It is characterised by the formation of painful abscesses in the mouth, lungs, or digestive organs. These abscesses grow larger as the disease progresses, often over a period of months. In severe cases, the abscesses may break through bone and muscle to the skin, where they break open and leak large amounts of pus.

Occurrences

Actinomycosis occurs in cattle and other animals as a disease called lumpy jaw. This name refers to the large abscesses that grow on the head and neck of the infected animal.

Causes

Actinomycosis is caused by any of several members of a group of bacteria called actinomyces. These bacteria are anaerobes - that is, they cannot survive in the presence of large amounts of oxygen. Actinomyces normally live in the small spaces between the teeth and gums. They cause infection only when they can multiply freely in places where oxygen cannot reach them. The three most common sites of infection are decayed teeth, the lungs, and the intestines.

Treatment

Doctors use penicillin to treat actinomycosis.

Sources of Information

World Book encyclopedia.

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Endobronchial actinomycosis associated with a pistachio nutshell
From CHEST, 10/1/05 by Manish Joshi

INTRODUCTION: Endobronchial actinomycosis is a rare condition often associated with a foreign body aspiration. We report such a case in a 45-year-old man who presented with dyspnea and cough. Bronchoscopy revealed a mass obstructing the bronchus intermedius and biopsy of the lesion revealed actinomycosis. On repeat bronchoscopy after 4 weeks of antimicrobial treatment, a pistachio nut shell was seen and successfully removed.

CASE PRESENTATION: A 45-year-old man, who never smoked, presented with dyspnea and cough that was attributed to worsening asthma. He had no other symptoms. There was no history of cerebrovascular event, swallowing difficulty, dental or periodontal problem. He had a clinical diagnosis of asthma for 9 years. He was treated with inhaled steroids and bronchodilators and oral corticosteroid without relief of his symptoms. On examination his vital signs were normal and oxygen saturation by pulse oximetry was 97%. No lymphadenopathy or dubbing was detected. Auscultation of the lung fields showed wheezing more prominent on the right side. The rest of his physical examination was unremarkable. Laboratory results revealed normal complete blood count and serum chemistries. Chest radiograph showed nonspecific right sided parechymal infiltrate. Computed tomography (CT) of the chest revealed marked narrowing of the bronchus intermedius, bronchiectasis of the right lower lobe with an infiltrate. Fiberoptic bronchoscopy revealed an endobronchial mass causing near total occlusion of the bronchus intermedius with severe mucosal inflammation and edema, mimicking endobronchial carcinoma. The bronchial mucus membrane was very friable and bled easily. Endobronchial biopsy revealed large multiple colonies of Actinomyces sp. ("sulphur granules") surrounded with inflammatory cells (Fig 1). He had allergy to penicillin. Intravenous ceftriaxone via an indwelling catheter was started. Bronchoscopy repeated 4 weeks after antibiotic treatment revealed a pistachio nutshell lodged in the bronchus intermedius (Fig 2) which was successfully removed using endobronchial biopsy forceps. Two weeks after bronchoscopic removal of the nutshell the patient was completely free of symptoms. He was continued on antibiotic for 3 months.

[FIGURES 1-2 OMITTED]

DISCUSSIONS: Actinomycosis is most frequently caused in humans by Actinomyces israelii and the usual route of lung infection is by aspiration of oropharyngeal or gastrointestinal secretions. Endobronchial actinomycosis is a rare form of pulmonary actinomycosis most often associated with foreign body aspiration. Chouabe et al reported the largest series of endobronchial actinomycosis cases in predominantly men with known risk factors--poor dental hygiene and debilitation--for actinomycosis (1). The presenting symptoms in these patients were cough, hemoptysis and recurrent pneumonia. The initial bronchoscopy findings in all the cases revealed endobronchial mass obstructing the bronchial lumen suggestive of malignancy. Foreign body was detected during initial bronchoscopy in 50% of cases; chicken bone being most common. Our case differs from previously reported cases. Our patient is young, without debilitation or predisposing conditions. Our literature review did not reveal any previous case of endobronchial actinomycosis associated with pistachio nutshell aspiration. However our patient is similar to the cases cited previously in having an endobronchial mass mimicking tumor.

CONCLUSION: In conclusion, endobronchial actinomycosis associated with foreign body aspiration is a rare cause of endobronchial mass and atelectasis. In our patient, prominent wheezing on the right side and CT finding of a nearly occluded bronchus intermedius raised the diagnostic consideration of bronchogenic carcinoma. Histopathologic examination confirmed the diagnosis of actinomycosis. The important learning point in this case is the importance of repeating fiberoptic bronchoscopy after few weeks of antibiotic therapy to specifically look for foreign body which may be missed on the initial bronchoscopy.

REFERENCE:

(1) Chouabe, S, Perdu, D, Deslee, C, et al (2002) Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest 121, 2069-2072

DISCLOSURE: Manish Joshi, None.

Manish Joshi MD * Sunil Sharma MD Basil Varkey MD Kavita Mundey MD William O'Neil MD Valarie Bonne MD Lee Hranicka RRT Veterans Affairs Medical Center and Medical College of Wisconsin, Milwaukee, WI

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