alertness, risk factor evaluation, and identification of Actinomyces species can prevent inappropriate antibiotic or intervention. We also compiled a total of 18 cases of Actinomyces bacteremia after conducting an online database search. Conclusions: In summary, we describe a case of fever and progressive cellulitis. Actinomyces species was isolated from blood culture, which was further identified as Actinomyces viscosus by 16S rRNA sequencing. The cellulitis improved after pathogen-directed antibiotics. Evaluation of risk factors in patients with Actinomyces bacteremia and further identification of the Actinomyces species are recommended for successful treatment.
... Several Actinomyces species have been detected in blood [3,[11][12][13] and the isolation of Actinomyces spp. from sterile clinical specimens is, traditionally, always viewed as significant. ...
... from sterile clinical specimens is, traditionally, always viewed as significant. However, some meta-analyses suggest that in patients without evidence of clinical disease these organisms are blood-culture contaminants or represent transitory bacteremia from the oropharyngeal or bowel mucosa [11]. Even though our patient of case 3 did not have any symptoms of any type of oral infection, oral origin was first suspected, as the mouth is an important source of Actinomyces bacteremia. ...
Introduction:
To review unusual actinomycosis cases that appeared as a diagnostic and therapeutic challenge at our institution and to present a literature review on the usual clinical presentations.
Methodology:
This retrospective review included all patients hospitalized for actinomycosis in a 10-year period at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia.
Results:
A total of 15 patients were hospitalized during the observed period, 9 (60%) females and 6 (40%) males. The localizations of actinomycosis were: pelvis (5), lungs (3), blood stream (2), colon (1), penis (1), stomach (1), skin (1), cervicofacial region (1). We present four unusual cases: subcutaneous actinomycotic abscess, actinomycosis of the stomach with underlying non-Hodgkin lymphoma, sepsis due to Actinomyces neslundii originated from chronic asymptomatic periapical tooth abscesses and actinomycosis of the distal part of the penile shaft.
Conclusions:
Actinomycosis was a very rare clinical problem in our clinical practice (0.032% of all hospitalizations and 0.0034% of all outpatients) but among those cases classical clinical presentations were also very rare.
... In the setting of co-infection, Actinomycetes spp. may contribute to cross-resistance to multiple antibiotics, thereby necessitating longer treatments or higher doses of typical antibiotics [6]. As Actinomyces spp. ...
Wound contamination and subsequent colonization by microbes can significantly impair tissue repair and lead to the development of chronic non-healing ulcers. Atypical Burkholderiaand Actinomycetesbacterial species are common in cases of soil contamination of open wounds leading to a complex infection that is both difficult to diagnose and treat. Despite much research on the involvement of atypical organisms, including Burkholderiaand Actinomycetes, in antibiotic resistance, there is no consensus on the timeline from contamination to infection and on an algorithm for early diagnosis and management. Thus, the ways in which these organisms interact in settings of co-infection and contribute to cross-resistance remains unclear. The generally low index of clinical suspicion for atypical microbial infections and the absence of clear diagnostic protocols have multiple consequences, ranging from excessive reliance on pathology, delayed treatment, expensive and ineffective investigations and treatment, and progressive wound sepsis and morbidity.
We are reporting a case of Burkholderia cepacia infection, co-infection with Actinomyces spp., and resistance to ceftazidime/avibactam and co-trimoxazole in a 28-year-old previously healthy farmer following soil contamination of an open wound. This is one of only a few reported cases of Burkholderia resistance to ceftazidime/avibactam and the first reported case ofB.cepacia bacteremia due to peripheral contamination.
... Primjena masene spektrometrije omogućuje nam identifikaciju izolata na razini roda [18] . U slučajevima bakterijemija, uzrokovanih ovakvim rijetkim mikroorganizmima, preporuča se dodatna klinička obrada radi isključenja drugih, vrlo često malignih bolesti u podlozi [9,19,20] . ...
Cilj : Prikaz slučaja bakterijemije, uzrokovane bakterijom Actinomyces sp., kod desetogodišnjeg dječaka s karioznim zubalom. Prikaz bolesnika: Prikazali smo dječaka koji je višekratno hospitaliziran zbog ponavljajućih febriliteta i povišenih upalnih parametara. Tijekom pregleda uočeni su povećani limfni čvorovi smješteni uz stražnji rub sternokleidomastoideusa, palpatorno bezbolni i pomični. Unatrag mjesec dana, višekratno je dobivao peroralne antibiotike radi tonzilofaringitisa praćenog povišenom temperaturom. U uzorcima krvi za hemokulturu porasli su gram pozitivni štapići koji su, Api-Coryne sustavom za identifikaciju, identificirani kao Arcanobacterium haemolyticum. Zbog rijetkosti takvog izolata, soj smo poslali na dodatnu identifikaciju 16S rDNA metodom sekvencioniranja genoma kojom se izolira Actinomyces sp ., a Microbacterium hydrocarbonoxydans naknadnom identifikacijom pomoću MALDI-TOF metode . Daljnjom hematološkom obradom pacijenta dokazan je Hodgkinov limfom. Zaključak: Obzirom da API sustavi identifikacije mogu biti nepouzdani, rijetke i neuobičajene izolate kod sistemskih infekcija i(li) bakterijemija potrebno je identificirati pouzdanijim i modernijim sustavima ili molekularnim metodama. Dostupnost molekularnih metoda i masene spektrometrije u rutinskoj laboratorijskoj dijagnostici omogućit će točniju i češću identifikaciju ovakvih izolata. Ako, kod sistemske aktinomikoze i(li) bakterijemije uzrokovane vrstama roda Actinomyces, nema dobrog odgovora na ciljanu terapiju, trebalo bi posumnjati na malignu bolest u pozadini.
... Actinomyces spp. are also present in the oral mucosa, pharynx, gut, skin, and female genitourinary tract [10,11]. As FG is typically seen in male patients, the less frequent colonization of the male genitourinary tract may contribute to Actinomyces' loose relation to the disease. ...
Introduction: Fournier's gangrene (FG) is a rare necrotizing fasciitis affecting the perineum. Symptoms include tender, edematous scrotal tissue along with fever and can rapidly disseminate. Though FG is frequently a polymicrobial infection of Staphylococcus, Escherichia coli, and Pseudomonas, other pathogens may be involved. Here, we present a rare case of FG that isolated Actinomyces species from its soft tissue culture.
... Geleneksel olarak bu türlerin steril vücut bölgelerinden izole edilmesi anlamlı olarak kabul edilmekteydi. Fakat Jeffery-Smith ve arkadaşları (20)'nın çalışmasında klinik bulgu olmadan kan kültürlerinden Actinomyces spp. izole edilmesi, bu izolatların kan kültürü kontaminasyonuna ya da kolonize bölgelerden bakteri translokasyonuyla oluşan geçici bakteriyemiye bağlı olabileceğini göstermiştir. ...
Objective: The incidence of anaerobic bacteremia varies according to regions, health institutions, and patient population. Anaerobic bacteria are isolated from blood cultures with a frequency of 0.5-13%. The aim of this study is to determine the incidence and the distribution of anaerobic bacteria in a university hospital over a three-year period. Methods: In this study, microbiological and demographic data of anaerobic bacteremia cases detected in our hospital between 2017 and 2019 were analyzed, retrospectively. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS, Bruker, Daltonik, Bremen, Germany) was used to identify the isolates. Results: Anaerobic bacteria isolated from blood cultures were Bacteroides fragilis group (n=40), Cutibacterium spp. (n=27), Gram-positive anaerobic cocci (n=17), Actinomyces spp. (n=14), Clostridium spp. (n=11), Fusobacterium spp. (n=2), Prevotella spp. (n=2) and Porphyromonas asaccharolytica, (n=1) respectively. In addition, two Gram-positive anaerobic bacilli and one Gram-negative anaerobic bacillus which could not be identified by MALDI-TOF MS were isolated. Polymicrobial anaerobic bacteremia was not detected. 53.8% of the patients were male and 46.2% were female. The median age of the patients was 64 (age range, 1-92) years and 96.6% of them were adult patients. Comorbidities were common in patients with anaerobic bacteremia, and the most common underlying diseases were solid and hematological malignancies. In our hospital, 30-day mortality rate in anaerobic bacteremia cases was 25.6%. Clostridum spp. and B. fragilis group constituted 73.3% of the cases with mortality. The 30-day mortality of the patients with bacteremia with these two species was found to be significantly higher than the other species (p=0.001). Conclusions: In conclusion, although the incidence of anaerobic bacteremia is low, hospitals should regularly examine the prevalence of anaerobic bacteremia and its related factors due to their high mortality rates, impact of appropriate antimicrobial therapy in prognosis, and the increasing rate of resistance in anaerobic bacteria in recent years.
... We considered that the chest CT finding suggested SPE because the peripheral nodule showed feeding vessel signs and was a wedge-shaped peripheral lesion abutting the pleura [11]. Blood cultures were negative in our case, but hematogenous spread is reportedly rare for Actinomyces spp [12]. ...
We herein report a case of primary sternal osteomyelitis caused by polymicrobial bacteria, including Actinomyces israelii. A 72-year-old man presented with a fever and precordial pain. Chest computed tomography (CT) revealed peristernal fluid associated with an osteolytic lesion and a peripheral nodule in the right upper lobe. We suspected sternal osteomyelitis, and an incision and drainage were performed. Culture of the drainage fluid and bone tissue yielded A. israelii, Fusobacterium necrophorum, and Streptococcus constellatus. Treatment with benzylpenicillin potassium (PCG) was administered. A subsequent chest CT scan showed that the peripheral nodule decreased in size after antimicrobial therapy. We therefore presumed the peripheral nodule as septic pulmonary embolism(SPE). Antimicrobial agents were administered for a total of 6 months. To our knowledge, this is the first case report of primary sternal osteomyelitis associated with presumed SPE caused by polymicrobial bacteria, including A. israelii. It is important to identify the causative pathogen in osteomyelitis, which requires long-term antibiotic treatment.
... Pathogenic to humans are: Actinomyces israeli, A. naeslundii, A. myeri, A. viscosus, A. odontolyticus (1). Infection caused by Actinomyces spp. is classified as an endogenous infection, due to the fact that some species are present in humans' physiological flora (commensals of the particular parts of the body like: the oral cavity, oropharynx, urogenital tract or gastrointestinal tract) (1,6). ...
... Zakażenie wywołane przez Actinomyces spp. klasyfikowane jest jako infekcja endogenna, ponieważ wybrane gatunki wchodzą w skład flory fizjologicznej określonych części ciała, takich jak jama ustna, gardło, układ moczowo-płciowy lub przewód pokarmowy (1,6). ...
p> ABSTRACT
Actinomycosis is one of the greatest ‘chameleons’ among infectious diseases. It may imitate inflammation, abscess or a neoplasmatic tumor. Moreover, correct diagnosis is even more challenging due to the fact that the disease takes on various forms like: cervicocephalic, abdominal, or affects the reproductive organs. In order to highlight the diagnostic difficulties of actinomycosis, we have decided to describe six cases of female patients (aged 31-73 years, mean age: 52 years) hospitalized due to actinomycosis in the Department of Infectious Diseases and Hepatology between 2014-2019. Additionally, a case of one patient was described in detail as the course of her disease was exceptionally non-specific. Only in 2 of 6 patients the primary diagnosis was correct. The four other patients were initially suspected with cancer or inflammation. Three of the patients were diagnosed with the abdominal form of actinomycosis, one – neck and head, and one presented both locations. Only histopathological examinations during invasive procedures allowed to state the final diagnosis. An adequate diagnosis was associated with a number of additional tests and delayed appropriate treatment. WBC and CRP were within normal range in all patients. Four patients completed treatment successfully after 60-192 days, one is still on therapy and one is lost to follow-up. In conclusion, common features of actinomycosis presented in this case series include predominance of female gender, abdominal localization and lack of typical symptoms. What is more, therapy with antibiotics, mainly doxycycline and beta-lactams resulted in complete regression of lesions in the majority of cases. Given the examples of our patients we believe that actinomycosis should be considered in the differential diagnosis of all abdominal tumors, especially in women.
Abbreviations: WBC – white blood cells, CRP – C-reactive protein, CT – computed tomography, IUD - Intra-Uterine Device, i.v. - intravenous.
STRESZCZENIE
Promienica to największy “kameleon” wśród chorób zakaźnych - może naśladować zapalenie, ropień, a nawet nowotwór. Postawienie prawidłowej diagnozy jest wymagające ze względu na fakt, że choroba ta występuje w wielu postaciach: twarzowo-szyjnej, brzusznej, bądź w obrębie miednicy mniejszej.
W latach 2014 - 2019 w naszym Oddziale z powodu aktynomykozy hospitalizowano 6 pacjentek pomiędzy 31. a 72. r.ż.. Przypadek jednej z pacjentek jest opisany szczegółowo w niniejszej pracy ze względu na nietypowy przebieg choroby. Jedynie u dwóch z sześciu pacjentek pierwotna diagnoza była prawidłowa, natomiast u pozostałych czterech pacjentek początkowo podejrzewano nowotwór lub zmiany o charakterze zapalnym.
U trzech pacjentek zdiagnozowano brzuszną postać promienicy, u jednej twarzowo-szyjną, natomiast u ostatniego zostały zdiagnozowane równolegle występujące postacie: brzuszna i twarzowo-szyjna. Jedynie badanie histopatologiczne, które może być przeprowadzone dzięki pobraniu materiału metodami inwazyjnymi, pozwala na jednoznaczne ustalenie diagnozy. Różnicowanie wymaga wykonania dodatkowych badań, co opóźnia wprowadzenie odpowiedniego leczenia. Liczba białych krwinek we krwi oraz CRP były prawidłowe u badanych pacjentek. Cztery pacjentki zakończyły leczenie z sukcesem po 60-192 dniach, jedna nadal jest leczona.
Podsumowując, do wspólnych cech prezentowanych w pracy przypadków należy płeć żeńska, lokalizacja (jama brzuszna i narządy w jamie brzusznej) oraz brak objawów charakterystycznych pozwalających postawić jednoznaczną diagnozę. Antybiotykoterapia, głównie doksycykliną i beta-laktamami, przyniosła w większości przypadków całkowitą regresję zmian chorobowych. Po wczesnym postawieniu prawidłowej diagnozy pacjent może uniknąć inwazyjnych zabiegów operacyjnych. Biorąc pod uwagę przykłady naszych pacjentów, uważamy, że promienica powinna być rozważana w diagnostyce różnicowej wszystkich guzów brzucha, zwłaszcza u kobiet.
Skróty: WBC – liczba białych krwinek, CRP – białko C-reaktywne, CT – tomografia komputerowa, i.v. - dożylnie.</p
