Pierre Isabelle, Zarrouk Virginie, Noussair Latifa, Molina Jean-Michel, Fantin Bruno
Service de Médecine Interne, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, 100 boulevard du général Leclerc, 92110 Clichy, France.
Service de Microbiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.
Int J Infect Dis. 2014 Dec;29:74-9. doi: 10.1016/j.ijid.2014.06.012. Epub 2014 Oct 24.
Actinomycosis is a rare disease favored by disruption of the mucosal barrier. In order to investigate the impact of immunosuppression on outcome we analyzed the most severe cases observed in patients hospitalized in three tertiary care centers.
We reviewed all cases of proven invasive actinomycosis occurring over a 12-year period (1997 to 2009) in three teaching hospitals in the Paris area.
Thirty-three patients (16 male) were identified as having an invasive actinomycosis requiring hospitalization. The diagnosis was made by microbiological identification in 26 patients, pathological examination in eight patients, and by both methods in one. Twenty patients (61%) were immunocompromised. Actinomycosis localization was abdominal or pelvic in 17 patients, thoracic in 11, cervicofacial in three, and neurological in two. Twenty patients (61%) underwent surgery. All strains were susceptible to amoxicillin. All patients were treated with a beta-lactam antibiotic, for a median length of 82 days. Twenty-eight patients (85%) were considered as cured. Overall mortality at hospital discharge was 21% (7/33). Mortality was higher in immunocompromised patients (7/20; 21%) compared to non-immunocompromised patients (0/13) (p=0.027). However, six of seven deaths were directly related to the underlying disease.
Actinomycosis is a cause of severe infection in immunocompromised patients and a surrogate marker of a poor prognosis in this specific population.
放线菌病是一种罕见疾病，黏膜屏障破坏易引发该病。为研究免疫抑制对预后的影响，我们分析了在三家三级医疗中心住院患者中观察到的最严重病例。
我们回顾了巴黎地区三家教学医院在12年期间（1997年至2009年）确诊的所有侵袭性放线菌病病例。
33例患者（16例男性）被确诊为侵袭性放线菌病需住院治疗。26例患者通过微生物鉴定确诊，8例通过病理检查确诊，1例通过两种方法确诊。20例患者（61%）存在免疫功能低下。放线菌病的发病部位为腹部或盆腔17例，胸部11例，颈面部3例，神经系统2例。20例患者（61%）接受了手术治疗。所有菌株对阿莫西林敏感。所有患者均接受β-内酰胺类抗生素治疗，中位疗程为82天。28例患者（85%）被认为治愈。出院时总体死亡率为21%（7/33）。免疫功能低下患者的死亡率（7/20；35%）高于非免疫功能低下患者（0/13）（p=0.027）。然而，7例死亡中有6例与基础疾病直接相关。
放线菌病是免疫功能低下患者严重感染的病因，也是该特定人群预后不良的替代指标。
