Wang Yung-Hsing, Tsai Hung-Chin, Lee Susan Shin-Jung, Mai Ming-Hsin, Wann Shue-Ren, Chen Yao-Shen, Liu Yung-Ching
Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Microbiol Immunol Infect. 2007 Dec;40(6):487-92.
Actinomycosis is an uncommon and frequently misdiagnosed infection that may present as an acute or indolent process. Even when clinical suspicion is high, the disease is commonly confused with other chronic inflammatory diseases and malignancy. An early diagnosis helps the clinician in deciding treatment and can avoid physical morbidity such as unwarranted surgery.
We retrospectively evaluated the histopathology and selected clinical information on all cases of actinomycosis that occurred at Kaohsiung Veterans General Hospital in Taiwan from 1993 to 2005. Data on the demographic characteristics, predisposing conditions, clinical presentations, diagnosis and treatment were analyzed.
A total 36 cases of actinomycosis were identified and evaluated. The mean age of patients was 52.14 +/- 13.28 years, and the male-to-female ratio was 1:1.1. Only three types of actinomycosis were found in this study: cervicofacial, at an incidence of 31%; thoracic (33%); and pelvic (36%). The clinical manifestations depended upon the region of infection; the most frequent presentations of cervicofacial, thoracic and pelvic actinomycosis were cutaneous soft tissue swelling with drainage sinus formation (55%), hemotypsis (75%) and abnormal vaginal spotting (54%), respectively. The most common initial laboratory abnormalities were normochromic anemia (69%) and leukocytosis (25%). While most patients had no history of a foreign body, all pelvic actinomycotic patients had a history of intrauterine device use. Nineteen patients (53%) had no comorbid conditions and 11 patients (31%) had malignancy. Most patients were initially diagnosed as malignancy (56%). All patients with actinomycosis were diagnosed by histopathologic findings. Twenty two patients (61%) were treated by surgery combined with antibiotics, 11 patients (31%) by surgery only and 3 patients (8%) by antibiotics only. No recurrence or mortality occurred.
Actinomycosis should be included in the differential diagnosis when patients present with chronic drainage sinus, chronic hemoptysis and abnormal vaginal spotting with use of intrauterine devices.
放线菌病是一种罕见且常被误诊的感染性疾病，可表现为急性或慢性病程。即便临床高度怀疑，该病仍常与其他慢性炎症性疾病及恶性肿瘤相混淆。早期诊断有助于临床医生确定治疗方案，并可避免诸如不必要手术等身体损害。
我们回顾性评估了1993年至2005年在台湾高雄荣民总医院发生的所有放线菌病病例的组织病理学及部分临床信息。分析了人口统计学特征、易感因素、临床表现、诊断及治疗等数据。
共识别并评估了36例放线菌病病例。患者的平均年龄为52.14±13.28岁，男女比例为1:1.1。本研究仅发现三种类型的放线菌病：颈面部，发病率为31%；胸部（33%）；盆腔（36%）。临床表现取决于感染部位；颈面部、胸部和盆腔放线菌病最常见的表现分别为伴有引流窦形成的皮肤软组织肿胀（55%）、咯血（75%）及异常阴道出血（54%）。最常见的初始实验室异常为正色素性贫血（69%）和白细胞增多（25%）。虽然大多数患者无异物史，但所有盆腔放线菌病患者均有宫内节育器使用史。19例患者（53%）无合并症，11例患者（31%）患有恶性肿瘤。大多数患者最初被诊断为恶性肿瘤（56%）。所有放线菌病患者均通过组织病理学检查确诊。22例患者（61%）接受了手术联合抗生素治疗，11例患者（31%）仅接受了手术治疗，3例患者（8%）仅接受了抗生素治疗。无复发或死亡病例。
当患者出现慢性引流窦、慢性咯血以及使用宫内节育器后出现异常阴道出血时，应将放线菌病纳入鉴别诊断。
