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Polymicrobial empyema; a novel case of Actinomyces turicensis.

ABSTRACT: Empyema or infection of the pleural space is a well described complication of pneumonia, however knowledge of culprit pathogens is still evolving. We report a novel case of empyema due to Actinomyces turicensis, a commensal of the oropharynx and female urogenital tract but previously undescribed cause of empyema. We additionally review general pathogenesis of Actinomyces species within the pleural space. Familiarity with this unique pleural infection pathogen is important for selection of adequate antimicrobial therapy given the propensity of anaerobes such as Actinomyces species to disobey anatomic boundaries and recrudescence of infection in the absence of appropriate therapy.

SUBMITTER: Johnson SW

PROVIDER: S-EPMC7935702 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Polymicrobial empyema; a novel case of Actinomyces turicensis.

Johnson Shelsey W SW Billatos Ehab E

Respiratory medicine case reports 20210224

Empyema or infection of the pleural space is a well described complication of pneumonia, however knowledge of culprit pathogens is still evolving. We report a novel case of empyema due to Actinomyces turicensis, a commensal of the oropharynx and female urogenital tract but previously undescribed cause of empyema. We additionally review general pathogenesis of Actinomyces species within the pleural space. Familiarity with this unique pleural infection pathogen is important fo ...[more]

PMID: 33728262

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Project description:BackgroundActinomyces 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.MethodsA 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.ResultsSearch 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.ConclusionsTo 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.

Project description:BackgroundBrain abscesses can occur when suppurative, bacterial or protozoan infections spread to the brain. Here, we report a rare case of Actinomyces meyeri-induced brain abscess in a pregnant woman.Case presentationWe present the case of a 38-years-old primipara admitted to the emergency department at our hospital with a 4-day history of fever and vomiting. The symptoms worsened rapidly during the 8 h prior to admission, and the patient experienced a sudden loss of consciousness 4 h before arrival to the unit. Brain magnetic resonance imaging revealed abnormal signals in the right parietal-temporal lobe, suggesting the possibility of abscess rupture into the ventricle and sulcus. Right lateral ventricle compression and midline structure deviation to the left were noted. A right temporal-occipital mass with midline shift was detected. Emergency procedures were promptly performed, including craniotomy, removal of the right temporal-occipital mass, decompressive craniectomy, implantation of an intracranial pressure monitoring device, and external ventricular drainage. Cerebrospinal fluid culture indicated infection with Actinomyces meyeri. After administration of antibiotics, including linezolid and meropenem injections, along with treatments to decrease intracranial pressure, the patient's vital signs stabilized. However, the patient developed hydrocephalus, requiring placement of a hydrocephalus shunt several months later. Throughout this period, the patient remained in a coma vigil state, and labor was induced for the fetus.ConclusionsAlthough the patient did not present with any apparent predisposing causes for brain abscess, a scout view of CT revealed dental caries. In addition, the occurrence of the brain abscess may have been influenced by the hormonal changes during pregnancy, including increased secretion of estrogen and progesterone, as well as decreased immune function. Early diagnosis and intervention are crucial in such cases. Therefore, it is recommended to seek early medical attention if symptoms such as fever, vomiting, and changes in mental state occur during pregnancy, as the prognosis for both the mother and infant is poor once the abscess ruptures.

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Polymicrobial empyema; a novel case of Actinomyces turicensis.

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Polymicrobial empyema; a novel case of <i>Actinomyces turicensis</i>.

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