ORIGINAL ARTICLEBronchopulmonary Actinomycosis Associated With Hiatal Hernia
Section snippets
PATIENTS AND METHODS
Clinical records, imaging studies, and histopathologic biopsy reports of 10 patients with bronchopulmonary actinomycosis were analyzed from the database of the Hospital Azienda Policlinico of Modena (8 patients) and the Hospital St Maria Nuova of Reggio Emilia (2 patients) between November 1, 2002, and January 31, 2008. The collected data include complete medical history, radiologic findings (including chest computed tomography [CT]), treatments, and histopathologic and histochemical findings
Clinical and Radiographic Findings
The age at diagnosis of the 6 men and 4 women ranged from 41 to 83 years (mean ± SD age, 63.5±12.5 years; median, 67.0 years). Of these 10 patients, 8 had a history of smoking: 6 were current smokers, and 2 were ex-smokers (defined as quitting >3 years before diagnosis). Presenting symptoms were cough (8 patients), fever (5 patients), dyspnea (2 patients), and gastroesophageal reflux disease (GERD; 1 patient) (Table).
Six patients had esophageal HH (Figure 1), but only 1 patient had symptoms
DISCUSSION
Bronchopulmonary actinomycosis is a chronic suppurative infectious disease with a protean spectrum of clinical and radiologic presentations. This disease mainly simulates primary or metastatic malignancies and other more common pulmonary infections.3, 4, 5, 6, 7, 8 Thus, the diagnosis can be challenging and is often delayed, with a mean of 6 months from symptom onset; less than 10% of cases are suspected by clinicians.3 Universally accepted predisposing factors for bronchopulmonary
CONCLUSION
Bronchopulmonary actinomycosis is a rare and often unexpected disease that is basically detected only at histologic examination. Most important, HH seems to represent a hitherto unreported potential predisposing condition for bronchopulmonary actinomycosis. This association based on a limited number of cases could simply be due to chance alone and clearly needs further confirmatory studies.
Acknowledgments
This work is dedicated to the memory of our friend and pneumologist colleague Alberto Fontana, MD.
REFERENCES (19)
- et al.
Actinomycete infections in humans-a review
Gene
(1992) - et al.
Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature
Chest
(2002) - et al.
Endobronchial actinomycosis simulating bronchogenic carcinoma: diagnosis by bronchial biopsy
Chest
(1991) - et al.
Diffuse bronchiolar disease due to chronic occult aspiration
Mayo Clin Proc
(2006) - et al.
Actinomycosis
Clin Infect Dis
(1998) - et al.
A study of 57 cases of actinomycosis over a 36-year period: a diagnostic ‘failure’ with good prognosis after treatment
Arch Intern Med
(1975) - et al.
Pulmonary actinomycosis
Eur Respir J
(2003) - et al.
Thoracic actinomycosis
Eur J Cardiothorac Surg
(1998) - et al.
Actinomycoses and Nocardia pulmonary infections
Curr Opin Pulm Med
(2006)
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Paediatric pulmonary actinomycosis: A forgotten disease
2022, Paediatric Respiratory ReviewsCitation Excerpt :Flexible bronchoscopy is usually not diagnostic in pulmonary actinomycosis unless there is clear endobronchial disease on which biopsy can be performed (Fig. 3 A-C) [44]. In adults, actinomycosis has been reported to manifest as granular thickening and partial occlusion of bronchi, submucosal or exophytic mass, with or without necrotic material, causing partial or full obstruction of bronchus and to mimic lung cancer or tuberculosis (Fig. 4 A-C) [45,46,47]. Bronchoscopy may be useful in the exclusion of other diagnosis, especially TB, intraluminal tumours and foreign bodies.
A case of pulmonary actinomycosis presented with endobronchial involvement
2019, Respiratory Medicine Case ReportsCitation Excerpt :Bronchoscopic findings of endobronchial actinomycosis are also no specific. In past reports, endobronchial actinomycosis have been reported to manifest bronchoscopically as granular thickening and partial occlusion of bronchi, submucosal or exophytic mass with or without necrotic material, causing partial or full obstruction of bronchus and mimicking as lung cancer or tuberculosis [5–7]. Therefore, endobronchial involvement of actinomycosis should be included in differential diagnosis of an endobronchial lesion.
Identification and diversity of Actinomyces species in a clinical microbiology laboratory in the MALDI-TOF MS era
2018, AnaerobeCitation Excerpt :While some Actinomyces species including A. israelii, A. gerencseriae and A. graevenitzii are typically involved in classical actinomycosis, other species are being increasingly found in a variety of polymicrobial infections at various body sites [4,8]. The pathogenic role of known and novel Actinomyces spp. in contributing alone or as part of polymicrobial flora to human invasive infections is underappreciated because many clinical microbiology laboratories have in the past relied on traditional phenotypic methods for identification [4–7]. Because Actinomyces spp. grow best under anaerobic conditions and are notoriously fastidious and slow -growing, they may be missed as important pathogens by routine aerobic culture techniques and incubation periods.
Agents of Actinomycosis
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious DiseasesDisseminated pulmonary actinomycosis with hepatic injury: A misleading form mimicking a polymetastatic picture
2012, Revue de Pneumologie Clinique