Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
J Mycol Med. 2021 Sep;31(3):101169. doi: 10.1016/j.mycmed.2021.101169. Epub 2021 Jun 19.
Actinomycosis is a rare indolent infectious disease with nonspecific clinical presentations that delay diagnosis. Although actinomycosis is thought to be more prevalent in developing countries, data from developing countries are scarce. This study aimed to profile actinomycosis in developing countries and identify how it differed from profiles of developed countries.
Patients fulfilling the inclusion criteria for actinomycosis from Nanfang Hospital in southern China between January 1999 and December 2018 were retrospectively analyzed. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.
Thirty‑one patients were included in this study. The disease was diagnosed predominately in the orocervicofacial (n = 14), cardiothoracic (n = 11), abdominopelvic (n = 5), and soft tissue (n = 1) regions. Diagnosis was obtained by either histopathology (n = 29, 94%) or microbiology (n = 2, 6%). Only one-third of patients presented with general symptoms, such as fever and weight loss. Ten were lost during follow-up, and the median duration of antibiotic use was 93.5 days (interquartile range 28-300), whereas the median follow-up time was 34 months (interquartile range 9-132). Ten patients receiving complete resection of the lesion were cured without postoperative use of antibiotics. Only one patient relapsed during the follow-up period.
Actinomycosis is a rare disease even in developing countries, and both misdiagnosis and missed diagnosis are common. Diagnosis was often delayed and was obtained postoperatively from histopathology in developing countries. Hence, clinicians should be aware of this disease in patients with high risk factors. In the future, specific molecular methods may help to improve early diagnosis and treatment.
放线菌病是一种罕见的、慢性的传染性疾病，临床表现不具特异性，导致诊断延迟。尽管放线菌病被认为在发展中国家更为普遍，但来自发展中国家的数据却很少。本研究旨在分析发展中国家的放线菌病，并确定其与发达国家的差异。
回顾性分析 1999 年 1 月至 2018 年 12 月期间中国南方南方医院符合放线菌病纳入标准的患者。我们描述了具有临床意义的放线菌病的临床特征、诊断程序、鉴别诊断和治疗。
本研究共纳入 31 例患者。疾病主要发生在口颌面（n=14）、心胸（n=11）、腹盆腔（n=5）和软组织（n=1）区域。诊断主要通过组织病理学（n=29，94%）或微生物学（n=2，6%）获得。仅有三分之一的患者出现发热、体重减轻等全身症状。10 例患者在随访过程中丢失，抗生素使用的中位时间为 93.5 天（四分位间距 28-300），中位随访时间为 34 个月（四分位间距 9-132）。10 例接受病变完全切除的患者未使用抗生素而治愈。仅 1 例患者在随访期间复发。
即使在发展中国家，放线菌病也较为罕见，误诊和漏诊均较为常见。诊断通常延迟，且在发展中国家通过术后组织病理学获得。因此，临床医生应在具有高危因素的患者中注意到这种疾病。未来，特定的分子方法可能有助于提高早期诊断和治疗水平。
