Pericarditis, pneumonia and brain abscess due to a combined Actinomyces—Actinobacillus actinomycetemcomitans infection

doi:10.1016/0163-4453(92)93633-2

Journal of Infection

Volume 25, Issue 1, July 1992, Pages 83-87

https://doi.org/10.1016/0163-4453(92)93633-2 Get rights and content

Summary

A patient is described in whom there developed a pulmonary infiltrate and constrictive pericarditis caused by a combined Actinomyces and Actinobacillus actinomycetemcomitans infection, presumably originating from his poor dentition. The diagnosis was only made following repeated thoracotomy. After surgery, long-term treatment with antibiotics led to complete clinical recovery. None the less, some months later he was found to have a brain abscess which resolved during a further course of antibiotics. The variable clinical picture of actinomycosis is discussed, as well as the role of other bacteria frequently associated with actinomycotic infection, in particular Actinobacillus actinomycetemcomitans. The therapeutic implications are described.

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Multiple clinical studies had reported that dental and oral health care reduces the number of oropharyngeal microbes and decreases pneumonia and incidence of nosocomial respiratory tract infections [48,80–82]. Moreover, oral obligate anaerobe and facultative microbes such as Porphyromonas gingivalis, Bacteroides grucilus, Eikenella corrodens, Fusobacterium nucleutum, Fusobacterium necrophorum, Peptostreptococcus, Clostridium, and Actinomyces had been detected in lung of patients with poor oral hygiene [25,74,83]. Aspiration pneumonia is a form of healthcare-acquired pneumonia that increased mortality and cost of care especially in old-age people [84].
The oral cavity (mouth) has various microbial habitats, including, teeth, gingival sulcus, gingiva, tongue, inner cheek, hard palate, and soft palate. The human oral cavity houses the second most diverse microbiome in the body harboring over 700 bacterial species. The fine-tuned equilibrium of the oral microbiome ecosystem maintains oral health. Oral dysbiosis caused by food habits and poor oral hygiene leads to various oral diseases such as periodontitis, caries, gingivitis, and oral cancer. Recent advances in technology have revealed the correlation between the oral microbiome and systemic diseases such as pulmonary diseases, cardiovascular diseases, rheumatoid arthritis, Alzheimer's disease, and other metabolic diseases. Since the oral cavity directly connects with the upper respiratory tract, the oral microbiome has easier access to the respiratory system compared to other organ systems. Direct aspiration of oral microflora in the respiratory system and oral dysbiosis-induced host immune reaction and inflammation are mainly responsible for various pulmonary complications. Numbers of literature have reported the correlation between oral diseases and pulmonary diseases, suggesting the possible role of the oral microbiome in respiratory diseases such as chronic obstructive pulmonary diseases, pneumonia, lung cancer, etc. This paper reviews the current evidence in establishing a link between the oral microbiome and pulmonary diseases. We also discuss future research directions focusing on the oral microbiome to unravel novel therapeutic approaches that could prevent or treat the various pulmonary complications.
Diaphragmatic mass caused by Aggregatibacter actinomycetemcomitams
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A 52-year-old man was evaluated in our outpatient facility because of a thoracic mass for one month. A needle biopsy of the chest mass was performed and microbiological culture showed growth of Aggregatibacter actinomycetemcomitans. Three months after starting antimicrobial therapy, acute phase reactants normalized, and chest CT showed a progressive reduction in the size of the phlegmon. To our knowledge, we report the first case of A. actinomycetemcomitans diaphragmatic and chest wall infection without pulmonary involvement. This supports the theory of hematogenous spread of the germ from oral mucosa to produce thoracic lesions.
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2018, World Neurosurgery
Citation Excerpt :
The striking male sex prevalence is also comparable with published literature.2,4 Cranial and intracranial infections are reported after direct trauma, cervicofacial actinomycosis, or hematogenous spread from systemic infection; local spread from an ear–nose–throat infection1,3,12-23; or without detection of any source1,3 but more often after an unrelated previous cranial intervention.2,3 Several risk factors also have been described—chronic sinusitis/mastoiditis/gingivitis and dental procedures, congenital heart diseases, infected intrauterine devices, and alcoholism.1,9
Actinomycosis is an uncommon chronic suppurative infection that rarely affects the central nervous system (CNS). It is caused by filamentous Gram-positive anaerobic bacteria that is a normal commensal but causes suppurative and granulomatous inflammation after disruption of anatomical barriers. We report the largest series of 17 histologically confirmed cases of CNS actinomycosis and review clinical, imaging, and histopathologic features.
All histologically confirmed cases of CNS actinomycosis diagnosed between January 2010 and June 2016 were retrieved from the neuropathology records. The demographic profile, clinical, radiologic, microbiologic, and histologic features, treatment, and clinical outcomes were reviewed.
Seventeen cases were histopathologically diagnosed to have CNS actinomycosis. Nine of these were primarily admitted and managed in our institute, whereas the remaining 8 were referred to us for histopathologic diagnosis. Mean age at presentation was 31.4 years, with male predilection (3.25:1). Mean duration of symptoms was 2.95 months. Systemic symptoms were noted in 5 patients, although no systemic focus was detectable. Pachymeningitis was most common type (9; 52.94%), and chronic abscess was identified in 7. History of previous surgery for osteomyelitis was forthcoming in 3. All patients underwent surgical excision/aspiration of the lesions. Histologically, lesions revealed characteristic suppurative granulomatous response with giant cells and actinomycotic colonies were detected within necrotic centers. Cultures failed to grow Actinomyces in all. Follow-up data were available in 9 patients managed in our institute, and all had good outcomes at the median follow-up period of 32 months after antibiotic treatment for mean period of 8.4weeks.
Histopathology remains the cornerstone for diagnosis of actinomycosis as on culture confirmation is very rare.
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It is well known that bacteria are the primary cause of infectious diseases, however, evidence is emerging that these organisms are also indirectly responsible for several diseases including cancer and rheumatoid arthritis. The oral cavity is home to several million bacteria that can cause two major diseases-periodontitis and caries. The relationship between periodontopathic bacteria and systemic diseases has been explored for several years. The concept of the oral cavity as a source of distant infection has been debated for at least a century. This review will discuss the historic aspects of the development of the focal infection theory, the reasons for its demise, its re-emergence and current status.
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^§: Present address: Public Health Laboratory, P.O. Box 21020, 8900JA Leeuwarden, The Netherlands.

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Journal of Infection

Summary

References (25)

Hand infection caused by Actinobacillus actinomycetemcomitans

J Hand Surg

Congenital fistula of right coronary artery to right ventricle complicated by Actinobacillus actinomycetemcomitans

J Thorac Cardiovasc Surg

Untersuchungen über menschliche Aktinomycose

Zentralbl Bakteriol (Orig)

Actinomyces and Arachnia species

Cardiac actinomycosis

Dis Chest

Actinomycosis

Actinomycosis of the brain

Can Med Assoc J

Studies on the aetiology of human actinomycosis. 1. The ‘other microbes’ of actinomycosis and their importance

Acta Pathol Scand

A study of 57 cases of actinomycosis over a 36-year period

Arch Intern Med

Actinomycosis: a 24-year experience

South Med J

Primary cutaneous actinomycosis : with note on Bacillus actinomycetemcomitans

Br J Dermatol

Actinobacillus actinomycetemcomitans and Hemophilus aphrophilus

J Infect Dis

Cited by (49)

The role of oral microbiome in respiratory health and diseases

Diaphragmatic mass caused by Aggregatibacter actinomycetemcomitams

Central Nervous System Actinomycosis—A Clinicoradiologic and Histopathologic Analysis

Oral microbiota and systemic disease

Case Report: Pericardial Actinomycosis in a 79-Year-Old Man with Poor Dental Hygiene

Pericardial infiltration and constriction due to cardiac actinomycosis - case report

Case reportPericarditis, pneumonia and brain abscess due to a combined Actinomyces—Actinobacillus actinomycetemcomitans infection

Summary

J Hand Surg

J Thorac Cardiovasc Surg

Untersuchungen über menschliche Aktinomycose

Zentralbl Bakteriol (Orig)

Actinomyces and Arachnia species

Cardiac actinomycosis

Dis Chest

Actinomycosis

Actinomycosis of the brain

Can Med Assoc J

Studies on the aetiology of human actinomycosis. 1. The ‘other microbes’ of actinomycosis and their importance

Acta Pathol Scand

A study of 57 cases of actinomycosis over a 36-year period

Arch Intern Med

Actinomycosis: a 24-year experience

South Med J

Primary cutaneous actinomycosis : with note on Bacillus actinomycetemcomitans

Br J Dermatol

Actinobacillus actinomycetemcomitans and Hemophilus aphrophilus

J Infect Dis

Case report
Pericarditis, pneumonia and brain abscess due to a combined Actinomyces—Actinobacillus actinomycetemcomitans infection