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A 26-year-old female with a history of preterm labor and cerclage placement presented at 29 weeks gestation. Twin girls were delivered at 2917 weeks. Twin A presented with clinical sepsis at birth. Twin A's blood cultures became positive for Actinomyces species on day of life 15. Despite aggressive medical management twin A died at 35 days of life.
This report describes a rare case of a pyogenic brain stem abscess. The lesion was readily identified by computed tomographic (CT) scan and magnetic resonance imaging (MRI). Streptococcus anginosus was grown from the pus and Actinomyces colonies were found on histopathology. The lesion was successfully treated with stereotactic surgery and antibiotic therapy. A review of the relevant literature including the role of stereotaxy in the treatment of the brain stem abscess is discussed. Copyright 1999 Harcourt Publishers Ltd.
A case of multiple cerebral abscesses caused by actinomyces is reported in a 37 year old male with mucoepidermoid carcinoma of the right lung. In conjunction with penicillin, sulfonamide and erythromycin, the patient underwent stereotactic surgery for aspiration of the brain abscesses under (CT). The bacteria, considered to originate from the right lung, were identified from the abscess material obtained at surgery. Using proper therapy to control infection and intracranial pressure is important. A lon g term follow up with frequent computerised tomography evaluation has been conducted and the patient outcome has been successful recovery.
A 79 years old patient developed a large pulmonary aspergilloma in the cavities of his right upper lobe after postinfarctional pneumonia with local abscess formation. The clinical follow-up was characterized by recurrent hemoptysis resulting in marked anemia as well as by a continuous growth of the mycetoma. Suddenly a purulent gangrene of the whole upper lobe occurred infected by actinomyces israelii and staphylococcus but not aspergillus as it could be demonstrated in specimens from repeated transthoracic needle aspirations. After percutaneously inserted chest-tube drainage during 30 days the upper lobe cavity cleared up and the previously impressive aspergilloma had disappeared completely, however, the serum precipitins from aspergillus fumigatus still remained positive. After a course of several months without further pulmonary complications the patient finally died from a ruptured aortic aneurysm. It is suggested, that the spontaneous lysis of the aspergilloma was due to a deprivation of it' nutritive basis by the infected pulmonary tissue. A similar mechanism may also account for a sometimes successful treatment of pulmonary aspergilloma after injection of an amphotericin containing paste as a novel therapeutic strategy which is recommended in the case of patient's inoperable conditions.
A cat was presented to a veterinary clinic with a severe pleural effusion from which an organism later identified as an Actinomyces spp., probably A. odontolyticus, was isolated along with Bacteroides melanogenicus. It was successfully treated with surgical drainage and a combination of amoxycillin and sulphadiazine/trimethoprim. The fluid was cytologically examined to obtain a provisional diagnosis and to allow treatment to be initiated while the organisms were cultured and identified. The cat is now clinically normal except for slight abdominal respiration, presumably resulting from adhesions following the severe infection.
OBJECTIVE: External fixation can be used for stabilization of the spine in salvage cases, especially in cases of infection of the spine. The advantages of this method are avoiding the needs for internal fixation devices and for postoperative bracing. The literature on this is scant. Reported is a rare case of osteomyelitis of the D2 vertebra with an epidural abscess caused by Actinomyces israelii that spread from the lung and was treated by decompression and external fixation. METHODS: A 51-year-old man with right upper lobe pneumonia due to A. israelii coccobacillus developed osteomyelitis of the D2 vertebra and an epidural abscess with a gradual paraparesis. He underwent a laminectomy of D1-D3 and 3 weeks later stabilization of the upper thoracic spine using a tubular external fixator that was inserted from C7-D1 to D3-D4. The patient was treated with antibiotic intravenously and later orally. After 2 months, the external fixator was removed. RESULTS: At the last follow-up, the patient had no fever, the erythrocyte sedimentation rate and C-reactive protein level had normal values, and there was only a slight limitation in the range of motion of the cervical paraparesis. Radiography and magnetic resonance imaging demonstrated stabilization of the affected segment without any sign of active osteomyelitis. There were no complications associated with the use of the external fixator. CONCLUSIONS: The use of external fixation offers an appropriate alternative for stabilization of the spine as a salvage procedure. The procedure could be performed easily and without any major complications. Especially for the treatment of complicated cases of spinal infection, the use of an external fixator can be of great benefit.
Arcanobacterium (Actinomyces) pyogenes, a causative agent of various pyogenic diseases in domestic animals, produces a hemolysin which is thought to be an important virulence factor. This hemolysin was purified from the culture supernatant of A. pyogenes swine isolate. The purified hemolysin showed a single band with a molecular mass of 56 kDa on SDS-polyacrylamide gel electrophoresis, and its isoelectric point was 9.2. The activity of this hemolysin was not enhanced by the addition of L-cysteine or sodium thioglycolate, but it was inhibited by cholesterol. The gene encoding the hemolysin was cloned, sequenced and expressed in Escherichia coli by means of ZAP Express vector. Analysis by SDS-polyacrylamide gel electrophoresis with immunoblotting showed that the molecular weight of the hemolysin expressed in E. coli is the same as that of the hemolysin purified from A. pyogenes. Nucleotide sequence analysis revealed an open reading frame of 1,605 bp encoding a 534 amino acid protein of 57,989 Da. The nucleotide sequence of the hemolysin gene from A. pyogenes swine isolate differed only slightly (97.6% identity) from the sequence of plo gene from A. pyogenes strain BBR1 reported by Billington et al (J. Bacteriol. 179: 6100-6106, 1997). The cysteine residue existed in the undecapeptide region of the hemolysin, which is highly conserved in thiol-activated cytolysins (cholesterol-binding cytolysins), and is replaced with alanine. Therefore, the hemolysin of A. pyogenes seems to be a novel member of the thiol-activated cytolysin family.
A total of 1919 cervical cytology smears from South Galmorgan family planning clinic patients were studied and actinomyces-like structures were identified in 38. All 38 were from women reported as having an intrauterine contraceptive device (IUCD) and they represent 25 per cent of the 147 women in the whole study who were reported as having an IUCD. There was no evidence of pelvic infection or significant increase in gynaecological problems amongst these 38 women, but there was a significant increase in atypical and dyskaryotic cells in the cervical smears.
A case of brain abscess involving Haemophilus paraphrophilus and Actinomyces odontolyticus is presented. This combination of organisms has not previously been described. All brain abscess specimens should routinely be processed rapidly and cultured for a prolonged period to ensure recovery of fastidious organisms which may have implications for antibiotic therapy.
Four cows were inoculated into the uterus with Actinomyces pyogenes between 30 and 41 days of gestation. Gross morphological changes were monitored by rectal palpation and with a realtime B-mode two-dimensional scanner with a 7.5 MHz transrectal linear transducer, shortly before infection and afterwards at three to 12 hours intervals. Two control groups of cows 27 to 50 days pregnant were used: two cows were inoculated with 6 ml of sterile saline into the uterine lumen and four cows were treated with cloprostenol (prostaglandin F2 alpha analogue). There was a change in the uterine fluid from a black, non-echogenic image before infection to a grey or cloudy echogenic image as early as 21 hours after infection. There was an increase in the thickness of the endometrium of the horns and body of the uterus. The embryonic membranes thickened and separated from the endometrium as early as four hours after infection, followed by cessation of the embryonic heart beat, opening of the cervix and abortion. Abortion was followed by an increase in the amount of echogenic intrauterine fluid leading to an increase in the size of the uterus, and the cervix remained open for at least eight days. The area of the corpus luteum remained greater than 2 cm2 throughout the whole period. Intrauterine inoculation with sterile saline had no effects, but the administration of cloprostenol was followed by the death of the embryo and abortion within 72 hours, and the regression of the corpus luteum from greater than 2 cm2 at treatment to 0.4 cm2, 24 hours after abortion.(ABSTRACT TRUNCATED AT 250 WORDS)
A 31-year-old man had back pain, weight loss, fever, and paraplegia, with radiographic evidence of a left upper lobe lesion and lytic lesions in ribs and vertebral bodies. Gallium uptake was increased over the spine. At surgery we found a paraspinal abscess due to Actinomyces israelii. The patient responded to surgery and penicillin therapy. This is the first report of a case of actinomycotic spinal epidural abscess necessitating emergency surgery since the advent of penicillin.
We present the first case of mediastinitis and the third case of pneumonia attributed to Actinomyces odontolyticus. The first patient presented 10 months after single-lung transplant with a subacute apical infiltrate in the native lung and responded to therapy with oral penicillin. The second patient developed pyogenic mediastinitis 25 days after a heart-lung transplant and required sternal debridement and intravenous penicillin. We also review the literature on thoracopulmonary infections due to A odontolyticus.
Actinomyces israelii is a rare cause of pericarditis. Infection spreads to pericardium from an intrathoracic focus. Branching gram-positive filaments are seen on microscopic examination of clinical specimens. Cultures should be performed under anaerobic conditions. Both surgical drainage and antibiotics (penicillin) are required for treatment. Nocardiosis may resemble actinomycosis in many respects.
We have previously reported that the sonicate extrast from Actinomyces viscosus T 14 V (Av. sup) causes polyclonal B cell activation (PBA) in murine splenic B cells without any T cell assistance. However, there are some reports describing T cell dependency of PBA induced by A. viscosus in human peripheral blood B cells, and it is still controversial whether or not A. viscosus has the capability of exhibiting PBA without the help of T cells. In this report, we examined PBA in human peripheral blood B cells using the same Av. sup which induced T cell independent PBA in murine splenic B cells. The PBA was evaluated in terms of immunoglobulin (Ig) production by means of micro-ELISA method and cell proliferation by incorporation of 3H-TdR after incubation of cells for 5 or 7 days with Av. sup. Human peripheral blood B cells were highly purified by the following methods; The peripheral blood was collected by venipuncture and the peripheral blood mononuclear cells were harvested using gradient centrifugations. These cells were passed through a Sephadex G-10 column, and T cells were eliminated by rosette formation with sheep red blood cells. B cells were highly purified from these T cell-depleted cell populations by panning method with anti-human Ig antibody coated dishes followed by complement-dependent cytotoxisity using monoclonal antibody cocktails consisting of OKT 3, OKT 4 and OKT 8. These highly purified B cells could not respond to T cell mitogens such as PHA.(ABSTRACT TRUNCATED AT 250 WORDS)
Biochemical mutants of Actinomyces griseus producing grisin were obtained under the action of chemical mutagens. The mutants were divided into 2 groups. The mutants with impaired synthesis of amino acids of the aspartic acid family, i.e. lysine, homoserine and methionine were included into the 1st group. The 2nd group included the mutants with impaired synthesis of the other amino acids, i.e. histidine, arginine, tyrosine, phenylalanine and valine. The antibiotic production level in the biochemical mutants was studied. It was found that the level of the antibiotic production was decreased in most of the biochemical mutants. A necessity for increased fonds of lysine and arginine for biosynthesis of grisin was shown.
The course of actinomycetic infections in two females with IUD is presented. Both patients needed surgery. Literature review taking into a special consideration laboratory diagnosis has been performed. Infection caused by other than Actinomyces israelii species was observed.
Actinomyces olivaceus and some other actinomycetes accumulate acetoin and 2,3-butanediol in the cultural broth. Addition of cobalt to the medium favours the accumulation of acetoin.
The luminescence of Actinomyces lucensis producing etruscomycin was found to be caused not by the antibiotic but by additional luminescent substances. No direct correlation has been established between the content of the luminescent substances and the intensity of the luminscence. The latter depends on the differentiation of the colonies, i.e. on the presence of a dark layer that screens the luminescence of the colonial mycelium and is localized under the aerial mycelium. The dark layer contains pigments of the melanin type.