Introduction:
Actinomycosis is a rare chronic infection caused by gram positive, filamentous facilities anaerobic bacteria from Actinomyces species. There are four subtypes of actinomycosis infection including: cervical-oral (60%), abdominal (20%), thoracic (15%) and pelvic (5%). Pulmonary Actinomycosis present a diagnostic challenge for clinicals and is often misdiagnosed for malignancy. Though rare untreated pulmonary disease but can be fatal due to risk of pulmonary empyema. This literature review to assess the presentation and management of pulmonary empyema secondary to actinomycosis infection.
Methods:
This review was performed across three databases including Pubmed, Medline and Embase. The following search terms were used; “pulmonary actinomycosis” AND “empyema”. A language restriction to English papers was applied and no date limit was applied. There were eight English case reports in the literature of complicated empyema pulmonary actinomycosis world-wide.
Results:
The seven cases included five males and three females between the age of 44 and 71. All cases presented with a slow progressing empyema formation but two. Two of the eight had known immunosuppression, while others had risk factors such a dental abscess, seizures and aspiration. Half of the patients required surgical intervention including pneumectomy and the other cases were managed with chest drains. All patients received a penicillin derived antibiotic therapy ranging from 6-12 months. One of the eight cases resulted in mortality.
Conclusion:
Though rare, clinicians should be aware of the different forms pulmonary actinomycosis can present from, chronic unresolving pulmonary infection to rapid empyema. The presence of pathognomonic yellow sulphur granules, sinus tracts on the chest wall and poor response to antimicrobials should raise suspicion of Actinomycosis. Gold standard diagnosis includes tissue sample histological and microbiological examination. Percutaneous drainage and chest drain insertion should be used as first line management when appropriate. Surgery (or percutaneous management) should be performed in conjunction with antimicrobial therapy as surgical management alone is rarely successful. Suggest antibiotic therapy includes high-dose penicillin antibiotics, intravenous for 2-6 weeks and then oral for 6-12 months. Appropriate treatment decreases morbidity and mortality in 98% of patients. A high level of suspicion and active diagnosis can help prevent pulmonary and cardiac complications, improve morbidity and mortality.