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[Abdominal actinomycosis]
1Depto de Cirugia, Universidad de Chile, Hospital Clínico San Borja-Arriarán. Santiago.
Abstract:
Actinomycosis is a non opportunistic chronic infection caused by a superior bacteria that forms grains in the pus or affected organs. Fifty four cases have been reported in the last 50 years in the chilean literature, 51% were abdominal actinomycoses, 25.5% pelvic and 18.5% pulmonary. Fourteen cases have been treated in the last 9 years at San Borja Arriaran. Of these 7 were abdominal (1 parietal and 6 visceral forms) and four involved the rectosigmoid; two were ileocecal and occurred after an appendicectomy. The presenting picture was of a giant abdominal mass in two cases (one with a colocutaneous fistula), rectal stricture in one case, tubo-ovarian abscess with colonic involvement in one case, parietal mass in one case and a fistula after an appendicectomy in two cases. Actinomyces Israelli was found in the histopathological study in three cases and in the bacteriological study in two. All visceral forms were treated with penicillin plus tetracycline or amoxicillin during 6 to 12 months with complete and permanent recovery. Two patients required a colonic resection due to a iatrogenic damage and an associated diverticular disease. Three patients required a colostomy to overcome the obstruction, all of them are asymptomatic and without colostomy 18 months to 8 years later. Due to its different presentation forms, actinomycosis has been called "the great pretender" and in several occasions the histological or bacteriological diagnosis is not achieved.
Insights
Actinomycosis, a chronic bacterial infection, often presents as a "great pretender" with varied symptoms. Early diagnosis and long-term antibiotic treatment, like penicillin, lead to complete recovery in most abdominal cases.
Area of Science:
- Infectious Diseases
- Microbiology
- Gastroenterology
Context:
- Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species.
- Historically, 54 cases reported in Chilean literature over 50 years, with abdominal (51%), pelvic (25.5%), and pulmonary (18.5%) distributions.
- Focus on 14 cases treated at San Borja Arriaran over 9 years, highlighting abdominal presentations.
Purpose:
- To review the clinical presentation, diagnosis, and treatment outcomes of actinomycosis cases.
- To emphasize the diagnostic challenges and varied clinical manifestations of actinomycosis.
- To assess the efficacy of antibiotic therapy and surgical interventions in managing actinomycosis.
Summary:
- Seven abdominal actinomycosis cases included 1 parietal and 6 visceral forms, with specific involvement of rectosigmoid and ileocecal regions.
- Presentations ranged from giant abdominal masses and fistulas to rectal strictures and tubo-ovarian abscesses with colonic involvement.
- Actinomyces israelii confirmed in 5 cases; treatment involved 6-12 months of penicillin combined with tetracycline or amoxicillin, achieving complete recovery.
Impact:
- Long-term antibiotic therapy (penicillin-based) resulted in complete and permanent recovery for visceral actinomycosis.
- Surgical intervention (colonic resection, colostomy) was necessary in some cases due to complications or iatrogenic damage, with patients becoming asymptomatic post-treatment.
- Highlights actinomycosis as a diagnostic challenge due to its diverse presentations, underscoring the importance of considering it in complex abdominal conditions.