Pulmonary Actinomycosis with Positive Blood Culture: One Case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZhangYouzhi ¹ , ZhangPeng ¹ , YangHaihua ¹ , XuYu ² ,  LongFeng ¹ , ChenXiaodong ¹ , JinXianqiao ¹

1. Department of Respiratory Medicine, North Huashan Hospital Affiliated to Fudan University, Shanghai, 201907, China;
2. ;

Corresponding author：

LongFeng, Email: longfenglf@sina.cn

Keywords：

Actinomycosis; Lung; Blood culture

DOI：

10.7507/1671-6205.2014138

Video：

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Objective To improve the knowledge of pulmonary actinomycosis. Methods One case of pulmonary actinomycosis with positive blood culture diagnosed on December 2013 in North Huashan Hospital was analyzed,and related literature from CNKI and Medline after 1990 were reviewed. Results A 57-year-old male had recurrent fever for 24 days.Chest CT showed pneumonia in the right middle lobe.Actinomyce culture was twice positive by anaerobic blood culture.The patient's temperature was normal after large doses of penicillin and doxycycline therapy.Literature review revealed that the incidence of pulmonary actinomycesis is common in males.Poor oral hygiene is the main predisposing factors.The common clinical presentations include cough,sputum production,chest pain and hemoptysis.The peripherally progressive enhancement on CT has a certain diagnostic value for pulmonary actinomycosis.Pulmonary actinomycosis can increase FDG uptake on ¹⁸F-FDG PET scan and can mimic lung cancer.Accurate diagnosis is generally made by histopathological examination of lung biopsy or surgical samples.High-dose intravenous penicillin therapy is preferred for pulmonary actinomycosis followed by prolonged oral antibiotics for 6 to 12 months.Surgical intervention may be necessary for refractory hemoptysis or patients who do not respond to antibiotic therapy. Conclusion Pulmonary actinomycosis is a rare disease.Symptoms of pulmonary actinomycosis are atypical.This patient is the first reported case of actinomyces with positive blood cultures.

Citation： ZhangYouzhi, ZhangPeng, YangHaihua, XuYu, LongFeng, ChenXiaodong, JinXianqiao. Pulmonary Actinomycosis with Positive Blood Culture: One Case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(6): 565-568. doi: 10.7507/1671-6205.2014138 Copy

1.	Schaal KP,Lee HJ.Actinomycete infections in humans--a review.Gene,1992,115:201-211.
2.	García-García JA,Corzo JE,Ramírez M,et al.Pulmonary actinomycosis secondary bacteremia in a HIV-infected patient.Med Clin (Barc),2004,123:599.
3.	Galaria Ⅱ,Marcos A,Orloff M,et al.Pulmonary actinomycosis in solid organ transplantation.Transplantation,2003,75:1914-1915.
4.	Wakabayashi K,Yano S,Kadowaki T,et al.Pulmonary actinomycosis caused by Actinomyces cardiffensis.Intern Med,2012,51:2929-2931.
5.	马楠,文仲光,李艳红,等.肺放线菌病一例并文献复习.中华结核和呼吸杂志,2009,32:485-488.
6.	Kim SR,Jung LY,Oh IJ,et al.Pulmonary actinomycosis during the first decade of 21st century:cases of 94 patients.BMC Infect Dis,2013,13:216.
7.	Pulverer G,Schutt-Gerowitt H,Schaal KP.Human cervicofacial actinomycoses:microbiological data for 1 997 cases.Clin Infect Dis,2003,37:490-497.
8.	Yildiz O,Doganay M.Actinomycoses and Nocardia pulmonary infections.Curr Opin Pulm Med, 2006,12:228-234.
9.	Gupta A,Lodato RF.Empyema necessitatis due to Actinomyces israelii. Am J Respir Crit Care Med,2012,185:e16.
10.	Cohen RD,Bowie WR,Enns R,et al.Pulmonary actinomycosis complicating infliximab therapy for Crohn's disease.Thorax,2007,62:1013-1014.
11.	Marie I,Lahaxe L,Levesque H,et al.Pulmonary actinomycosis in a patient with diffuse systemic sclerosis treated with infliximab.QJM,2008,101:419-421.
12.	吴晓华,马大庆,张淑红,等.酷似肺癌的肺放线菌病2例影像分析.中国医学影像学杂志,2013,21:543-544.
13.	El GH,Bai C,Qiao R.Pulmonary actinomycosis presenting as a mass-like consolidation.South Med J,2010,103:81-83.
14.	Kim TS,Han J,Koh WJ,et al.Thoracic actinomycosis:CT features with histopathologic correlation.Am J Roentgenol,2006,186:225-231.
15.	柴晓明,杨秀荣.肺放线菌病的CT诊断及误诊分析.中华放射学杂志,2013,47:509-512.
16.	Cheon JE,Im JG,Kim MY,et al.Thoracic actinomycosis:CT findings.Radiology,1998,209:229-233.
17.	Lee Y,Lee KW.¹⁸F-FDG PET finding of pulmonary actinomycosis. Conference:2012 20th Anniversary Congress of the European Society of Thoracic Imaging,ESTI 2012 London United Kingdom.Conference Publication:(var.pagings).27 (5) (pp W151),2012.
18.	Song JU,Park HY,Jeon K,et al.Treatment of thoracic actinomycosis:a retrospective analysis of 40 patients.Ann Thorac Med,2010,5:80-85.
19.	Choi J,Koh WJ,Kim TS,et al.Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis.Chest,2005,128:2211-2217.
20.	Kilani B,Amari L,Tiouiri H,et al.Efficacy of doxycycline in thoracic actinomycosis:a case report.Tunis Med,2004,82:233-236.
21.	Endo S,Murayama F,Yamaguchi T,et al.Surgical considerations for pulmonary actinomycosis.Ann Thorac Surg,2002,74:185-190.

1. Schaal KP,Lee HJ.Actinomycete infections in humans--a review.Gene,1992,115:201-211.
2. García-García JA,Corzo JE,Ramírez M,et al.Pulmonary actinomycosis secondary bacteremia in a HIV-infected patient.Med Clin (Barc),2004,123:599.
3. Galaria Ⅱ,Marcos A,Orloff M,et al.Pulmonary actinomycosis in solid organ transplantation.Transplantation,2003,75:1914-1915.
4. Wakabayashi K,Yano S,Kadowaki T,et al.Pulmonary actinomycosis caused by Actinomyces cardiffensis.Intern Med,2012,51:2929-2931.
5. 马楠,文仲光,李艳红,等.肺放线菌病一例并文献复习.中华结核和呼吸杂志,2009,32:485-488.
6. Kim SR,Jung LY,Oh IJ,et al.Pulmonary actinomycosis during the first decade of 21st century:cases of 94 patients.BMC Infect Dis,2013,13:216.
7. Pulverer G,Schutt-Gerowitt H,Schaal KP.Human cervicofacial actinomycoses:microbiological data for 1 997 cases.Clin Infect Dis,2003,37:490-497.
8. Yildiz O,Doganay M.Actinomycoses and Nocardia pulmonary infections.Curr Opin Pulm Med, 2006,12:228-234.
9. Gupta A,Lodato RF.Empyema necessitatis due to Actinomyces israelii. Am J Respir Crit Care Med,2012,185:e16.
10. Cohen RD,Bowie WR,Enns R,et al.Pulmonary actinomycosis complicating infliximab therapy for Crohn's disease.Thorax,2007,62:1013-1014.
11. Marie I,Lahaxe L,Levesque H,et al.Pulmonary actinomycosis in a patient with diffuse systemic sclerosis treated with infliximab.QJM,2008,101:419-421.
12. 吴晓华,马大庆,张淑红,等.酷似肺癌的肺放线菌病2例影像分析.中国医学影像学杂志,2013,21:543-544.
13. El GH,Bai C,Qiao R.Pulmonary actinomycosis presenting as a mass-like consolidation.South Med J,2010,103:81-83.
14. Kim TS,Han J,Koh WJ,et al.Thoracic actinomycosis:CT features with histopathologic correlation.Am J Roentgenol,2006,186:225-231.
15. 柴晓明,杨秀荣.肺放线菌病的CT诊断及误诊分析.中华放射学杂志,2013,47:509-512.
16. Cheon JE,Im JG,Kim MY,et al.Thoracic actinomycosis:CT findings.Radiology,1998,209:229-233.
17. Lee Y,Lee KW.¹⁸F-FDG PET finding of pulmonary actinomycosis. Conference:2012 20th Anniversary Congress of the European Society of Thoracic Imaging,ESTI 2012 London United Kingdom.Conference Publication:(var.pagings).27 (5) (pp W151),2012.
18. Song JU,Park HY,Jeon K,et al.Treatment of thoracic actinomycosis:a retrospective analysis of 40 patients.Ann Thorac Med,2010,5:80-85.
19. Choi J,Koh WJ,Kim TS,et al.Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis.Chest,2005,128:2211-2217.
20. Kilani B,Amari L,Tiouiri H,et al.Efficacy of doxycycline in thoracic actinomycosis:a case report.Tunis Med,2004,82:233-236.
21. Endo S,Murayama F,Yamaguchi T,et al.Surgical considerations for pulmonary actinomycosis.Ann Thorac Surg,2002,74:185-190.

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Pulmonary Actinomycosis with Positive Blood Culture: One Case Report and Literature Review

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