[Pelvic actinomycosis in Tunisia: five cases]

Area of Science:

• Gynecology
• Infectious Diseases
• Microbiology

Background:

• Actinomycosis is a rare bacterial infection caused by Actinomyces species, typically found in the oropharynx and bowel.
• Pelvic actinomycosis is an uncommon condition in women, presenting with diverse and non-specific acute or chronic symptoms.

Observation:

• A review of five pelvic actinomycosis cases managed over eight years revealed an average patient age of 39.2 years.
• Four of the five patients used intrauterine devices (IUDs) for contraception and presented with acute symptoms like pelvic pain, fever, and urinary obstruction.
• Surgical intervention was necessary for all patients, with four requiring laparotomy and experiencing complications such as pelvic abscess and digestive issues.

Findings:

• Diagnosis of pelvic actinomycosis was consistently made post-surgery via histological examination, highlighting diagnostic challenges.
• The study established a clear link between pelvic actinomycosis and IUD use, a common contraceptive method in Tunisia.
• Non-specific clinical and imaging findings complicate early diagnosis, though laboratory tests indicating inflammation and biopsy can aid detection.

Implications:

• Pelvic actinomycosis management lacks standardization, with treatment often involving long-term penicillin G, sometimes supplemented by surgery for resistant cases.
• Early diagnosis and appropriate treatment, including prolonged antibiotic therapy, are crucial for a generally good prognosis.
• Further research into standardized diagnostic and therapeutic protocols for pelvic actinomycosis is warranted, particularly concerning IUD users.