Can intestinal TB be cured

What lesions could actinomycosis be behind?

The infection often mimics other diseases

The laboratory head of the microbiology department at the University of Nottingham explains with a colleague and a radiologist from Cambridge University why early actinomycosis is not easy to detect and why misdiagnoses are common. If the pathogen is detected, the patient can be cured.

The rare, chronic and slowly progressive granulomatous disease is caused by thread-like gram-positive anaerobes from the actinomycete family. It is often misunderstood as it can mimic other problems such as cancer and TB. The bacteria are found as commensals in the oropharynx, gastrointestinal and urogenital tracts. If the tissue integrity is disturbed by a mucosal lesion, they can penetrate local structures and organs and become pathogenic. Actinomycosis is essentially an endogenous infection.

Other commensals are often isolated with the pathogens; the pattern depends on the location. Anyone can get sick; There are no more recent data on the incidence (1960s FRG, Netherlands 1: 1 million, 1970s Cleveland, USA 1: 300,000). The incidence is believed to have decreased in recent years thanks to better oral hygiene and sensitivity to many antibiotics. Most of the reports are from immunocompetent patients.

In addition to frequent localizations (see box), musculoskeletal forms (also after prosthesis operations) or dissemination (extremely rare) can occur. Orofacial cases arise i. d. Usually after dental treatment or trauma, but also spontaneously. It can include Fever, chronic painless, or painful swelling may occur. Regional lymphadenopathy is typically only found in later stages. Thoracic actinomycosis is more common in lung conditions. The picture may initially resemble pneumonia, with not very high fever, cough, shortness of breath and chest pain. Empyemes occur; the pathogens can also spread from the mediastinum z. B. Spread into the pericardium. Abdominal or pelvic involvement can occur after acute appendicitis, especially with perforation (65% of these cases). Fistulas sometimes reach the abdominal wall or the perianal region. Germs from the abdomen can get into the pelvis; However, pelvic actinomycosis is usually associated with IUDs (intrauterine devices) (usually fever, discharge, pain, weight loss, mostly IUD use for more than two years).

In order to definitively diagnose actinomycosis, the germ must be isolated from a sample from the patient. Laboratory values ​​are unspecific (possibly anemia, slight leukocytosis, increased ESR and CRP, increased AP with liver involvement). In the early stages of imaging i. d. Usually unspecific findings. They can resemble other localized inflammations or tumors. CT or MRI cross-sections usually only show signs of abscess or phlegmon, but also the exact location of the lesion, which can be helpful when taking tissue samples. Local or regional lymphadenopathy is rarely found. In later stages, infiltration of the surrounding area through layers of tissue and fistulas can be noticed.

The authors explain the histopathological signs, which include sulfur granules (not always detectable, can also be found in other infections). In the case of microbiological detection, inter alia Rapid transport and advance warning of the laboratory are important (avoid antibiotics before taking samples if possible; smears are unfavorable as microscopy cannot be performed).

Previously, high doses were used for treatment. B. penicillin for six to twelve months (sometimes surgery is necessary). Other pathogens found should be considered when choosing a therapy. Today shorter treatment times are also possible (close monitoring of compliance, clinical and radiological response). Actinomycosis of the CNS has the highest mortality. SN


Actinomycosis Risk Factors
Age 20 to 60 years, male gender,
Diabetes, immunosuppression, steroids,
Bisphosphonates, leukemia with chemotherapy
pie, HIV, lung and kidney transplant,
Alcohol disease, local tissue damage caused by
Trauma, recent surgery, radiation
Clinical warning signs
indolent course, chronicity,
Signs of a mass,
Development of fistulas that
to be able to heal and arise again,
step through layers of tissue,
refractory or recurrent infection
short-term use of antibiotics
Differential diagnoses
orocervicofacial (approx. 50% of cases)
Abscess caused by other typical bacteria,
Cyst, neoplasm, TB (scrofula), nocardiosis
thoracic (approx. 15 to 20%)
Tb, lymphoma, bronchial CA, mesothelioma,
Blastomycosis, nocardiosis, histoplasmosis,
Cryptococcosis, pulmonary infarction, or abscess
Pneumonia due to more typical pathogens
abdominal or in the pelvis (approx. 20%)
intestinal TB, nocardiosis, tubo-ovarian or
Pelvic abscess, carcinoma, lymphoma, chronic
cal appendicitis, regional enteritis, others
Intestinal inflammation, diverticulitis, endome-
triose, pelvic inflammatory disease
(pelvic inflammatory disease)
Infection or abscess caused by pyogenic bacteria
rien, tb, nocardiosis, neoplasm, colloid
or dermoid cyst, cholesteatoma, basilar artery

Source:Wong VK et al .: Actinomycosis, journal: BRITISH MEDICAL JOURNAL, issue 343 (2011), pages: d6099; doi: 10.1136 / bmj.d6099