Coexistence of COVID-19, Pseudomonas, and thoracic actinomycosis in a cystic bronchiectasis case

Area of Science:

• Infectious Diseases
• Pulmonology
• Microbiology

Background:

• Actinomycosis commonly affects the cervicofacial region, with thoracic involvement being less frequent.
• Thoracic actinomycosis leading to empyema is a rare clinical manifestation.
• Patients with underlying respiratory conditions like asthma and bronchiectasis may be at increased risk.

Purpose of the Study:

• To report the first documented case of coexisting thoracic actinomycosis (empyema), Pseudomonas aeruginosa infection, and COVID-19.
• To highlight the diagnostic challenges and management of a rare polymicrobial thoracic infection.

Main Methods:

• Diagnosis of actinomycosis was established via pleural effusion cytology.
• Sputum culture identified Pseudomonas aeruginosa.
• Nasopharyngeal sampling confirmed SARS-CoV-2 infection via RT-PCR.
• Management involved tube thoracostomy for pleural effusion drainage.

Main Results:

• Actinomycosis was identified as the causative agent of empyema in a patient with pre-existing bronchiectasis and asthma.
• The patient presented with a concurrent Pseudomonas aeruginosa infection and tested positive for SARS-CoV-2.
• This represents a unique combination of three distinct pathogens in a single thoracic infection.

Conclusions:

• Thoracic actinomycosis, though rare, should be considered in patients with empyema, especially those with underlying lung disease.
• The coexistence of COVID-19 and bacterial infections like Pseudomonas aeruginosa can complicate the clinical picture of actinomycosis.
• Early diagnosis and appropriate management are crucial for favorable outcomes in polymicrobial thoracic infections.