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Thoracic actinomycosis

A I Taştepe1, N G Ulaşan, S T Liman

  • 1Atatürk Centre For Chest Disease and Chest Surgery, Ankara, Turkey.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 8, 1999
PubMed
Summary

Thoracic actinomycosis is challenging to diagnose preoperatively due to varied presentations. Thoracotomy is often necessary for diagnosis and sometimes treatment, with penicillin being the primary therapy post-diagnosis.

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Area of Science:

  • Medical Science
  • Infectious Diseases
  • Thoracic Surgery

Background:

  • Thoracic actinomycosis presents with diverse symptoms and radiographic findings, often mimicking other conditions like lung cancer or tuberculosis.
  • Preoperative diagnosis of thoracic actinomycosis is frequently unsuccessful, leading to surgical intervention for definitive diagnosis.

Purpose of the Study:

  • To evaluate the role of thoracotomy in the diagnosis and treatment of thoracic actinomycosis.
  • To highlight the diagnostic challenges and management strategies for this rare infection.

Main Methods:

  • Retrospective analysis of seven patients diagnosed with thoracic actinomycosis after thoracotomy between July 1990 and November 1997.
  • Surgical procedures included lobectomy and wedge resection; diagnosis was confirmed via intraoperative smears and postoperative histopathology.

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Main Results:

  • Thoracotomy was required for diagnosis in all seven patients due to non-specific preoperative findings.
  • Three major complications occurred post-surgery, including one fatality from sepsis.
  • Six patients survived and had no long-term issues following treatment with intravenous crystalline penicillin G and oral procaine penicillin.

Conclusions:

  • Thoracic actinomycosis diagnosis can be difficult, often necessitating thoracotomy for both diagnosis and treatment.
  • Resective surgery may be required for irreversible parenchymal damage.
  • Actinomyces israelii infections should be considered in chronic infiltrative, nodular, cavitary, or tumor-like lesions, with penicillin chemotherapy as the standard treatment.