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Pulmonary actinomycosis is an uncommon clinical entity that can be challenging to diagnose due to its non-specific symptomatology. Misdiagnosis and delayed treatment may result in invasive procedures and extended antimicrobial treatment courses. We report a case involving a 65-year-old female with poor oral dentition admitted for acute respiratory failure subsequently found to have a left-sided pleural effusion and perihepatic abscess formation. Cytopathology examination and microbiology studies confirmed the diagnosis of pulmonary actinomycosis.

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Bronchopulmonary sequestration, a rare congenital anomaly, involves a nonfunctioning lung tissue mass supplied by anomalous vessels. It is rarely infected by Actinomyces, further complicating the clinical presentation, with limited reported cases. This case highlights the distinctive clinical aspects, diagnostic challenges, and successful management strategies of such a rare clinical entity.

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Actinomycosis is a chronic granulomatous disease that can affect various parts of the body, including the head and neck, lungs, abdominal and pelvic cavities, and wounds. It is caused by different actinomycetes like Actinomyces sherdii, Actinomyces glasii, Actinomyces cariosa, Actinomyces zurichensis, and Actinomyces europaea. Reported infections caused by actinomycetes include pulmonary actinomycosis, pelvic and abdominal infections, bone or artificial joint infections, endocarditis, complicated urinary tract infections, and soft tissue abscesses. The combination of pulmonary actinomycosis with gastric cancer is exceptionally rare in clinical practice, and the presence of actinomycetal infection alongside tumors in elderly patients poses significant challenges in treatment. This article presents the diagnosis and treatment process of an elderly patient with pulmonary actinomycosis and gastric adenocarcinoma.

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Background: Pulmonary actinomycosis (PA) is a rare type of Actinomyces infection that can be challenging to diagnose since it often mimics lung cancer. Methods: Published case reports and case series of PA in patients with suspicion of lung cancer were considered, and data were extracted by a structured search through PubMed/Medline. Results: After analyzing Medline, 31 studies were reviewed, from which 48 cases were extracted. Europe had the highest prevalence of reported cases with 45.1%, followed by Asia (32.2%), America (19.3%), and Africa (3.2%). The average age of patients was 58.9 years, and 75% of all patients were above 50 years old. Male patients (70%) were predominantly affected by PA. The overall mortality rate was 6.25%. In only eight cases, the causative agent was reported, and Actinomyces odontolyticus was the most common isolated pathogen with three cases. Based on histopathological examination, 75% of the cases were diagnosed, and the lobectomy was performed in 10 cases, the most common surgical intervention. In 50% of the cases, the selective antibiotics were intravenous and oral penicillin, followed by amoxicillin (29.1%), amoxicillin-clavulanic acid, ampicillin, levofloxacin, and doxycycline. Conclusion: The non-specific symptoms resemble lung cancer, leading to confusion between PA and cancer in imaging scans. Radiological techniques are helpful but have limitations that can lead to unnecessary surgeries when confusing PA with lung cancer. Therefore, it is important to raise awareness about the signs and symptoms of PA and lung cancer to prevent undesirable complications and ensure appropriate treatment measures are taken.

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A 66-year-old male patient diagnosed with small-cell lung cancer received chemotherapy and immunotherapy, resulting in successful tumor control. However, the patient subsequently experienced a fever and rapid progression of the pulmonary cavity. Despite sampling bronchoscopic bronchoalveolar lavage fluid for targeted next-generation sequencing (tNGS), the cause remained unidentified. Adding bronchoalveolar lavage fluid to sense metagenomic next-generation sequencing (mNGS) confirmed the infection caused by actinomycetes. The patient's condition improved after active anti-infection treatment. This case was further analyzed and discussed through a comprehensive literature review, focusing on molecular microbiological diagnosis and treatment processes. The points outlined were as follows: the advancement of molecular microbiology has gradually reduced the challenges associated with diagnosing rare infectious diseases such as pulmonary actinomycosis. Additionally, in immunodeficient individuals, certain infectious diseases with a chronic course may exhibit acute and aggressive characteristics, which is of concern to all colleagues. Currently, tNGS and mNGS are widely employed in clinical settings as practical tools for diagnosing infectious diseases. Notably, these two methods are not substitutes for each other but complement each other.

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Pulmonary actinomycosis is a rare anaerobic infection with non specific clinical and radiographic presentations that delay diagnosis. Throughout literature, a significant number of misdiagnosed cases have been reported. The diagnosis is substantially based on histopathological pattern. We describe the cases of two patients evaluated and treated in pulmonary department 1 of Abderrahmane Mami hospital of Tunisia with a diagnosis of pulmonary actinomycosis. There are two men. The first patient had hypertension and chronic obstructive pulmonary disease and the second one underwent surgery for bronchiectasis. Clinical presentation was consistent with productive cough, hemoptysis, and deterioration of general status. The medical examination was non-specific. The chest X-ray revealed an apical opacity, excavated in the first case and retractable in the second one. Biology showed an inflammatory syndrome. Bronchoscopy was performed in the two cases and showed lesions mimicking lung malignancy. Diagnosis is confirmed by histopathological examinations of surgical specimens in the two cases. Both patients were received antibiotic therapy. The results were excellent with a favorable clinical course and no deaths. This study highlights the misleading patterns of actinomycosis to prompt accurate diagnosis and earlier treatment, thus improving the outcome. Given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice, histological examination of lung tissue specimens is crucial to get the correct diagnosis.

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This case contemplates the unusual presentation, challenging diagnostic workup and conservative therapeutic process of a patient with Actinomyces empyema complicated along the way due to drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The patient was a 40-year-old male, who presented with pleurodynia and fever. Laboratory exams showed elevated inflammatory markers and imaging revealed two biconvex fluid pockets located in the right lower lobe, from which the fluid was positive for Actinomyces meyeri. The initial conservative process with intravenous antibiotics and successful drainage with intrapleural fibrinolysis improved our patient. However, after a few days, the patient's fevers relapsed, and as regress of the empyema was discussed as a complication, he developed a maculopapular symmetrical rash of the trunk and legs accompanied by enlarged lymph nodes, eosinophilia, thrombocytopenia, and atypical lymphocytes. The diagnosis of DRESS syndrome due to antibiotic therapy for actinomyces empyema was established and a balance between bactericidal and immunosuppression medication had to be found. Fortunately, the patient withstood prolonged antibiotic therapy and got fully treated without any relapses.

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BACKGROUND: Actinomycosis by Actinomyces meyeri is rare and scarcely reported in the literature. The lung is the main organ involved. Penicillin and amoxicillin are the first-choice treatments. Surgery is indicated when empyema and abscesses are resistant to medical treatment. CASE PRESENTATION: We report an underdiagnosed case of pleural empyema due to A. meyeri in a patient with closed chest trauma. The patient, a male, 47 years old, presented with a dry cough, thoracic pain, and dyspnea a month after the trauma. A chest X-ray showed a left lower lobe pleural effusion, so he was subjected to a thoracentesis, leading to a partial re-expansion of the left lung. The patient also complained about gum discomfort; thus, a dental x-ray scan was taken, which showed the presence of vertical bone resorption in a periodontal pocket. The patient was treated with levofloxacin 500 mg orally once a day, which was continued for 15 days after discharge. Two months after the accident, he presented again with intermittent fever, a worsening cough, and dyspnea. A CT scan showed thickening of the left pleura and a loculated pleural effusion with partial collapse of the left lower lobe. A decision was made to refer the patient to the Thoracic Unit to undergo surgery via a left thoracoscopic uniportal approach. The lung was thoroughly decorticated, and the purulent fluid was aspirated. The postoperative course was uneventful. Cultures showed the growth of Actinomyces meyeri, which is sensitive to imipenem and amoxicillin. The patient started a proper antibiotic regimen and, whenever possible, was discharged. At 12 months follow-up, a chest X-ray showed a complete resolution of the left pleural effusion with complete re-expansion of the left lung. CONCLUSIONS: Although rare, Actinomycetes infections must be considered especially in front of non-solving empyema or severe pneumonia of unknown cause because in the majority of cases, with the proper treatment, the restitutio ad integrum is possible.

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Background: Actinomadura geliboluensis was first isolated in 2012 in Gelibolu, Canakkale, Turkey, and has not been reported to be isolated from humans until now. We have isolated it from the bronchoalveolar lavage fluid (BLF) of a patient with pneumonia and found its drug resistance. It is the first time that Actinomadura geliboluensis has been isolated from humans since its discovery and naming. This case may provide new ideas and methods for the clinical diagnosis and treatment of pulmonary actinomycosis. Case Description: The patient was a 75-year-old male who was hospitalized in a township hospital and failed to improve after penicillin treatment. After admission to our hospital, the patient was treated with piperacillin/tazobactam according to clinical guidelines for 14 days. Actinomadura geliboluensis was isolated from the patient's BLF and was identified by 16S rRNA sequencing. This report shows the biological characteristics and in vitro drug susceptibility testing, as well as the genomics analysis based on next-generation sequencing (NGS). The results demonstrated that Actinomadura geliboluensis was easy to be mistakenly identified as Actinomyces dental caries by using the Merieux ANC identification card. Based on the MIC test, Actinomadura geliboluensis was susceptible to tetracyclines, quinolones and sulfonamides, but resistant to carbapenems, penicillins and cephalosporins. The K-B test results showed Actinomadura geliboluensis was highly sensitive to piperacillin/tazobactam. Genomic analysis based on NGS showed that the Actinomadura geliboluensis belongs to Planobispora rosea EF-Tu mutants conferring resistance to inhibitor GE2270A, AAC(3)-VIIa, vanRO, chrB, and mexY. Conclusion: Actinomycetes is generally sensitive to Penicillin but Actinomadura geliboluensis is not. In vitro drug susceptibility test is needed to support individualized drug use to avoid delay in the disease.

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Pulmonary actinomycosis is an uncommon and challenging infectious disease with non-specific symptoms and imaging findings. The authors report a case of a 68-year-old man with diabetes and a history of past smoking who presented with anorexia and weight loss with no significant findings on physical examination. A parenchymal consolidation in the anterior segment of the right upper lobe was detected after a chest computed tomography (CT). Bacterial colonies of Actinomyces species were identified in the histology of transbronchial biopsy. Imaging reassessment after six weeks of treatment with oral amoxicillin showed progression with a high metabolism 10.5 standardized uptake value (SUV) documented on the f-fluorodeoxyglucose positron emission tomography/CT. Concern about the possibility of lung cancer was raised and ruled out by a negative transthoracic needle biopsy. The diagnosis of pulmonary actinomycosis with pyogenic superinfection was presumed. The patient was successfully treated with intravenous amoxicillin and clavulanate for two weeks, followed by six months of oral treatment.

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The role of a bronchoalveolar lavage sample cell block in the diagnosis of pulmonary actinomycosis.

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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.

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 Actinomycosis is a chronic inflammatory infectious disease that can affect various organ systems. Pulmonary actinomycosis is an exceptionally uncommon clinical occurrence that yet deserves special attention, as it closely mimics a broad spectrum of infectious and neoplastic lung pathologies. The non-specific nature of its clinical features and radiological appearances makes early diagnosis quite challenging. The authors reported a 25-year-female with poorly controlled diabetes mellitus and morbid obesity who presented with a one-week history of unilateral, right-sided, pleuritic chest pain and shortness of breath. Chest imaging revealed a suspicious right hilar soft tissue mass encasing the right upper lobe bronchus with post-obstructive atelectasis. Transbronchial biopsy revealed suppurative granulomatous inflammation, and anaerobic cultures from the bronchial tissues grew Actinomyces species that were identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) technique. A long course of penicillin-based antibiotics was employed, and follow-up imaging revealed a satisfactory response to the antimicrobial therapy. This case demonstrates that microbiological examination is imperative to accurately diagnose the etiology of suspicious lung masses in young immunocompromised hosts. It also proves the diagnostic value of the MALDI-TOF technique in the early identification of Actinomyces species.

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Background: Pulmonary actinomycosis (PA), a chronic indolent infection, is a diagnostic challenge. Actinomyces graevenitzii is a relatively rare Actinomyces species isolated from various clinical samples. Case Presentation: A 47-year-old patient presented with a 3-month history of mucopurulent expectoration and dyspnea and a 3-day history of fever up to 39.0°C. He had dental caries and a history of alcoholism. Computed tomography (CT) images of the chest revealed a consolidation shadow in the right upper and middle lobes, with necrosis containing foci of air. Actinomyces graevenitzii was isolated from bronchoalveolar lavage fluid (BALF) culture and was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. He received treatment with intravenous piperacillin-sulbactam for 10 days and oral amoxicillin-clavulanate for 7 months. His clinical condition had considerably improved. The consolidation shadow was gradually absorbed. Conclusion: Early diagnosis and treatment of pulmonary actinomycosis are crucial. Bronchoscopy plays a key role in the diagnostic process, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) is an accurate tool for Actinomyces identification.

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Pulmonary actinomycosis is a common clinical infection caused by Actinomyces species. Although its treatment is very effective with Intravenous (IV) antibiotics, its diagnosis is challenging and easily missed. Organizing Pneumonia (OP) can be cryptogenic or secondary to different clinical diseases. Herein, we discuss a case of acute hypoxemic respiratory failure that was found to be due to OP, secondary to pulmonary actinomycosis, with a brief review of the literature. A 64-year-old male presented with acute hypoxemic respiratory failure two days after undergoing elective right total hip arthroplasty. Chest imaging with CT scan showed symmetric bilateral ground-glass opacities most pronounced within the upper lung lobes. The patient was treated initially with IV diuresis, steroids, and broad-spectrum antibiotics. However, his clinical status continued to worsen and his chest imaging showed worsening lung opacities. Video-assisted thoracoscopic lung biopsy (VATS) was done, and pathology results showed features of organizing pneumonia. Tissue culture confirmed Actinomyces species. The patient had clinical improvement after treatment with IV methylprednisolone and IV penicillin G. Pulmonary actinomycosis is very rarely associated with OP but this bacterial infection should always be in the differential diagnosis when OP is confirmed as the treatment is effective with IV antibiotics.

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INTRODUCTION: Pulmonary actinomycosis due to Actinomyces Odontolyticus is a rare and seldom reported pathology in pediatrics. The unspecific radio-clinical symptomatology and the slow growth of the germ make the diagnosis difficult. CASE REPORT: A 2-year-old boy is admitted to the emergency room for acute respiratory distress in a context of febrile bronchitis that had been evolving for 10days. Quickly, the patient's state deteriorate, invasive ventilation was required. Bronchial fibroscopy was performed immediately and enabled extraction of large mucous filaments, leading to significant improvement. Mechanical ventilation was stopped after 72hours. Five days later, blood culture tested positive for Actinomyces Odontolyticus. In the absence of any other cause and given a compatible clinical picture, the child was treated with long-term antibiotherapy for a total duration of 6months, which was stopped following reassuringly normal endoscopic and radiological control. CONCLUSIONS: This is the second pediatric case of pulmonary actinomycosis due to A. Odontolyticus reported in the literature. The clinical symptoms and imaging are not specific. The presence of sulphide granules on pathological examination or in germ culture at a sterile site confirms the diagnosis. Prolonged antibiotic therapy is still recommended to avoid pulmonary sequels.

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Clinical data of a case of occult pulmonary actinomycosis with foreign body admitted to Shenzhen Children′s Hospital were retrospectively analyzed, and the relevant literatures were retrieved and reviewed.A female patient aged 6 years and 9 months planned to receive hematopoietic stem cell transplantation due to thalassemia.During the plain chest CT examination before the transplantation, flakes of shadows were examined in the right lower lung.The child had no clinical symptoms or pulmonary signs.The granulation tissue hyperplasia of the right lower lobe was detected by tracheoscopy, which was harvested for examination under tracheoscopy, and actinomycete infection was confirmed.Several bone fragments were found wrapped inside the granulation.After 6 months of treatment with Amoxicillin and Clavulanate potassium, the tracheoscopic manifestations and chest CT were improved.Pulmonary actinomycosis is a rare pulmonary infectious disease, which is much rarer in children than adults, manifesting as an insidious onset and atypical clinical manifestations.However, foreign bodies in children′s airway are common, which is favorable to infection.In clinical detection of actinomycete infection, the cause of infection should be concerned to prevent misdiagnosis and mistreatment.

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Isolated pulmonary actinomycosis is a rare entity. Its clinical features and radiological findings are nonspecific, making early diagnosis difficult for clinicians. We report a case of 40-year-old nonsmoker, immunocompetent male without an underlying structural lung disease who presented to us with recurrent hemoptysis and was diagnosed to have Actinomycosis after multiple readmissions.

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Background: Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract; it consists of a nonfunctioning mass of lung tissue that is irrigated by an anomalous systemic artery. The association with Actinomyces superinfection has not been well established. Methods: We present the case of a 35-year-old woman with a history of recurrent episodes of pneumonia. Based on radiological and histopathological examination, she was diagnosed with intralobar bronchopulmonary sequestration associated with Actinomyces infection. Promoting clinical suspicion is essential to diagnose pulmonary actinomycosis in patients with recurrent pneumonia, to improve early recognition and timely management.

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Pulmonary actinomycosis (PA) is an uncommon pulmonary infectious disease that often is misdiagnosed. Metagenomic next-generation sequencing (mNGS) is a highly sensitive and culture-independent new molecular technology for precise infectious disease diagnosis. Here we report a PA case diagnosed by the combination of a radial endobronchial-ultrasonography guide sheath (R-EBUS-GS) and mNGS, along with a brief review of the literature.

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