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Actinobacillus actinomycetemcomitans pneumonia with chest wall involvement and rib destruction
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
Abstract:
There are four cases of Actinobacillus actinomycetemcomitans pulmonary infections reported in the English literature prior to 1990. We report a case of A actinomycetemcomitans pulmonary infection with invasion of overlying soft tissue, rib, and sternum. This manifestation has not been previously reported. The clinical manifestation is similar to that of Actinomyces israelii, which may be misinterpreted as malignancy initially. The portal of entry of A actinomycetemcomitans may be via hematogenous spread or aspiration. The diagnosis depends on culture after prolonged incubation of the involved tissue obtained by aspiration or biopsy. Elevated serum antibody is helpful for diagnosis of active infection. A actinomycetemcomitans is susceptible to most antibiotics, but is frequently resistant to penicillin, vancomycin, clindamycin, and erythromycin. Isolation of the organism and an in vitro drug sensitivity testing are important in managing the patient. Our patient recovered after a three-month regimen of penicillin.
Insights
Actinobacillus actinomycetemcomitans can cause rare pulmonary infections with bone invasion. Early diagnosis through culture and antibody tests is crucial for effective antibiotic treatment.
Area of Science:
- Infectious Diseases
- Microbiology
- Pulmonary Medicine
Background:
- Actinobacillus actinomycetemcomitans (A.a.) is a rare cause of pulmonary infections.
- Previous literature documented only four cases before 1990.
Observation:
- A novel case of A.a. pulmonary infection is presented, involving invasion of soft tissue, rib, and sternum.
- This extensive manifestation has not been previously reported in medical literature.
- Clinical presentation mimicked malignancy, highlighting diagnostic challenges.
Findings:
- Diagnosis relies on prolonged culture incubation of aspirated or biopsied tissue.
- Elevated serum antibodies aid in confirming active infection.
- A.a. exhibits variable antibiotic susceptibility, often resistant to penicillin, vancomycin, clindamycin, and erythromycin.
Implications:
- This case expands the known clinical spectrum of A.a. pulmonary infections.
- Prompt microbiological diagnosis and in vitro sensitivity testing are vital for treatment selection.
- Despite resistance patterns, the patient recovered with a penicillin regimen.