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Background Methods Results Conclusions Actinomycosis can be caused by periapical endodontic infection, trauma, or surgical dental procedures. Due to its rare occurrence in a healthy adult patient, persistent actinomycotic osteomyelitis around implants presenting as severe peri‐implantitis may be challenging to diagnose.A 26‐year‐old male patient with non‐contributory medical history presented to the Oral and Maxillofacial Surgery Clinic in 2018 with pain and edema associated with endodontically treated maxillary premolar teeth with poor prognosis. Oral examination revealed fair oral hygiene, heavily restored dentition, multiple carious teeth, failing restorations, endodontic treatments in both maxillary quadrants, and normal periodontal examination.Two years following extractions and restoration with implants, the patient returned with a bony sequestrum and fistula in the buccal gingiva adjacent to the implants. The patient reported shifting of implants and slight change in his occlusion. Clinical, radiographic, and endodontic examinations did not demonstrate a clear origin of the fistula. A periodontist was consulted regarding the possibility of peri‐implantitis and tracing of the fistula suggested intraosseous involvement of the implant surface. Flap surgery, biopsy, culture, implant removal, and surgical debridement were performed. Histologic examination revealed colonies of actinomycotic organisms and confirmed likely diagnosis of actinomycosis. The patient was placed on a long course of penicillin VK.The occurrence of actinomycosis in a healthy adult patient is rare. This case report describes persistent actinomycosis presenting as osteomyelitis with severe peri‐implantitis in a healthy patient, which may have been associated with a previously existing periapical endodontic infection. [ABSTRACT FROM AUTHOR]

A 3‐year‐old Holstein cow was examined in an intensive system due to unilateral swelling in the mandible. A right mandibular mass was associated with painful mastication and Ptyalism. In palpation, the mass was raised, ulcerated, attached to the mandible bone and firm, approximately 17 × 12 × 10 cm3 in size. The lesion was sampled, and after routine bacteriology and histopathology procedures, the occurrence of lumpy jaw caused by Nocardia farcinica was confirmed. The bacterium was analysed using genome sequencing and new strain called Najm 114. Due to the risk of zoonosis of the isolated agent, the cow was euthanized. This is the first report of lumpy jaw caused by N. farcinica in a cow. This study showed that N. farcinica should be considered a possible etiological agent for lumpy jaw in cattle. [ABSTRACT FROM AUTHOR]

Esophageal stenosis can cause vomiting or dysphagia in children and is commonly treated with esophageal balloon dilation. However, surgery may be required if the stenosis does not respond to dilation. Although esophageal actinomycosis can cause severe esophageal strictures and be refractory to balloon dilation, it has been reported to respond effectively to antimicrobial therapy in adults. However, the course of the disease and appropriate treatment strategies in children are not well understood. We present a case of a previously healthy 2-year-old boy diagnosed with esophageal stenosis because of actinomycosis. The patient was treated with intravenous penicillin G, followed by oral amoxicillin for 8 weeks and 6 months, respectively. After completion of the antimicrobial treatment, the patient showed improvement in symptoms and endoscopic findings. At the 1-year follow-up, the patient showed consistent weight gain and normal growth without further intervention. This case highlights the importance of considering esophageal actinomycosis as a potential cause of esophageal stenosis in children and the potential effectiveness of anti-microbial therapy in avoiding surgical intervention. [ABSTRACT FROM AUTHOR]

Actinomycosis, an oral cavity commensal, causes cervicofacial infection in patients associated with an immunosuppression state and local mucosal injuries. Bone involvement by this commensal is rare. In the present case, we report a case of left peri mandibular soft tissue, soft to firm, tender swelling in a 39‐year‐old immunocompetent male diagnosed as Actinomycosis infection on fine needle aspiration cytology (FNAC) and cell block preparation. [ABSTRACT FROM AUTHOR]

Actinomycosis is a rare disease. Its diagnosis is challenging clinically as it mimics many other infectious diseases and neoplasms. In this scenario, a simple timely biopsy can come to the clinician’s rescue. Actinomycosis can be reliably diagnosed on histopathological examination accompanied by special stains without losing much time. Culturing this organism is a tedious job in view of its fastidious nature and requires a long waiting time. Polymerase chain reaction (PCR) can be useful and is less time‑consuming, but histopathology is more cost‑effective in our country like India. This case report emphasizes the fact that a rare possibility of actinomycosis should also be kept in mind even in immunocompetent individuals in rare sites like gingiva even if there are no discharging sinuses noted clinically. Actinomycosis requires long‑duration antibiotic treatment, so if diagnosis time is reduced, timely treatment of actinomycosis can be started and complications can be prevented. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Actinomycosis is a clinically significant but uncommon infectious disease caused by anaerobic commensals of Actinomyces species, and the incidence of thoracic empyema is rare. We report an extremely rare case of empyema caused by Actinomyces naeslundii (A. naeslundii). Case Report: A 39-year-old man presented to our hospital with fever and dyspnea. He had massive pleural effusion and was diagnosed with a left lower-lobe abscess and left thoracic empyema. Thoracic drainage was performed and Ampicillin/Sulbactam was administered for 3 weeks. Four years later, the patient presented with back pain, and chest X-ray showed increased left pleural effusion. After close examination, malignant pleural mesothelioma was suspected, and computed tomography-guided needle biopsy was performed, which yielded a viscous purulent pleural effusion with numerous greenish-yellow sulfur granules. A. naeslundii was identified through anaerobic culture. Thoracoscopic surgery of the empyema cavity was conducted, and Ampicillin/Sulbactam followed by Amoxicillin/Clavulanate was administered for approximately 6 months. No recurrence has been observed for 1 year since the surgical procedure. Conclusions: Actinomyces empyema is a rare condition, and this case is the second reported occurrence of empyema caused by A. naeslundii. The visual identification of sulfur granules contributed to the diagnosis. Long-term antibiotic therapy plays a crucial role in treatment. [ABSTRACT FROM AUTHOR]

The article describes the case of a six-year-old girl with schizencephaly, shunted hydrocephalus, epilepsy, global development delay, diabetes insipidus, and spastic quadriplegic cerebral palsy. Topics discussed include findings on her medical examination, major categories of the differential diagnosis for a child with acquired chest wall mass, and final diagnosis of thoraco-abdominal actinomycosis with chest wall invasion.

Background: Actinomyces turicensis is rarely responsible of clinically relevant infections in human. Infection is often misdiagnosed as malignancy, tuberculosis, or nocardiosis, therefore delaying the correct identification and treatment. Here we report a case of a 55-year-old immunocompetent adult with brain abscess caused by A. turicensis. A systematic review of A. turicensis infections was performed. Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases MEDLINE, Embase, Web of Science, CINAHL, Clinicaltrials.gov and Canadian Agency for Drugs and Technology in Health (CADTH) were searched for all relevant literature. Results: Search identified 47 eligible records, for a total of 67 patients. A. turicensis infection was most frequently reported in the anogenital area (n = 21), causing acute bacterial skin and skin structure infections (ABSSSI) including Fournier's gangrene (n = 12), pulmonary infections (n = 8), gynecological infections (n = 6), cervicofacial district infections (n = 5), intrabdominal or breast infections (n = 8), urinary tract infections (n = 3), vertebral column infections (n = 2) central nervous system infections (n = 2), endocarditis (n = 1). Infections were mostly presenting as abscesses (n = 36), with or without concomitant bacteremia (n = 7). Fever and local signs of inflammation were present in over 60% of the cases. Treatment usually involved surgical drainage followed by antibiotic therapy (n = 51). Antimicrobial treatments most frequently included amoxicillin (+clavulanate), ampicillin/sulbactam, metronidazole or cephalosporins. Eighty-nine percent of the patients underwent a full recovery. Two fatal cases were reported. Conclusions: To the best of our knowledge, we hereby present the first case of a brain abscess caused by A. turicensis and P. mirabilis. Brain involvement by A. turicensis is rare and may result from hematogenous spread or by dissemination of a contiguous infection. The infection might be difficult to diagnose and therefore treatment may be delayed. Nevertheless, the pathogen is often readily treatable. Diagnosis of actinomycosis is challenging and requires prompt microbiological identification. Surgical excision and drainage and antibiotic treatment usually allow for full recovery. [ABSTRACT FROM AUTHOR]

Primary Gastric Actinomycosis is extremely rare. We report two cases of Primary Gastric Actinomycosis. First case, a 90-year-old gentleman with multiple co-morbidities came with post prandial non radiating epigastric pain for 2 weeks. Gastroscopy showed a submucosal gastric SOL. Endoscopic ultrasonography-guided Gastric SOL aspiration grew Actinomyces naeslundii. Second case, a 56 year old gentleman, known diabetic came with abdominal pain for 5 to 6 months and weight loss. Ultrasound abdomen revealed pyloric thickening. Upper gastrointestinal endoscopy showed gastric ulcer. Biopsies were suggestive of Actinomycosis. Cautious used of long term proton pump inhibitor in elderly and immunosuppressed individual. All efforts should be made to acquire the appropriate tissue sample for histopathology examination and culture. All actinomycosis infections need not have Sulphur pigments. Actinomycosis has a good prognosis with appropriate treatment. [ABSTRACT FROM AUTHOR]

Actinomycosis is a chronic suppurative infection caused by gram-positive bacteria, Actinomyces, which commonly colonize the oral cavity, urogenital tract and gastrointestinal tract. It causes opportunistic infection where the mucosal barrier is compromised and is often misdiagnosed as malignancy. We report a case of a 58-year-old female with severe abdominal pain and a palpable tender mass in the left lower quadrant. Computed tomography scan with contrast showed thickening of the transverse, descending to sigmoid colon wall and intense contrast enhancement resembling colitis with mesenteritis. At laparotomy, we found an adherent mass involving sigmoid colon with adjacent small bowel and peritoneum. We decided to perform adhesiolysis and Hartmann procedure. The culture result was negative, whereas the biopsy of sigmoid colon revealed characteristic sulfur granules of actinomycosis colony. Intravenous antibiotic combination of ceftazidime and metronidazole was administered for 14 days followed by complete resolution of symptoms. Histopathological and bacteriological examinations are keys to diagnose actinomycosis. Patients require long-term antibiotic therapy, but surgery is often required because preoperative diagnosis is difficult. Main novel aspects? We presented the rare case of intra-abdominal actinomycosis in Indonesia The case was challenging to diagnose pre-operatively based on physical examination and Exploratory laparotomy revealed pseudotumor mimicking advanced stage of colon neoplasm [ABSTRACT FROM AUTHOR]

Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of >90%. [ABSTRACT FROM AUTHOR]

Actinomycosis is an uncommon, subacute to chronic, suppurative bacterial infection caused by Actinomyces Israelii. About 3% of all actinomycosis cases occur in the tongue, often affecting adult patients (mean age, 50 years). The clinical characteristics of actinomycosis can resemble malignant or benign tumors, and other infectious diseases. A 56-year-old woman was referred presenting an ulcerated lesion on the tongue 1 year ago. Intraoral examination revealed an edematous nodular lesion with an ulcerated surface, slightly symptomatic, on the midline dorsum of posterior tongue, suggesting nodular median rhomboid glossitis. Cytology smear was negative for fungus. After excisional biopsy, histopathological examination showed a chronic inflammatory infiltrate supported by a fibrovascular connective tissue stroma, and at the deepest part, broad basophilic areas surrounded by neutrophils, containing numerous filamentous bacilli, which were highlighted by Gram and Groccott-Gomori staining. The final diagnosis was lingual actinomycosis. Oral amoxicillin treatment (8/8 h for 2 weeks) was started, and after 1-month complete resolution was observed. Lingual actinomycosis is a rare lesion that must be recognized by dentists, because its early diagnosis and correct treatment reduce the possibility of a clinical complication that compromises the patient's quality of life. Noteworthy, when located on the midline dorsum of posterior tongue, actinomycosis can simulate nodular median rhomboid glossitis, expanding its spectrum of clinical differential diagnosis. [ABSTRACT FROM AUTHOR]

Cervicofacial actinomycosis being one of the unusual infections is of high relevance to a head and neck onco-surgeon. As the diagnosis may be made difficult by its nature to mimic malignancy and egregiously low culture sensitivity, the differential diagnosis for a lesion appearing to be malignant after irradiation does not usually include actinomycotic infection. Treatment usually requires a long-term antibiotic course after confirmation with histopathology, albeit surgical debridement is required in selective cases. Here we report two cases that were clinico-radiologically diagnosed as osteoradionecrosis and histopathological analysis done to rule out cancer recurrence. Unanticipated, they turned out to be cervicofacial actinomycosis, subsequently treated with long-term antibiotics following which the infection subsided. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Actinomyces, a filamentous, branching, anaerobic gram-positive bacillus, typically found as a commensal organism in the oral cavity, can lead to rare chronic bacterial infections in various anatomical regions. Chest wall involvement represents an uncommon presentation, posing significant diagnostic challenges. This report focuses on the case of a 13-year-old boy presenting with chest wall actinomycetoma that closely resembled Ewing sarcoma on imaging. Case Report: We present the case of a 13-year-old male with no previous medical history who presented to the Emergency Department with progressive left-sided chest pain following a sports-related fall. Physical examination revealed mild swelling and tenderness on the left anterior chest wall. A chest computed tomography (CT) scan revealed a large tumor involving the lower left chest wall, suggesting Ewing sarcoma. However, a histopathological examination unexpectedly confirmed actinomycosis of the chest wall. Intravenous penicillin G was promptly initiated for 4 weeks. A follow-up CT scan after 4 weeks of therapy demonstrated a significant response with notable reduction in the size of the chest wall mass. The patient then continued with maintenance therapy using oral amoxicillin for 12 months. Throughout this period, complete resolution of the chest wall mass occurred, with no significant adverse events or complications observed. Conclusions: This case highlights the importance of considering uncommon differential diagnoses like chest wall actinomycosis in patients presenting with chest wall masses. The diagnostic complexities associated with this rare condition emphasize the need for a comprehensive evaluation strategy, incorporating histopathological examination and imaging. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We reported herein a case of isolated cerebral actinomycosis in a 54‐year‐old immunocompetent man. Brain MRI showed a left frontal intra‐axial lesion and perilesional edema. We performed an open biopsy of the left frontal enhancing lesion. Intraoperative findings showed a yellowish, malleable, and capsulated lesion that was well defined with surrounding normal tissue within pus inside and lacked any necrotic content. MR spectroscopy showed a high level of choline, lactate, and lipid peaks with a choline/N‐Acetylaspartic acid ratio of 1.8. The diagnosis was confirmed histologically, and the patient was treated successfully for 3 months after surgical aspiration. Surgical management allowed to confirm the diagnosis with a shorten antibiotics, a rapid resolution of symptoms, and a complete recovery. [ABSTRACT FROM AUTHOR]

Gerald R. Ford was the 38th president of the United States. He was appointed as vice president by Richard Nixon in 1974 upon the resignation of Spiro T. Agnew. In the midst of the Watergate Crisis, Nixon resigned making Ford the only president to serve without being elected as either president or vice president. In the year 2000, 13 years after his abbreviated term in office, he was attending the Republican National Convention in Philadelphia where he developed pain in his tongue, slurring of his speech, and signs of a stroke. He was taken to the emergency room of Hahnemann University Hospital where a CT scan showed a posterior circulation stroke. Within 24 hours, all of Ford's symptoms improved except for his tongue pain and speech. An MRI of the head and neck showed a tongue mass and he was taken to the operating room where an abscess was found. The bacteriology confirmed actinomycosis of the tongue and Ford rapidly improved after the incision and drainage. This paper will review the clinical course of Gerald Ford's lingual actinomycosis and will discuss this rare condition. [ABSTRACT FROM AUTHOR]

Introduction. Actinomycosis is an uncommon subacute or chronic suppurative bacterial granulomatous infectious disease with clinical heterogeneity. The majority of actinomycosis cases were of extra-abdominal origin, with oro-cervicofacial cases representing 55%, abdominopelvic representing 20%, and thoracic representing 15% of total reports. Currently, abdominal actinomycosis incidence is approximately 1 case per 119,000 people, being found three times more frequently among males. We report two rare clinical presentations of abdominal actinomycosis affecting the mesentery and the retroperitoneum, respectively. Case Report 1. A 58-year-old Caucasian male presented to our clinic with abdominal pain in the right upper quadrant. Pre-operative evaluation, although inconclusive, showed a mesocolic mass infiltrating the right and transverse colon. The patient underwent exploratory laparotomy. After partial resection of the mass, the histopathology report demonstrated mesenteric actinomycosis. Case Report 2. A 40-year-old Caucasian male presented to our clinic complaining about a mucopurulent material from an orifice at the right inguinal region. After appropriate work-up, a large abdominopelvic, stellate mass (75 x 22.8 mm) in the retroperitoneum was revealed. Surgery along with the appropriate antibiotics was used to treat the patient. Conclusion. Preoperative suspicion and diagnosis of actinomycosis are very challenging, with a high rate of misdiagnosis often resulting in delayed treatment. Our case reports highlight that abdominal actinomycosis should always be part of differential diagnosis, especially when there is involvement of multiple organs. The gold standard treatment of actinomycosis is surgical excision with prolonged antibiotic treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Actinomycosis is a rare cause of appendicitis with an incidence of 0.3–1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination. Appendicular actinomycosis, a rare, chronic granulomatous infection caused by actinomyces species, holds a significant preoperative diagnostic summons and is often diagnosed serendipitously during the regular histopathological examination. Herein, we present a case of a 36‐year‐old female who presented with features suggestive of acute appendicitis, underwent laparoscopic appendicectomy, and was diagnosed with appendicular actinomycosis from the histopathological examination. [ABSTRACT FROM AUTHOR]

Actinomyces israelii (AI) is a Gram-positive, rod-shaped bacterium that lives commensally on and within humans as a typical colonizer within the gastrointestinal tract, including the mouth. As an opportunistic pathogen, infection often results from tissue injury or breach of the mucosal barrier (ie, during various dental or GI procedures, aspiration, or specific pathologies such as diverticulitis). Symptoms generally present slowly as a non-tender, indurated mass that evolves into multiple abscesses, fistulae, or draining sinus tracts without regard for anatomical barriers, including fascial planes or lymphatic drainage. However, it may also present as an acute suppurative infection with pain and rapid progression to abscess formation. [ABSTRACT FROM AUTHOR]

Actinomycosis is a rare infection caused by filamentous, non acid fast staining and gram positive bacteria. The diagnosis is rarely made preoperatively, and only histopathological examination can confirm it, as the condition presents with varied clinical manifestations, often resembling a malignant lesion on radiographic images. Hereby, the authors present a case of a 67-year-old female, who was admitted for evaluation of an abdominal mass. Radiologically, the mass resembled a desmoplastic fibroma, and clinically, it was suspected to be the same. The mass was excised and sent for histopathological examination. Grossly, two specimens were received. The first consisted of adherent bowel loops, including the ileum, appendix, caecum and descending colon, with the mass arising from mesentery involving the bowel, measuring 11.5x9.5x6 cm. The second specimen was a partial cystectomy specimen, with the abdominal wall mass infiltrating the bladder anteroposteriorly, measuring 11x10x8 cm. Microscopic examination revealed extensive areas of inflammation with actinomycotic organisms exhibiting the Splendore-Hoeppli phenomenon, along with numerous multinucleated giant cells and acute on chronic inflammatory infiltrate. Surrounding areas showed dense collagen bundles. The prognosis after complete surgical resection is good, along with the administration of broad spectrum intravenous antibiotics. [ABSTRACT FROM AUTHOR]

Actinomycosis is caused by actinomyces israelii, a gram positive nonacid fast, anaerobic, commensal bacterium within the oral cavity. Though it is a commensal in oral cavity, it seldom presents as cervicofacial actinomycosis. But there is limited access to literature proving cervicofacial actinomycosis existence so far. We report a case of 35 year old gentleman who presented with painless progressive neck swelling associated with pain while chewing food. On examination, 3.5*2.5 swelling was noted in right submandibular gland area, radiologically a foreign body was detected in the right submandibular gland. Mass was excised in toto and sent for HPE which revealed submandibular gland actinomycosis. Post operatively, patient was managed with long-term broad-spectrum beta lactams and was on regular follow-up. No evidence of recurrence/ fresh complaints noted till date. Although cervicofacial actinomycosis is rare and dangerous with debilitating complications, timely diagnosis and early intervention with broad spectrum antibiotics and surgical excision (if required) shows promising results with complete eradication of disease leaving no residues. [ABSTRACT FROM AUTHOR]

Background: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. Case presentation: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. Conclusion: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started. [ABSTRACT FROM AUTHOR]

Pulmonary actinomycosis is an extremely rare disease in children. The diagnosis is challenging as the clinical presentation and radiological investigations may be atypical. We report a case of a pulmonary lesion extending to the chest wall posing as a malignant lesion. Biopsy revealed colonies of Actinomyces. Antibiotic therapy resolved the mass. A rare diagnosis of pulmonary actinomycosis should be kept as a differential diagnosis of such a mass in children. [ABSTRACT FROM AUTHOR]

Aim: Actinomycosis is a rare subacute to chronic granulomatous infection which can mimic other infectious or malignant diseases. This study examined the epidemiology and treatment outcome of actinomycosis in children. Methods: A retrospective study on children admitted for actinomycosis in a tertiary paediatric hospital in Singapore, from January 2004 to December 2020. Clinical profile, therapeutic interventions and outcomes were examined. Results: A total of 10 patients were identified; 7 were female. The median age at first presentation was 9.8 years (range 4.7–15.7). The most common presenting symptom was fever (n = 6, 60%), followed by facial or neck swelling (n = 3, 30%) and ear pain (n = 3, 30%). Actinomycosis occurred predominantly in the orocervicofacial region (n = 6, 60%). Four patients (40%) had preceding dental infections in the form of dental caries or gingivitis. One patient had poorly controlled insulin‐dependent diabetes mellitus. Actinomycosis was confirmed via culture in four patients, histopathology in four patients and both methods in two patients. All except one patient (n = 9, 90%) underwent surgical procedures. All patients received ampicillin or amoxicillin/clavulanate or other beta‐lactams, for a median duration of 6.5 months (range 1.5–14). Complications included osteomyelitis (n = 4, 40%), mastoiditis (n = 2, 20%), brain abscess (n = 1, 10%) and recurrent neck abscess (n = 1, 10%). There was no mortality and all patients achieved complete resolution. Conclusions: Paediatric actinomycosis was rare in our 16‐year review, but had a high complication rate. It can occur in immunocompetent patients, and dental infection was the predominant risk factor identified. Prognosis was excellent after surgical intervention and appropriate antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background: CNS actinomycosis is a rare chronic suppurative infection with non-specific clinical features. Diagnosis is difficult due to its similarity to malignancy, nocardiosis and other granulomatous diseases. This systematic review aimed to evaluate the epidemiology, clinical characteristics, diagnostic modalities and treatment outcomes in CNS actinomycosis. Methods: The major electronic databases (PubMed, Google Scholar, and Scopus) were searched for the literature review by using distinct keywords: "CNS" or "intracranial" or "brain abscess" or "meningitis" OR "spinal" OR "epidural abscess" and "actinomycosis." All cases with CNS actinomycosis reported between January 1988 to March 2022 were included. Results: A total of 118 cases of CNS disease were included in the final analysis. The mean age of patients was 44 years, and a significant proportion was male (57%). Actinomycosis israelii was the most prevalent species (41.5%), followed by Actinomyces meyeri (22.6%). Disseminated disease was found in 19.5% of cases. Most commonly involved extra-CNS organs are lung (10.2%) and abdomen (5.1%). Brain abscess (55%) followed by leptomeningeal enhancement (22%) were the most common neuroimaging findings. Culture positivity was found in nearly half of the cases (53.4%). The overall case-fatality rate was 11%. Neurological sequelae were present in 22% of the patients. On multivariate analysis, patients who underwent surgery with antimicrobials had better survival (adjusted OR 0.14, 95% CI 0.04–0.28, p value 0.039) compared to those treated with antimicrobials alone. Conclusion: CNS actinomycosis carries significant morbidity and mortality despite its indolent nature. Early aggressive surgery, along with prolonged antimicrobial treatment is vital to improve outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the demographic characteristics, clinical presentation, microbiologic profile, and treatment results of patients with primary canaliculitis. Materials and Methods: Patients diagnosed and treated for primary canaliculitis between May 2014 and May 2021 were analyzed retrospectively. Results: There were 26 patients with primary canaliculitis, including 17 females (65.4%) and 9 males (34.6%) with a mean age of 50.6±16.4 years (range: 9-80 years). Canaliculitis affected the right eye in 11 patients, the left eye in 13 patients, and bilateral involvement was seen in 2 patients. Inferior canaliculus involvement was more frequent (73%). The most common complaint was epiphora (46.1%). Five patients (19.2%) were wrongly diagnosed as chronic conjunctivitis. The time interval between the beginning of symptoms and canaliculitis diagnosis was 18.2±14.3 months (range: 1-60 months). Canaliculotomy and curettage of canalicular content with dacryolith removal were performed in 23 patients. After surgery, antibiotic irrigation of the canaliculus was added to the treatment regimen in 12 of these 23 patients. Intracanalicular antibiotic therapy was administered to the remaining 3 patients. The most cultured organism was Actinomyces (6 patients). Gemella (1 patient), Porphyromonas (1 patient), Candida parapsilosis (1 patient), Citrobacter koseri (1 patient) were also grown in culture. The follow-up time of patients was 26.2±23.7 months (range: 6-83 months). All symptoms and findings resolved in all patients in one month. In two patients, recurrence occurred at 4 and 16 months after surgical treatment. With appropriate treatment, no further recurrence was seen in either patient over 24-month follow-up. One patient presented with iatrogenic canaliculus blockage during follow-up. Conclusion: Primary canaliculitis is often overlooked and can be misdiagnosed. The most common symptom was epiphora. All patients with epiphora and chronic conjunctivitis should be examined carefully for canaliculitis. [ABSTRACT FROM AUTHOR]

Actinomycosis often leads to cervicofacial infections, but thoracic involvement may also occur. However, the development of empyema is rare. While being followed up with the diagnosis of asthma and bronchiectasis, our case was hospitalized for infected bronchiectasis. As empyema developed in the follow-up, the pleural effusion was drained by tube thoracostomy. Actinomycosis was diagnosed through pleural effusion cytology. Growth of Pseudomonas aeruginosa was observed in sputum culture, and SARS-CoV2 RT-PCR was also positive in nasopharyngeal sampling. Polymicrobial agents can often be detected in actinomycosis. Actinomycosis cases have also been reported in the post-COVID period. Our case is presented since it would be the first in the literature regarding the coexistence of COVID-19, Pseudomonas, and thoracic Actinomycosis (empyema). [ABSTRACT FROM AUTHOR]

Background: Bronchoalveolar lavage (BAL) is a widely accepted investigative tool for the diagnosis of pulmonary lesions. This study was done to find out the usefulness of BAL in diagnosis of pulmonary lesions from central Indian patient population. Methods: A cross-sectional prospective study was performed over a period of three years. All the BAL specimens of patients presenting to Department of Pulmonary Medicine and Tuberculosis during a period of January 2017 to December 2019 were included in the study. Cyto-histopathologic correlation was done, wherever available. Results: Of total 277 cases, there were 178 (64.5%) males and 99 (35.5%) females. The age of patients ranged from 4 years to 82 years. In 92 (33%) cases, specific infective etiology could be identified on BAL cytology, the most common being tuberculosis (26%) followed by fungal infections (2%). Rarely, infections like nocardia, actinomycosis, and hydatidosis were also identified. Eight cases (3%) of malignancy were identified which included two cases of adenocarcinoma, one case of small cell carcinoma, three cases of poorly differentiated carcinoma, and two cases suspicious for malignancy. Some rare diagnoses like diffuse alveolar damage, pulmonary alveolar microlithiasis, and pulmonary alveolar proteinosis could be identified on BAL. Conclusion: BAL is useful in primary diagnosis of infections and malignancies of lower respiratory tract. BAL may aid in diagnostic workup of diffuse lung diseases. A combination of clinical information, high-resolution computed tomography, and BAL analysis may furnish an assured diagnosis to the clinician and obviate need for invasive procedures. [ABSTRACT FROM AUTHOR]

This article, published in the Qatar Medical Journal, discusses a rare case of thoracic actinomycosis in a patient with bronchopulmonary sequestration (BPS), a congenital lung anomaly. The patient, a 48-year-old man, presented with symptoms of productive cough and hemoptysis, and was found to have an intralobular BPS on chest computed tomography (CT). Surgical intervention confirmed the diagnosis of BPS and revealed an underlying actinomycosis infection. The article emphasizes the importance of early identification and accurate diagnosis of such cases, as well as the need to consider atypical pathogens like Actinomyces in BPS patients. [Extracted from the article]

This article discusses a rare case of asymptomatic primary gastric actinomycosis in a 63-year-old woman with a history of diabetes, hypertension, and dyslipidemia. The condition was diagnosed following a screening esophagogastroduodenoscopy (EGD) that revealed a subepithelial tumor-like lesion in the gastric fundus. Treatment with oral amoxicillin resulted in improvement of the lesion after one month, and the patient continued treatment for five months. The authors suggest that reporting this case may help clinicians consider actinomycosis as a possible diagnosis for gastric subepithelial tumor-like lesions. [Extracted from the article]

Isolated CNS involvement has been reported to occur in approximately 2-3% of cases.[5] Brain abscess remains the most common type of actinomycotic brain infection, others being meningoencephalitis, subdural empyema and epidural abscess.[1] Concurrent cutaneous and CNS involvement has been rarely described. Dear Editor, Cutaneous actinomycosis commonly manifests as an abscess with sinuses and characteristic sulfur granules caused by I Actinomyces i spp.[1] filamentous bacteria that are commensal on certain body sites and cause tissue infection rarely in predisposed individuals.[1] Here we describe a case of scalp actinomycosis associated with brain and ocular involvement in a healthy man. Hence, draining sinuses over the scalp should arouse suspicion of actinomycosis as one of the differentials, and an active search for CNS involvement might be mandatory in such cases. [Extracted from the article]

Actinomycosis is a chronic granulomatous condition caused by filamentous gram-positive anaerobic bacteria that colonizes the mouth, gastrointestinal tract and urogenital tract. Infection occurs through the mucosal surfaces, often resulting from dental procedures or trauma, primarily affecting the maxillary sinus. We report a case of Actinomyces sinusitis affecting the right maxillary and right ethmoidal sinuses of a 41-year-old woman. The diagnosis was made through a combination of histopathological report and computed tomography scan. The patient underwent endoscopic sinus surgery followed by long-term antibiotics for 6 months and reported improvement of her symptoms. [ABSTRACT FROM AUTHOR]

The article describes the case of chest pain in an a 14-year-old male patient. Topics discussed include the symptoms experienced by the patient, the patient's medical history, the results of the patient's medical examinations, the surgical procedure performed on the patient, and the final diagnosis.

Actinomycosis is a rare disease caused by the Actinomyces, that is a commensal bacillus, anaerobic and gram positive. Actinomycosis of the nasal cavity has few cases described and it is part of the cervicofacial form. The diagnosis is confirmed by the presence of the Actinomyces in the anatomopathological study and/or culture of the material. The treatment considered as the gold standard is the combination of the antibiotic therapy for a prolonged period, essential for the therapeutic success, and the surgical procedure. This case report presents a patient with an Actinomyces infection diagnosed after the anatomopathological study of the removed material during the surgery which the initial suspicion was rhinolithiasis. [ABSTRACT FROM AUTHOR]

We report an interesting case of a post-traumatic actinomycotic oro-antral fistula of the left posterior maxilla, that was not salvageable via local flaps due to the size of the defect and was managed with the patient-specific titanium implant, fabricated by three-dimensional stereolithographic model planning followed by primary closure. [ABSTRACT FROM AUTHOR]

Introduction: Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease that is more common in women, especially during puberty and menopause. It is believed that the initial pathogenetic mechanism is hyperkeratinization of the follicular cavity, followed by follicular occlusion, expansion, and rupture. Ultimately, the presence of bacterial agents in the focus leads to a local inflammatory reaction. Many concomitant diseases and triggers have been identified, including bacterial flora, which can significantly complicate the course of HS, leading to disease chronicity and a poor response to therapy. Early diagnosis of HS leads to timely treatment; the diagnosis is based on clinical features. The appropriate treatment must be chosen depending on the stage of severity. Case Presentation: We present a case of HS complicated by actinomycosis and viral hepatitis C. Actinomycosis is a rare diagnosis, especially in developed countries. In clinical practice, the diagnosis of actinomycosis can be difficult due to the pathogen's nonspecific clinical and pathological features, inherent difficulties in vitro cultivation, and complex histological characteristics. Conclusion: Given the growing number of immunocompromised patients worldwide (for example, HIVinfected or hepatitis C patients) and the numerous reports of infection with actinomycetes in these conditions, actinomycosis should be considered as a possible opportunistic infection. Identifying and eliminating concomitant bacterial flora can significantly increase the chances of successful and effective therapy of HS. [ABSTRACT FROM AUTHOR]

Actinomycosis is rarely accompanied by fungus balls. It is difficult to distinguish between actinomycosis and a fungus ball due to their similar clinical and computed tomography scan results. Thus, a meticulous histopathological examination is required for definite diagnosis. We report a case of actinomycosis accompanied by a fungus ball, found incidentally in a patient without rhinologic symptoms. The patient was successfully treated with endoscopic sinus surgery, followed by short-term antibiotic therapy. We suggest that shortterm antibiotic therapy may be more appropriate than long-term antibiotic therapy based on our case study as well as several other studies. [ABSTRACT FROM AUTHOR]

Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising fromunusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n=9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n=6), middle turbinate (n=3), posterior septum (n=3), sphenoid sinus ostium (n=1), and inferior meatus (n=1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n=12), actinomycosis (n=1), and rhinosporidiosis (n=1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence. [ABSTRACT FROM AUTHOR]

Actinomycosis is an infection characterized by abscess formation, draining sinuses, and tissue fibrosis. The causative bacterium is a Gram-positive facultative anaerobe from the genus Actinomyces. Infections classically affect the cervicofacial, thoracic, or pelvic region and often require prolonged antibiotic therapy. Actinomycosis of the breast is a rare condition that may present as a recurrent breast abscess. We present a 33-year-old female with a recurrent breast abscess which grew A. radingae and A. israeli on aspirated fluid cultures. Treatment with surgical aspiration and a 6-week course of oral amoxicillin/clavulanic acid 875 mg twice daily resulted in clinical improvement. Our case demonstrates how recurrent breast abscesses caused by Actinomyces can be difficult to manage. Long-term antibiotic therapy with surgical aspiration and regular follow-up offer the best chance of clinical resolution. [ABSTRACT FROM AUTHOR]

Background: Secondary bacterial and fungal infections in COVID patients have been documented during current pandemic. The present study provides detailed account of histomorphology of debridement tissue received for suspected fungal infections. The primary objective was to determine the morphological characteristics that must be recognized for the identification of fungal hyphae. Methods: The detailed histological examination of debridement tissue was performed. Demographic and clinical findings with treatment provided was recorded. Presence or absence of necrosis and lecocytoclasis was noted. Results: A total of 110 cases of debrided tissues were included in the study. Eosinophilic granular necrosis with lecocytoclasis was observed in 103cases; fungal elements were identified in 89.3% (92/103) of these. Eleven cases where necrosis was observed, strong suspicion of fungus was reported, 6 of them displayed fungus on KOH preparation, 3 on repeat biopsy. However, in 2 of these cases, neither KOH nor repeat biopsies identified the fungus. Mucor with aspergillus was observed in 7 cases and actinomyces in 3. In all these 10 cases dense fungal colonies were evident. In 7 cases careful observation revealed fruiting bodies of aspergillus. Cotton ball appearance of actinomyces was evident. Mucor infection in current disease was so rampant that aseptate ribbon like branching mucor hyphae were evident on H&E sections. Diabetes was significantly associated with fungal infection (97.2%; 70/72; P <.005). 90% [19/21] of the patients who were on room air and diagnosed with fungal infection were diabetic. Conclusions: Eosinophilic granular necrosis with the presence of neutrophilic debris in a case of suspected fungal disease suggests the presence of fungal elements. This warrants processing of the entire tissue deposited for examination, careful observation, application of fungal stains, and repeat biopsy if clinical suspicion is strong. Moreover, uncontrolled diabetes is more frequently associated with secondary fungal infection in COVID patients as compared to oxygen therapy. [ABSTRACT FROM AUTHOR]

Eosinophilic granuloma (EG) is a type of histiocytosis X with uncertain etiology. The lesion manifests as single or multiple areas of bone destruction with mild-to-severe pain or may be asymptomatic in some cases. In this article, a case of EG with actinomycosis is reported which occurred in an 11-year-old male in the left buccal vestibule extending from 22 to 24. Histopathologically, it showed dense, cellular infiltrate in the connective tissue composed of abundant eosinophils intermixed with atypical cells. After 4 months, the same patient reported with a recurrence in the palatal region. Histopathologically, the section showed some colonies of actinomycosis along with the features of EG. EG with metachronous actinomycosis is very rare in the literature. This article reports a new case of EG with actinomycosis and reviews previously reported cases of actinomycosis associated with other lesions. [ABSTRACT FROM AUTHOR]

Actinomycosis is an uncommon bacterial disease caused by actinomyces. Cervicofacial infection accounts for more than 60% of all cases. However, nasal and paranasal sinus involvement has rarely been described. We report herein a case of a patient presenting with middle turbinate actinomycosis. The diagnosis of nasal and paranasal actinomycosis should be kept in mind even though it is a rare condition. It has no specific clinic presentation nor pathognomonic scanographic features. The confirmation of the diagnosis is microbiological. Histology examination is useful. Its treatment is Surgical and medical, combined. A minimum of two to six weeks of general antibiotic therapy is needed. Follow‐up care is essential. [ABSTRACT FROM AUTHOR]

Pulmonary actinomycosis is a rare chronic granulomatous bacterial disease caused by Actinomyces species. Given its nonspecific clinical and radiological manifestations, the diagnosis might be delayed or even missed. Pulmonary actinomycosis mimics tuberculosis, aspergillosis, or malignancy both clinically and radiographically, and it should be considered in patients with chronic lung diseases. [ABSTRACT FROM AUTHOR]

Keywords: actinomycosis israelii; CNS actinomycosis; microbiological next-generation sequencing; moyamoya syndrome EN actinomycosis israelii CNS actinomycosis microbiological next-generation sequencing moyamoya syndrome 1139 1142 4 06/06/22 20220701 NES 220701 ACKNOWLEDGMENTS We are grateful to staff at Hugo biotech Co., Ltd., (Beijing, China) for sequencing. Central nervous system (CNS) actinomycosis is a rare infectious disease associated with several types of lesions, including abscesses, meningitis/meningoencephalitis, and actinomycetoma.1 Here, we report a case of moyamoya syndrome caused by CNS actinomycosis in a woman who had just undergone a cesarean section a month ago and was probably immunocompromised. [Extracted from the article]

• In this work,we evaluated actinomycosis is a rare saprophytic infection characterized by a slow progression, leading to the development of granulomatous and suppurative lesions. • This condition is caused by actinomycetes, which are part of the resident oral microbiome. • The symptoms and signs of actinomycosis are atypical and rarely manifest in the nasopharynx. • Consequently, it can be challenging to distinguish actinomycosis from nasopharyngeal carcinoma, making diagnosis difficult. • Histopathology is usually relied upon for diagnosis, although culture may pose challenges. Fortunately, actinomycetes are highly sensitive to penicillin. • Therefore, timely treatment with high doses of penicillin is crucial for successful recovery. • In this case study, we present the details of a 53-year-old female patient with no history of mucosal damage or tooth decay but with a previous partial thyroidectomy. • The patient experienced recurring neck pain accompanied by progressive limitation of neck movement. • Nasopharyngoscopy revealed the presence of a smooth-surfaced mass. • Subsequent biopsy, clinical imaging, microbiological analysis, and histological findings confirmed the diagnosis of actinomycosis.Following a comprehensive treatment plan involving a combination of penicillin and doxycycline for a duration of two months, the disease was successfully eradicated.I hope this paper is suitable for "Oral Oncology". Actinomycetes are predominantly pathogenic bacteria that lack aerial hyphae and do not form spores. They are generally anaerobic or facultative anaerobic Gram-positive bacteria, belonging to the prokaryotic group. Actinomycetes are widely distributed in nature, similar to other bacteria, and are mostly saprophytic, with a few being parasitic. They are named as such due to their colony's radial form. The symptoms and signs of actinomycosis are atypical and rarely manifest in the nasopharynx. Consequently, it can be challenging to distinguish actinomycosis from nasopharyngeal carcinoma, making diagnosis difficult. Histopathology is usually relied upon for diagnosis, although culture may pose challenges. Fortunately, actinomycetes are highly sensitive to penicillin. Therefore, timely treatment with high doses of penicillin is crucial for successful recovery. In this case study, we present the details of a 53-year-old female patient with no history of mucosal damage or tooth decay but with a previous partial thyroidectomy. The patient experienced recurring neck pain accompanied by progressive limitation of neck movement. Nasopharyngoscopy revealed the presence of a smooth-surfaced mass. Subsequent biopsy, clinical imaging, microbiological analysis, and histological findings confirmed the diagnosis of actinomycosis.Following a comprehensive treatment plan involving a combination of penicillin and doxycycline for a duration of two months, the disease was successfully eradicated. [ABSTRACT FROM AUTHOR]

Keywords: bronchoalveolar lavage (BAL); pulmonary actinomycosis; sulfur granules EN bronchoalveolar lavage (BAL) pulmonary actinomycosis sulfur granules 158 160 3 02/07/23 20230301 NES 230301 The role of a bronchoalveolar lavage sample cell block in the diagnosis of pulmonary actinomycosis. FNAC is usually done for localised mass lesions, especially those mimicking malignancy.[9] Very few cases of pulmonary actinomycosis are diagnosed on cytology, especially on BAL samples when compared to FNAC. A single reported case showed a ball-in-hole appearance on chest X-ray, CT chest, and bronchoscopic examination.[3] Fine needle aspiration cytology (FNAC) is the most commonly performed procedure for the diagnosis of pulmonary actinomycosis. [Extracted from the article]

Here we report urinary bladder actinomycosis in an elderly gentleman with past history of long-term catheterisation; he presented with recent onset hematuria and difficulty in micturition. CECT examination revealed smooth circumscribed thickening of urinary bladder wall with presence of blood clots and air locules within the bladder. Cystoscopy showed presence of friable to fibrotic particulate matter filling the bladder lumen. With a clinical suspicion of neoplastic lesion, TURBT and prostate biopsies were submitted for pathology examination that confirmed the presence of actinomycotic colonies. [ABSTRACT FROM AUTHOR]