[Clinical feature analysis of 30 cases with pulmonary actinomycosis]

Objective: To summarize the clinical characteristics of pulmonary actinomycosis and analyze its diagnostic methods. Methods: The clinical symptoms, underlying diseases, imaging characteristics, preliminary diagnosis, diagnostic methods, treatment and prognosis of 30 patients with pulmonary actinomycetes admitted into the First Affiliated Hospital of Zhejiang University School of Medicine during the 10 years (January 2007 to November 2017) were retrospectively analyzed. Results: The 30 patients with pulmonary actinomycetes included were from 47 to 81 years old, with an average age of (59.5±7.8) years, with a course of disease from 5 days to 48 months, and a median course of disease of 1.5 months; 18 patients (60.0%) were complicated with underlying diseases, 10 patients (33.3%) had a history of smoking, 10 patients (33.3%) had a history of alcohol abuse. The main clinical manifestations were cough in 29 cases (96.7%), followed by sputum in 22 cases (73.3%), hemoptysis in 20 cases (66.7%), fever in 12 cases (40.0%), chest pain in 5 cases (16.7%) and shortness of breath in 3 cases (10.0%). Mass, nodules, consolidation, atelectasis can be seen by imaging, there can be a low-density lesion necrosis, formation of voids or vacuoles. Among the 25 patients (83.3%) who underwent bronchoscopy, 14 cases were abnormal, 5 cases showed endotracheal polypoid neoplasms, 9 cases showed endotracheal mucosal inflammatory changes, 2 cases of them showed bronchial foreign body, and 1 case showed broncholithiasis. All cases were diagnosed by pathology. Nine cases (30.0%) were confirmed by bronchoscopic biopsy. Two cases (6.7%) underwent CT-guided percutaneous lung biopsy, 18 cases (60.0%) underwent surgical resection of pathology, and 1 case (3.3%) was diagnosed by puncture of chest wall mass. Sufficient dose and course of penicillin were effective. Surgical excision of the lesion with antibiotics for 2-4 weeks was effective. Conclusion: The clinical manifestation of pulmonary actinomycosis is lack of specificity, obtaining positive pathological specimens is the key to the diagnosis of this disease, the first choice is bronchoscopy and percutaneous lung biopsy.