Materiały źródłowe

• #1 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4094581/

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #2 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. […] Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. […] However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #3 Actinomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482151/

  Actinomycosis is generally not diagnosed until the chronic phase. […] The diagnosis can be difficult, as isolation of the organism requires prolonged bacterial culture under anaerobic conditions. […] The gold standard test for diagnosis is tissue biopsy culture with anaerobic pus cultures. […] Cultures can be falsely negative; gram-stain may demonstrate the presence of branched, beaded, gram-positive filamentous rods with sulfur granules, which helps in making a preliminary diagnosis. […] The characteristic of the disease is the yellow sulfur granules. […] The most appropriate specimen is a tissue biopsy of the infected site or pus. […] For better results, the clinician should note their suspicion for the infection to the microbiologist or pathologist. This will ensure anaerobic cultures are performed for prolonged time frames to ensure an optimal growth environment.

• #4 Actinomycosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/actinomycosis

  Actinomycosis is suspected clinically and confirmed by identification of A. israelii or other Actinomyces species using microscopy and culture of sputum (ideally obtained endoscopically), pus, or a biopsy specimen. […] The laboratory must be notified that actinomycosis is suspected because special procedures are required to isolate and identify these organisms. […] Lesions in any location may simulate malignant growths. Lung lesions must be distinguished from those of TB and cancer. Most abdominal lesions occur in the ileocecal region and are difficult to diagnose, except during laparotomy or when draining sinuses appear in the abdominal wall.

• #5 Actinomycosis: Microbiology, epidemiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/actinomycosis-microbiology-epidemiology-clinical-manifestations-and-diagnosis

  Actinomycosis: Microbiology, epidemiology, clinical manifestations, and diagnosis […] The microbiology, pathophysiology, epidemiology, clinical sites of infection, and diagnosis of actinomycosis will be reviewed here. […] Actinomycosis has two unique characteristics that distinguish it from other infections. […] The presence of either of these findings should prompt immediate suspicion of actinomycosis. […] A hallmark of actinomycosis is the tendency to spread without regard for anatomical barriers (including tissue planes or lymphatic drainage). […] This is often noted on imaging where a mass is seen aggressively crossing anatomic tissue planes. […] The term „sulfur granule” is a misnomer, reflecting only the yellow color of the granule in pus, since they are not composed of any sulfur at all.

• #6 Actinomycosis: Microbiology, epidemiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/actinomycosis-microbiology-epidemiology-clinical-manifestations-and-diagnosis

  The granules are actually discrete macroscopic grains of hard consistency, 100 to 1000 mcm in diameter, often visible to the naked eye or by microscopy with low magnification (10x). […] When to suspect actinomycosis […] Approach to diagnosis […] Obtain specimens for testing […] Sending specimens for testing […] Establishing a diagnosis […] Incidental finding on culture or histology.

• #7 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  Because actinomycosis is difficult to diagnose based on the typical clinical features, direct identification and/or isolation of the infecting organism from a clinical specimen or from sulfur granules is necessary for definitive diagnosis in most cases. […] Acceptable specimen material is obtained from draining sinuses, deep needle aspirate, or biopsy specimens; swabs, sputum, and urine specimens are unacceptable or inappropriate. […] A Gram-stained smear of the specimen may demonstrate the presence of beaded, branched, gram-positive filamentous rods, suggesting the diagnosis of actinomycosis. […] Cultures should be placed immediately under anaerobic conditions and incubated for 48 hours or longer; the isolation and definitive identification of actinomycetes may require 2-3 weeks. […] Current serologic tests have no role in diagnosing actinomycosis.

• #8 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  The most appropriate clinical specimens are tissue from surgical biopsy or pus; swabs must be avoided. […] Finally, clinicians should indicate suspicion for actinomycosis to the microbiologist to ensure that prolonged culture on appropriate media and in an appropriate atmosphere is performed. […] Gram staining of pus and pathology of infected tissue is of great interest for the diagnosis of actinomycosis, as it is usually more sensitive than culture, which remains sterile in more than 50% of cases. […] These findings are highly suggestive of the diagnosis but are not specific, as they can be encountered in other pathogenic conditions such as nocardiosis or chronic cervicofacial fungal infections. […] The gold standard for diagnosing pulmonary actinomycosis is histological examination and bacterial culture of a lung biopsy, obtained by percutaneous biopsy guided by CT scan or by open surgical resection.

• #9 Actinomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482151/

  Actinomycosis is generally not diagnosed until the chronic phase. […] The diagnosis can be difficult, as isolation of the organism requires prolonged bacterial culture under anaerobic conditions. […] The gold standard test for diagnosis is tissue biopsy culture with anaerobic pus cultures. […] Cultures can be falsely negative; gram-stain may demonstrate the presence of branched, beaded, gram-positive filamentous rods with sulfur granules, which helps in making a preliminary diagnosis. […] The characteristic of the disease is the yellow sulfur granules. […] The most appropriate specimen is a tissue biopsy of the infected site or pus. […] For better results, the clinician should note their suspicion for the infection to the microbiologist or pathologist. This will ensure anaerobic cultures are performed for prolonged time frames to ensure an optimal growth environment.

• #10 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  Because actinomycosis is difficult to diagnose based on the typical clinical features, direct identification and/or isolation of the infecting organism from a clinical specimen or from sulfur granules is necessary for definitive diagnosis in most cases. […] Acceptable specimen material is obtained from draining sinuses, deep needle aspirate, or biopsy specimens; swabs, sputum, and urine specimens are unacceptable or inappropriate. […] A Gram-stained smear of the specimen may demonstrate the presence of beaded, branched, gram-positive filamentous rods, suggesting the diagnosis of actinomycosis. […] Cultures should be placed immediately under anaerobic conditions and incubated for 48 hours or longer; the isolation and definitive identification of actinomycetes may require 2-3 weeks. […] Current serologic tests have no role in diagnosing actinomycosis.

• #11 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  Because actinomycosis is difficult to diagnose based on the typical clinical features, direct identification and/or isolation of the infecting organism from a clinical specimen or from sulfur granules is necessary for definitive diagnosis in most cases. […] Acceptable specimen material is obtained from draining sinuses, deep needle aspirate, or biopsy specimens; swabs, sputum, and urine specimens are unacceptable or inappropriate. […] A Gram-stained smear of the specimen may demonstrate the presence of beaded, branched, gram-positive filamentous rods, suggesting the diagnosis of actinomycosis. […] Cultures should be placed immediately under anaerobic conditions and incubated for 48 hours or longer; the isolation and definitive identification of actinomycetes may require 2-3 weeks. […] Current serologic tests have no role in diagnosing actinomycosis.

• #12 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4094581/

  A Gram stain of the specimen is usually more sensitive than culture, especially if the patient had received antibiotics. Actinomyces are non-spore-forming Gram-positive rods. […] The gold standard for diagnosing pulmonary actinomycosis is histological examination and bacterial culture of a lung biopsy, obtained by percutaneous biopsy guided by CT scan or by open surgical resection. […] The diagnosis is mainly based on stereotaxic aspiration of pus, revealing Actinomyces spp. in cultures and sulfur granules in pathology. […] The main implication for physicians in enhancing the care of patients with actinomycosis is to be aware of the different clinical forms of actinomycosis. Indeed, the diagnosis is crucial for an accurate diagnosis, by using specific culture media that allow the growth of Actinomyces spp. and looking for sulfur granules.

• #13 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  Because actinomycosis is difficult to diagnose based on the typical clinical features, direct identification and/or isolation of the infecting organism from a clinical specimen or from sulfur granules is necessary for definitive diagnosis in most cases. […] Acceptable specimen material is obtained from draining sinuses, deep needle aspirate, or biopsy specimens; swabs, sputum, and urine specimens are unacceptable or inappropriate. […] A Gram-stained smear of the specimen may demonstrate the presence of beaded, branched, gram-positive filamentous rods, suggesting the diagnosis of actinomycosis. […] Cultures should be placed immediately under anaerobic conditions and incubated for 48 hours or longer; the isolation and definitive identification of actinomycetes may require 2-3 weeks. […] Current serologic tests have no role in diagnosing actinomycosis.

• #14 Actinomycosis: Diagnosis, Clinical Features and Treatment | IntechOpen

  https://www.intechopen.com/chapters/82972

  Imaging studies such as CT scan and MRI are nonspecific and nondiagnostic, specially at the earlier stages of the disease as other inflammatory diseases and neoplastic processes such as lung and intestinal cancer may show similar findings. […] Histopathological findings strongly support the diagnosis of Actinomycosis. […] Identification of the organism from a sterile specimen confirms diagnosis, but failure rates are high due to inhibition of Actinomycosis growth by a coexistent/contaminant organism, the previous use of antibiotic therapy or inadequate incubation period. […] Culture growth is slow, with the earliest identification done as a minimum of 5 days, but may take up to 20 days to be identified. […] Actinomycosis culture should be performed on chocolate agar media at 37 degrees Celsius, as well as brain heart infusion broth and Brucella Blood Agar with vitamin K and hemin.

• #15 Actinomycosis: Diagnosis, Clinical Features and Treatment | IntechOpen

  https://www.intechopen.com/chapters/82972

  Imaging studies such as CT scan and MRI are nonspecific and nondiagnostic, specially at the earlier stages of the disease as other inflammatory diseases and neoplastic processes such as lung and intestinal cancer may show similar findings. […] Histopathological findings strongly support the diagnosis of Actinomycosis. […] Identification of the organism from a sterile specimen confirms diagnosis, but failure rates are high due to inhibition of Actinomycosis growth by a coexistent/contaminant organism, the previous use of antibiotic therapy or inadequate incubation period. […] Culture growth is slow, with the earliest identification done as a minimum of 5 days, but may take up to 20 days to be identified. […] Actinomycosis culture should be performed on chocolate agar media at 37 degrees Celsius, as well as brain heart infusion broth and Brucella Blood Agar with vitamin K and hemin.

• #16 Actinomycosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/actinomycosis

  Actinomycosis is suspected clinically and confirmed by identification of A. israelii or other Actinomyces species using microscopy and culture of sputum (ideally obtained endoscopically), pus, or a biopsy specimen. […] The laboratory must be notified that actinomycosis is suspected because special procedures are required to isolate and identify these organisms. […] Lesions in any location may simulate malignant growths. Lung lesions must be distinguished from those of TB and cancer. Most abdominal lesions occur in the ileocecal region and are difficult to diagnose, except during laparotomy or when draining sinuses appear in the abdominal wall.

• #17 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  The most appropriate clinical specimens are tissue from surgical biopsy or pus; swabs must be avoided. […] Finally, clinicians should indicate suspicion for actinomycosis to the microbiologist to ensure that prolonged culture on appropriate media and in an appropriate atmosphere is performed. […] Gram staining of pus and pathology of infected tissue is of great interest for the diagnosis of actinomycosis, as it is usually more sensitive than culture, which remains sterile in more than 50% of cases. […] These findings are highly suggestive of the diagnosis but are not specific, as they can be encountered in other pathogenic conditions such as nocardiosis or chronic cervicofacial fungal infections. […] The gold standard for diagnosing pulmonary actinomycosis is histological examination and bacterial culture of a lung biopsy, obtained by percutaneous biopsy guided by CT scan or by open surgical resection.

• #18 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4094581/

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #19 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. […] Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. […] However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #20 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. […] Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. […] However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #21 Thoracic actinomycosis – EMCrit Project

  https://emcrit.org/ibcc/actinomycosis/

  Culture samples should ideally be obtained with a protected brush and delivered to the lab under anaerobic conditions. […] In practice, culture confirmation of Actinomyces is obtained in only a minority of cases. […] Actinomycosis may coexist with malignancy. In some cases, necrotic malignancy may represent an initial nidus of superinfection with Actinomyces. Therefore, the presence of actinomycosis doesn’t necessarily exclude the possibility of underlying malignancy.

• #22 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  Because actinomycosis is difficult to diagnose based on the typical clinical features, direct identification and/or isolation of the infecting organism from a clinical specimen or from sulfur granules is necessary for definitive diagnosis in most cases. […] Acceptable specimen material is obtained from draining sinuses, deep needle aspirate, or biopsy specimens; swabs, sputum, and urine specimens are unacceptable or inappropriate. […] A Gram-stained smear of the specimen may demonstrate the presence of beaded, branched, gram-positive filamentous rods, suggesting the diagnosis of actinomycosis. […] Cultures should be placed immediately under anaerobic conditions and incubated for 48 hours or longer; the isolation and definitive identification of actinomycetes may require 2-3 weeks. […] Current serologic tests have no role in diagnosing actinomycosis.

• #23 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/actinomycosis-2/

  Actinomyces spp. are microaerophilic and grow best when cultured anaerobically. This can be difficult for many clinical laboratories. […] Culture of an actinomycete from affected site is the gold standard of diagnosis. This is challenging for several reasons. […] Finding characteristic organisms by pathology or by staining of sulfur granules may not give a species level diagnosis, but can be quick and easy as compared to culture. In practice, this is often how the infection is diagnosed. […] Serologic tests for the agents of actinomycosis are appealing, but their utility is limited. False positive and false negative results are common. […] Polymerase chain reaction (PCR) tests for actinomycosis are not commercially available but might be helpful in the future. […] Making a diagnosis of actinomycosis is very helpful since the duration of therapy for this disease is longer than most other bacterial infections.

• #24 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  The relationship between a Papanicolaou test that is positive for actinomycetelike organisms and the eventual development of pelvic actinomycosis is unclear. […] Because of the lack of sensitivity and specificity and low positive predictive value, the prognostic significance of detecting Actinomyces organisms is minimal in the absence of concomitant symptoms. […] CT scan or ultrasound-guided fine-needle aspiration and/or biopsy have been used successfully to obtain clinical material for diagnosis of actinomycosis. […] Actinomycosis is characterized by mixed suppurative and granulomatous inflammatory reactions, connective-tissue proliferation, and the presence of sulfur granules. The sulfur granules are nearly pathognomonic for actinomycosis, although similar findings have been reported with infections caused by Nocardia brasiliensis, Streptomyces madurae, and Staphylococcus aureus presenting as botryomycosis.

• #25 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  The relationship between a Papanicolaou test that is positive for actinomycetelike organisms and the eventual development of pelvic actinomycosis is unclear. […] Because of the lack of sensitivity and specificity and low positive predictive value, the prognostic significance of detecting Actinomyces organisms is minimal in the absence of concomitant symptoms. […] CT scan or ultrasound-guided fine-needle aspiration and/or biopsy have been used successfully to obtain clinical material for diagnosis of actinomycosis. […] Actinomycosis is characterized by mixed suppurative and granulomatous inflammatory reactions, connective-tissue proliferation, and the presence of sulfur granules. The sulfur granules are nearly pathognomonic for actinomycosis, although similar findings have been reported with infections caused by Nocardia brasiliensis, Streptomyces madurae, and Staphylococcus aureus presenting as botryomycosis.

• #26 Diagnosis of Actinomycosis in the Physician’s Clinic | IntechOpen

  https://www.intechopen.com/chapters/82015

  Microbiological assessment of the tissue specimens is often braised with challenges. It is generally difficult to obtain bacteriological identification of Actinomyces as a result of various factors. […] Histopathological sections of affected tissue may depict abscesses and sinuses in the midst of mixed inflammatory cell infiltrate and fibrotic changes. […] The diagnosis of Pelvic Actinomycosis is of equal perplexity, with patients often presenting with nonspecific symptoms (lower abdominal or suprapubic pain, weight loss, vaginal discharge, and low-grade fever if at all). […] It is the authors view that actinomycosis remains a diagnosis of exclusion, therefore this calls for a high index of clinical suspicion, and an astute physician for the successful diagnosis and management therein.

• #27 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. […] Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. […] However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #28 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. […] Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. […] Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. […] The bacteriological identification of Actinomyces from a sterile site confirms the diagnosis of actinomycosis. […] However, isolation and identification of these causative bacteria occur in only a minority of cases; the failure rate of culture is high because of previous antibiotic therapy, inhibition of Actinomyces growth by concomitant and/or contaminant microorganisms, inadequate culture conditions, or inadequate short-term incubation.

• #29 Diagnosis of Actinomycosis in the Physician’s Clinic | IntechOpen

  https://www.intechopen.com/chapters/82015

  Human actinomycosis is an unusual but insidiously chronic granulomatous bacterial infection caused by Actinomyces genera. […] Due to its insidious chronicity and rarity, human actinomycosis is often misdiagnosed for other more common conditions such as tuberculosis and even malignancy. […] In clinical practice, the diagnosis of actinomycosis requires a physician to be highly suspicious of the disease. […] The diagnosis often rests in the physicians highest index of suspicion. Once such a suspicion is raised, then necessary investigations should be undertaken. A tissue sample is always necessary for the diagnosis that almost always depends on a combination of clinical and characteristic histopathological features. […] The gold standard diagnostic method is through a tissue sample plus clinical correlation in some cases. Tissue biopsy must be performed usually with two separate specimens. One specimen should be sent for microbiological microscopy, culture and sensitivity for confirmation, or to exclude other possible infections that could mimic the actinomycosis. The second specimen is then sent for histopathological sectioning and assessment.

• #30 Actinomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482151/

  The imaging for actinomycosis is nonspecific. […] The gold standard test is a histological examination and bacterial culture of a biopsy, which can be obtained with bronchoscopy (pulmonologist), a CT-guided biopsy (interventional radiologist), or video-assisted thoracoscopic surgery (VATS) performed by a thoracic surgeon. […] The best test is a culture of the infected site.

• #31 Actinomycosis: Diagnosis, Clinical Features and Treatment | IntechOpen

  https://www.intechopen.com/chapters/82972

  Imaging studies such as CT scan and MRI are nonspecific and nondiagnostic, specially at the earlier stages of the disease as other inflammatory diseases and neoplastic processes such as lung and intestinal cancer may show similar findings. […] Histopathological findings strongly support the diagnosis of Actinomycosis. […] Identification of the organism from a sterile specimen confirms diagnosis, but failure rates are high due to inhibition of Actinomycosis growth by a coexistent/contaminant organism, the previous use of antibiotic therapy or inadequate incubation period. […] Culture growth is slow, with the earliest identification done as a minimum of 5 days, but may take up to 20 days to be identified. […] Actinomycosis culture should be performed on chocolate agar media at 37 degrees Celsius, as well as brain heart infusion broth and Brucella Blood Agar with vitamin K and hemin.

• #32 Actinomycosis: Diagnosis, Clinical Features and Treatment | IntechOpen

  https://www.intechopen.com/chapters/82972

  Imaging studies such as CT scan and MRI are nonspecific and nondiagnostic, specially at the earlier stages of the disease as other inflammatory diseases and neoplastic processes such as lung and intestinal cancer may show similar findings. […] Histopathological findings strongly support the diagnosis of Actinomycosis. […] Identification of the organism from a sterile specimen confirms diagnosis, but failure rates are high due to inhibition of Actinomycosis growth by a coexistent/contaminant organism, the previous use of antibiotic therapy or inadequate incubation period. […] Culture growth is slow, with the earliest identification done as a minimum of 5 days, but may take up to 20 days to be identified. […] Actinomycosis culture should be performed on chocolate agar media at 37 degrees Celsius, as well as brain heart infusion broth and Brucella Blood Agar with vitamin K and hemin.

• #33 Actinomycosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/actinomycosis/

  Suspected cases based on the clinical presentation (e.g., presence of sulfur granules) can be confirmed via identification of the organism from tissue specimen (e.g., pus, biopsy tissue from suspected lesion) or sulfur granules. […] Definitive diagnosis is based on the identification of actinomycotic sulfur granules or bacteria. […] Culture (confirmatory test) […] Microscopy: direct visualization and staining of specimen accumulations of radially protruding and branching Actinomyces (conglomerates with a cauliflower-like appearance) that are surrounded by numerous granulocytes […] CT scan: assists in the identification of the exact location, extent of pathology, and/or guiding percutaneous aspiration of pus.

• #34 Actinomycosis in the Mandible: CT and MR Findings | American Journal of Neuroradiology

  https://www.ajnr.org/content/35/2/390

  The visualization of actinomycotic granules in exudates or in histopathologic tissue sections is strongly supportive of the diagnosis. […] In our study, all lesions had ill-defined, infiltrative margins with surrounding soft tissue inflammatory response that extended to the skin. […] Soft tissue fistula/sinus tract formation and intralesional gas were seen in 4 of 6 patients; these findings are useful to differentiate actinomycosis from other infection. […] MR imaging has higher accuracy in the detection of inflammatory and infiltrative changes in the surrounding soft tissue extending to the skin, particularly in the muscles of mastication, though visualization of gas is challenging. […] Although bone marrow signal changes of MA were similar to osteomyelitis secondary to other causes, very extensive soft tissue inflammatory and infiltrative changes in the surrounding soft tissues extending to the skin may be useful in the differentiation of actinomycosis from osteomyelitis due to other causes.

• #35 Actinomycosis in the Mandible: CT and MR Findings | American Journal of Neuroradiology

  https://www.ajnr.org/content/35/2/390

  Absence of lymphadenopathy may be suggestive of MA rather than other acute or chronic infections or malignant tumors, particularly in patients with extensive soft tissue changes with fistula formation. […] CT and MR imaging findings of MA were reviewed. Characteristics imaging findings including the presence of intralesional gas, osteolytic changes with extensive inflammatory changes in the surrounding soft tissue extending to the skin surface, fistula formation, and absence of lymphadenopathy were frequently seen and are helpful in narrowing the differential diagnosis.

• #36 Cervicofacial actinomycosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cervicofacial-actinomycosis?lang=us

  Cervicofacial actinomycosis is the most frequent manifestation of Actinomyces infection 1,2. […] Although tissue culture is an accurate diagnostic method for cervicofacial actinomycosis, it is limited due to the prolonged incubation and difficulty growing Actinomyces. […] Actinomycosis is treated with a prolonged course of Penicillin G, however, treatment is often tailored to individual cases.

• #37 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Diagnosis can be difficult, and especially making a distinction between neoplastic conditions, malignant hemopathy, and other cervicofacial infections such as nocardiosis or mycobacterial infections. […] The gold standard for diagnosing cervicofacial actinomycosis is histological examination and bacterial culture of an abscess or of a suspected bone, if osteomyelitis is suspected. […] In patients with odontogenic cervicofacial actinomycosis, prescription of oral antimicrobials is common before surgery, leading frequently to false negative results of the cultures. […] In typical cases, ie, especially in patients with lumpy jaw syndrome, Actinomyces spp. have always been targeted by antimicrobial therapy, regardless of the results of microbiological cultures or the result of pathology.

• #38 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Diagnosis can be difficult, and especially making a distinction between neoplastic conditions, malignant hemopathy, and other cervicofacial infections such as nocardiosis or mycobacterial infections. […] The gold standard for diagnosing cervicofacial actinomycosis is histological examination and bacterial culture of an abscess or of a suspected bone, if osteomyelitis is suspected. […] In patients with odontogenic cervicofacial actinomycosis, prescription of oral antimicrobials is common before surgery, leading frequently to false negative results of the cultures. […] In typical cases, ie, especially in patients with lumpy jaw syndrome, Actinomyces spp. have always been targeted by antimicrobial therapy, regardless of the results of microbiological cultures or the result of pathology.

• #39 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  Diagnosis can be difficult, and especially making a distinction between neoplastic conditions, malignant hemopathy, and other cervicofacial infections such as nocardiosis or mycobacterial infections. […] The gold standard for diagnosing cervicofacial actinomycosis is histological examination and bacterial culture of an abscess or of a suspected bone, if osteomyelitis is suspected. […] In patients with odontogenic cervicofacial actinomycosis, prescription of oral antimicrobials is common before surgery, leading frequently to false negative results of the cultures. […] In typical cases, ie, especially in patients with lumpy jaw syndrome, Actinomyces spp. have always been targeted by antimicrobial therapy, regardless of the results of microbiological cultures or the result of pathology.

• #40

  https://journals.lww.com/md-journal/fulltext/2016/06140/clinical_features_of_actinomycosis__a.61.aspx

  The clinical picture was misinterpreted as malignancies or other infectious diseases, such as tuberculosis, pyogenic abscesses, and nocardiosis. […] Our study highlights the miscellaneous clinical patterns of actinomycosis, and the essential differential diagnoses are discussed below according to main anatomical forms. […] As shown in our study, clinical symptoms and imaging lack of specificity to definite the disease, thus biopsy should be performed in cases when actinomycosis is considered as differential diagnosis. […] The proportion (46%) and composition of concomitant microbial flora were consistent with the literature. […] Thus, the length of treatment is controversial and further studies are needed. […] Earlier diagnosis should then be obtained, preventing complicated forms and improving the outcome of actinomycosis while decreasing costly unnecessary investigations.

• #41 Actinomycosis in the Mandible: CT and MR Findings | American Journal of Neuroradiology

  https://www.ajnr.org/content/35/2/390

  The visualization of actinomycotic granules in exudates or in histopathologic tissue sections is strongly supportive of the diagnosis. […] In our study, all lesions had ill-defined, infiltrative margins with surrounding soft tissue inflammatory response that extended to the skin. […] Soft tissue fistula/sinus tract formation and intralesional gas were seen in 4 of 6 patients; these findings are useful to differentiate actinomycosis from other infection. […] MR imaging has higher accuracy in the detection of inflammatory and infiltrative changes in the surrounding soft tissue extending to the skin, particularly in the muscles of mastication, though visualization of gas is challenging. […] Although bone marrow signal changes of MA were similar to osteomyelitis secondary to other causes, very extensive soft tissue inflammatory and infiltrative changes in the surrounding soft tissues extending to the skin may be useful in the differentiation of actinomycosis from osteomyelitis due to other causes.

• #42 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4094581/

  A Gram stain of the specimen is usually more sensitive than culture, especially if the patient had received antibiotics. Actinomyces are non-spore-forming Gram-positive rods. […] The gold standard for diagnosing pulmonary actinomycosis is histological examination and bacterial culture of a lung biopsy, obtained by percutaneous biopsy guided by CT scan or by open surgical resection. […] The diagnosis is mainly based on stereotaxic aspiration of pus, revealing Actinomyces spp. in cultures and sulfur granules in pathology. […] The main implication for physicians in enhancing the care of patients with actinomycosis is to be aware of the different clinical forms of actinomycosis. Indeed, the diagnosis is crucial for an accurate diagnosis, by using specific culture media that allow the growth of Actinomyces spp. and looking for sulfur granules.

• #43 Actinomycosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482151/

  The imaging for actinomycosis is nonspecific. […] The gold standard test is a histological examination and bacterial culture of a biopsy, which can be obtained with bronchoscopy (pulmonologist), a CT-guided biopsy (interventional radiologist), or video-assisted thoracoscopic surgery (VATS) performed by a thoracic surgeon. […] The best test is a culture of the infected site.

• #44 Thoracic actinomycosis – EMCrit Project

  https://emcrit.org/ibcc/actinomycosis/

  Actinomycosis is a chronic infection with a tendency to dissect across tissue planes, in a fashion which often mimics cancer. It is frequently misdiagnosed initially. […] Culture may be difficult, since Actinomyces species are anaerobic. Consequently, diagnosis may depend on histopathological evaluation. […] Diagnosis is generally made based on the microscopic identification of sulfur granules (masses of bacterial filaments). […] However, sulfur granules may also be caused by Nocardia, Coccidioides, and Aspergillus. […] This usually requires a histologic biopsy, but collection of purulent material draining from a sinus tract may also be adequate. […] Bronchoscopy is frequently nondiagnostic, unless endobronchial disease is present (histologic exam of tissue may confirm the diagnosis; more on this below).

• #45 Thoracic actinomycosis – EMCrit Project

  https://emcrit.org/ibcc/actinomycosis/

  Culture samples should ideally be obtained with a protected brush and delivered to the lab under anaerobic conditions. […] In practice, culture confirmation of Actinomyces is obtained in only a minority of cases. […] Actinomycosis may coexist with malignancy. In some cases, necrotic malignancy may represent an initial nidus of superinfection with Actinomyces. Therefore, the presence of actinomycosis doesn’t necessarily exclude the possibility of underlying malignancy.

• #46 Actinomycosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/actinomycosis

  Actinomycosis is suspected clinically and confirmed by identification of A. israelii or other Actinomyces species using microscopy and culture of sputum (ideally obtained endoscopically), pus, or a biopsy specimen. […] The laboratory must be notified that actinomycosis is suspected because special procedures are required to isolate and identify these organisms. […] Lesions in any location may simulate malignant growths. Lung lesions must be distinguished from those of TB and cancer. Most abdominal lesions occur in the ileocecal region and are difficult to diagnose, except during laparotomy or when draining sinuses appear in the abdominal wall.

• #47 Thoracic actinomycosis – EMCrit Project

  https://emcrit.org/ibcc/actinomycosis/

  Culture samples should ideally be obtained with a protected brush and delivered to the lab under anaerobic conditions. […] In practice, culture confirmation of Actinomyces is obtained in only a minority of cases. […] Actinomycosis may coexist with malignancy. In some cases, necrotic malignancy may represent an initial nidus of superinfection with Actinomyces. Therefore, the presence of actinomycosis doesn’t necessarily exclude the possibility of underlying malignancy.

• #48 Actinomycosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/actinomycosis

  Actinomycosis is suspected clinically and confirmed by identification of A. israelii or other Actinomyces species using microscopy and culture of sputum (ideally obtained endoscopically), pus, or a biopsy specimen. […] The laboratory must be notified that actinomycosis is suspected because special procedures are required to isolate and identify these organisms. […] Lesions in any location may simulate malignant growths. Lung lesions must be distinguished from those of TB and cancer. Most abdominal lesions occur in the ileocecal region and are difficult to diagnose, except during laparotomy or when draining sinuses appear in the abdominal wall.

• #49 Actinomycosis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/211587-overview

  Actinomycosis is a subacute-to-chronic bacterial infection caused by filamentous, gram-positive, nonacid-fast, anaerobic-to-microaerophilic bacteria. […] Diagnosis is usually established postoperatively, following exploratory laparotomy for a suspected malignancy. […] When actinomycosis is diagnosed early and treated with appropriate antibiotic therapy, the prognosis is excellent. […] The more advanced and complicated actinomycotic forms require aggressive antibiotic and surgical therapy for optimal outcome; however, deaths can occur despite such therapy. […] Cervicofacial Actinomycosis: Diagnosis and Management.

• #50 Diagnosis of Actinomycosis in the Physician’s Clinic | IntechOpen

  https://www.intechopen.com/chapters/82015

  Microbiological assessment of the tissue specimens is often braised with challenges. It is generally difficult to obtain bacteriological identification of Actinomyces as a result of various factors. […] Histopathological sections of affected tissue may depict abscesses and sinuses in the midst of mixed inflammatory cell infiltrate and fibrotic changes. […] The diagnosis of Pelvic Actinomycosis is of equal perplexity, with patients often presenting with nonspecific symptoms (lower abdominal or suprapubic pain, weight loss, vaginal discharge, and low-grade fever if at all). […] It is the authors view that actinomycosis remains a diagnosis of exclusion, therefore this calls for a high index of clinical suspicion, and an astute physician for the successful diagnosis and management therein.

• #51 Actinomycosis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/211587-workup

  The relationship between a Papanicolaou test that is positive for actinomycetelike organisms and the eventual development of pelvic actinomycosis is unclear. […] Because of the lack of sensitivity and specificity and low positive predictive value, the prognostic significance of detecting Actinomyces organisms is minimal in the absence of concomitant symptoms. […] CT scan or ultrasound-guided fine-needle aspiration and/or biopsy have been used successfully to obtain clinical material for diagnosis of actinomycosis. […] Actinomycosis is characterized by mixed suppurative and granulomatous inflammatory reactions, connective-tissue proliferation, and the presence of sulfur granules. The sulfur granules are nearly pathognomonic for actinomycosis, although similar findings have been reported with infections caused by Nocardia brasiliensis, Streptomyces madurae, and Staphylococcus aureus presenting as botryomycosis.

• #52 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/actinomycosis-3/

  In these institutions, partial sequencing of the 16s ribosomal RNA (rRNA) gene has become the reference method for bacterial identification. Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry is a promising method that can accurately identify Actinomyces at the genus level; however, 16s rRNA sequencing remains the preferred technique for precise species identification.

• #53 The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02744-z

  CNS actinomycosis is a rare chronic suppurative infection with non-specific clinical features. Diagnosis is difficult due to its similarity to malignancy, nocardiosis and other granulomatous diseases. […] The diagnosis of CNS disease was made by characteristic histopathological findings and culture. In 55% of patients, actinomycosis was identified in culture. […] The molecular diagnosis was established in 12 cases by MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization-Time of Flight), PCR and 16S RNA sequencing methods. […] The demonstration of characteristic sulfur granules also supports the diagnosis of actinomycosis though it can also be seen in nocardiosis and botryomycosis. […] The exact antimicrobial regimen and duration of therapy are not well defined in actinomycosis. […] We recommend at least 36 months of antibiotics in CNS actinomycosis, which can be extended if an adequate clinical response is not achieved or source control (surgery) is not possible.

• #54 The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02744-z

  The clinical significance of polymicrobial infection and the need for antibiotics for other co-isolates is still debatable, it should be decided on case-to-case basis. […] Early suspicion and differentiation from tuberculosis, nocardiosis and malignancy is vital to improve outcomes. The diagnostic utility of molecular methods could be helpful in such settings.

• #55 Actinomycosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24981-actinomycosis

  Actinomycosis is an infection with Actinomyces bacteria. Providers treat it with high doses of antibiotics over several months. […] A healthcare provider diagnoses actinomycosis based on your symptoms and by taking a sample of fluid or tissue. A pathologist uses a microscope to look for Actinomyces or the granules it causes in the sample. […] Actinomycosis is rare and can look similar to other conditions, like cancer. Sometimes, it can take a long time to diagnose it.

• #56

  https://journals.lww.com/md-journal/fulltext/2016/06140/clinical_features_of_actinomycosis__a.61.aspx

  Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. […] We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. […] In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). […] This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. […] In the literature, most reported cases of actinomycosis are not suspected at the clinical onset of the symptoms.

• #57

  https://journals.lww.com/md-journal/fulltext/2016/06140/clinical_features_of_actinomycosis__a.61.aspx

  Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. […] We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. […] In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). […] This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. […] In the literature, most reported cases of actinomycosis are not suspected at the clinical onset of the symptoms.

• #58 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/actinomycosis-3/

  Actinomycosis is often called the great masquerader of the head and neck. Prompt diagnosis is difficult because of the lack of clinical symptoms. […] The principal method of diagnosis is by detection of sulfur granules, Grams stain, and histopathologic examination. Serologic tests and direct fluorescent antibody staining techniques have been used at times, but they lack sensitivity, specificity, and widespread availability. Imaging studies can be obtained to delineate the abscess limits and extension for surgical planning. […] The principal diagnostic methods are not suitably specific; diagnostic confirmation comes via microbiological culture. Unfortunately, the failure rate is high for a number of reasons: prior antibiotic therapy, overgrowth of other bacteria, or inadequate sample collection.

• #59

  https://journals.lww.com/md-journal/fulltext/2016/06140/clinical_features_of_actinomycosis__a.61.aspx

  Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. […] We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. […] In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). […] This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. […] In the literature, most reported cases of actinomycosis are not suspected at the clinical onset of the symptoms.

• #60

  https://journals.lww.com/md-journal/fulltext/2016/06140/clinical_features_of_actinomycosis__a.61.aspx

  Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. […] We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. […] In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). […] This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. […] In the literature, most reported cases of actinomycosis are not suspected at the clinical onset of the symptoms.

• #61 Renal Actinomycosis, A Rare Diagnosis Which Can Clinically Mimic a Malignancy, Case Report and Review of the Literature

  https://brieflands.com/articles/apid-13049

  Actinomycosis is difficult to diagnose due to its non-specific clinical findings and near similarity to other inflammatory and tumoral conditions. […] Early diagnosis is important for medical treatment and decrease of un-necessary surgery. Using auxiliary diagnostic methods can be helpful in this aspect. Percutaneous core needle biopsy or fine needle aspiration possesses higher accuracy and specificity in comparison with other methods. […] Accurate diagnosis is essential for choosing appropriate treatment modality and subsequent successful treatment outcome. […] An early and accurate diagnosis is crucial for gaining the best medical care. […] Accurate diagnosis is essential for early medical treatment and avoiding unnecessary surgery.

• #62

  https://journals.lww.com/md-journal/fulltext/2016/06140/clinical_features_of_actinomycosis__a.61.aspx

  The clinical picture was misinterpreted as malignancies or other infectious diseases, such as tuberculosis, pyogenic abscesses, and nocardiosis. […] Our study highlights the miscellaneous clinical patterns of actinomycosis, and the essential differential diagnoses are discussed below according to main anatomical forms. […] As shown in our study, clinical symptoms and imaging lack of specificity to definite the disease, thus biopsy should be performed in cases when actinomycosis is considered as differential diagnosis. […] The proportion (46%) and composition of concomitant microbial flora were consistent with the literature. […] Thus, the length of treatment is controversial and further studies are needed. […] Earlier diagnosis should then be obtained, preventing complicated forms and improving the outcome of actinomycosis while decreasing costly unnecessary investigations.

• #63 Actinomycosis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/211587-overview

  Actinomycosis is a subacute-to-chronic bacterial infection caused by filamentous, gram-positive, nonacid-fast, anaerobic-to-microaerophilic bacteria. […] Diagnosis is usually established postoperatively, following exploratory laparotomy for a suspected malignancy. […] When actinomycosis is diagnosed early and treated with appropriate antibiotic therapy, the prognosis is excellent. […] The more advanced and complicated actinomycotic forms require aggressive antibiotic and surgical therapy for optimal outcome; however, deaths can occur despite such therapy. […] Cervicofacial Actinomycosis: Diagnosis and Management.

• #64 Actinomycosis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/211587-overview

  Actinomycosis is a subacute-to-chronic bacterial infection caused by filamentous, gram-positive, nonacid-fast, anaerobic-to-microaerophilic bacteria. […] Diagnosis is usually established postoperatively, following exploratory laparotomy for a suspected malignancy. […] When actinomycosis is diagnosed early and treated with appropriate antibiotic therapy, the prognosis is excellent. […] The more advanced and complicated actinomycotic forms require aggressive antibiotic and surgical therapy for optimal outcome; however, deaths can occur despite such therapy. […] Cervicofacial Actinomycosis: Diagnosis and Management.

• #65 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  The treatment of choice is a prolonged course of oral amoxicillin. […] The traditional prolonged course of up to 6-12 months of treatment can likely be shortened if an optimal surgical resection of infected tissues has been performed, in the absence of bone involvement, and if a satisfactory patient response to treatment is rapidly observed. […] The main implication for physicians in enhancing the care of patients with actinomycosis is to be aware of the different clinical forms of actinomycosis. Indeed, the diagnosis is crucial for an accurate diagnosis, by using specific culture media that allow the growth of Actinomyces spp. and looking for sulfur granules.

• #66 Actinomycosis: etiology, clinical features, diagnosis, treatment, and | IDR

  https://www.dovepress.com/actinomycosis-etiology-clinical-features-diagnosis-treatment-and-manag-peer-reviewed-fulltext-article-IDR

  The treatment of choice is a prolonged course of oral amoxicillin. […] The traditional prolonged course of up to 6-12 months of treatment can likely be shortened if an optimal surgical resection of infected tissues has been performed, in the absence of bone involvement, and if a satisfactory patient response to treatment is rapidly observed. […] The main implication for physicians in enhancing the care of patients with actinomycosis is to be aware of the different clinical forms of actinomycosis. Indeed, the diagnosis is crucial for an accurate diagnosis, by using specific culture media that allow the growth of Actinomyces spp. and looking for sulfur granules.

• #67 Actinomycosis: etiology, clinical features, diagnosis, treatment, and management – SEARCH

  https://primo.qatar-weill.cornell.edu/discovery/fulldisplay/cdi_hal_primary_oai_HAL_hal_01908879v1/974WCMCIQ_INST:VU1

  Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. Preventive measures, such as reduction of alcohol abuse and improvement of dental hygiene, may limit occurrence of pulmonary, cervicofacial, and central nervous system actinomycosis. In women, intrauterine devices must be changed every 5 years in order to limit the occurrence of pelvic actinomycosis.

• #68 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/actinomycosis-2/

  The suggestion that initial intravenous treatment is necessary has been challenged in several case series including one from Korea with 28 patients treated for thoracic actinomycosis. […] A review of the treatment of cervicofacial actinomycosis supported penicillin as the drug of choice with a treatment duration of 2-12 months.

• #69 Actinomycosis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/actinomycosis-2/

  The suggestion that initial intravenous treatment is necessary has been challenged in several case series including one from Korea with 28 patients treated for thoracic actinomycosis. […] A review of the treatment of cervicofacial actinomycosis supported penicillin as the drug of choice with a treatment duration of 2-12 months.

• #70 The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02744-z

  CNS actinomycosis is a rare chronic suppurative infection with non-specific clinical features. Diagnosis is difficult due to its similarity to malignancy, nocardiosis and other granulomatous diseases. […] The diagnosis of CNS disease was made by characteristic histopathological findings and culture. In 55% of patients, actinomycosis was identified in culture. […] The molecular diagnosis was established in 12 cases by MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization-Time of Flight), PCR and 16S RNA sequencing methods. […] The demonstration of characteristic sulfur granules also supports the diagnosis of actinomycosis though it can also be seen in nocardiosis and botryomycosis. […] The exact antimicrobial regimen and duration of therapy are not well defined in actinomycosis. […] We recommend at least 36 months of antibiotics in CNS actinomycosis, which can be extended if an adequate clinical response is not achieved or source control (surgery) is not possible.

• #71 The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02744-z

  The clinical significance of polymicrobial infection and the need for antibiotics for other co-isolates is still debatable, it should be decided on case-to-case basis. […] Early suspicion and differentiation from tuberculosis, nocardiosis and malignancy is vital to improve outcomes. The diagnostic utility of molecular methods could be helpful in such settings.

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