Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations.
Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60-180), whereas the median follow-up time was 12 months (interquartile range 5.25-18). Two patients died.This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.
Internal Medicine Unit, Teaching Hospital of La Réunion, France Department of internal Medicine and Infectious Diseases, Teaching Hospital of Poitiers, France Department of Internal Medicine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France Internal Medicine Unit, French Army Teaching Hospital of Metz, France Internal Medicine Unit, Teaching Hospital of Bordeaux, France Internal Medicine Unit, Henri Mondor Hospital, Aurillac, France.
Simon
S
Bonnefond
Mélanie
M
Catroux
Cléa
C
Melenotte
Ludovic
L
Karkowski
Ludivine
L
Rolland
Sébastien
S
Trouillier
Loic
L
Raffray
D000190:Actinomyces / Q000302:isolation & purification*; D000196:Actinomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012867:Skin / Q000000981:diagnostic imaging* / Q000382:microbiology; D013997:Time Factors
D000900:Anti-Bacterial Agents