Actinomyces canaliculitis: diagnosis of a masquerading disease.
BACKGROUND
To review the diagnosis and management of seven cases of Actinomyces canaliculitis.


METHODS
Culture of discharge was performed in six of seven patients with Actinomyces canaliculitis using a PD Plus/F blood culture bottle. All patients were treated by canaliculotomy with curettage of dacryoliths, followed by treatment with systemic penicillin and Sulphacetamide drops over a period of 3-6 months. Part of the curetted concretions was fixed on a glass slide and part was sent to the laboratory for culture.


RESULTS
Four patients were women and three men with age ranging between 43 and 90 years. The average time lapse between onset of symptoms until diagnosis was 3 years. All cases presented with epiphora, chronic conjunctivitis, palpably thickened canaliculus, and yellow punctal discharge. Diagnosis was achieved by culture of discharge in three of six cases, culture of concretions in three of five cases, and staining of dacryoliths in all seven cases. Follow-up ranged between 12 and 48 months. The canaliculitis resolved completely and all patients have patent canalicula.


CONCLUSIONS
Actinomyces canaliculitis presents with epiphora, chronic purulent conjunctivitis, a palpably thickened canaliculus, and yellow punctual discharge. In suspect cases canuliculotomy and curettage should be performed, although canalicular reconstruction is generally unnecessary. Culture of discharge and concretions using PD Plus/F blood culture medium gave improved results over accepted norms. Fixation of smeared concretions on a slide in alcohol is simple and is diagnostic of the disease. We recommend long-term systemic penicillin treatment in Actinomyces canaliculitis.
Briscoe
Daniel
D
Department of Ophthalmology, Sapir Medical Center, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University, Israel. briscoe@barak-online.net
Edelstein
Evgeny
E
Zacharopoulos
Ioannis
I
Keness
Yoram
Y
Kilman
Avi
A
Zur
Fruma
F
Assia
Ehud I
EI
D000196:Actinomycosis / Q000150:complications / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D003231:Conjunctivitis / Q000382:microbiology; D003475:Curettage; D003607:Dacryocystitis / Q000382:microbiology* / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D013409:Sulfacetamide / Q000008:administration & dosage / Q000627:therapeutic use
D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; D010406:Penicillins; D013409:Sulfacetamide