Actinomycosis differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
Actinomycosis most commonly involves face and oral cavity. It rarely infects other organ systems. If involved it has a wide variety of presentation. Most common symptoms of actinomycosis includes abscess with draining sinus tracts. Other symptoms are mostly non-specific for actinomycosis. Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:<ref name="pmid17560191">{{cite journal| author=Yiğiter M, Kiyici H, Arda IS, Hiçsönmez A| title=Actinomycosis: a differential diagnosis for [[appendicitis]]. A case report and review of the literature. | journal=J Pediatr Surg | year= 2007 | volume= 42 | issue= 6 | pages= E23-6 | pmid=17560191 | doi=10.1016/j.jpedsurg.2007.03.057 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560191 }} </ref><ref name="pmid19149697">{{cite journal |vauthors=Hasper D, Schefold JC, Baumgart DC |title=Management of severe abdominal infections |journal=Recent Pat Antiinfect Drug Discov |volume=4 |issue=1 |pages=57–65 |year=2009 |pmid=19149697 |doi= |url=}}</ref><ref name="pmid15342974">{{cite journal |author=Lederman ER, Crum NF |title=A case series and focused review of nocardiosis: clinical and microbiologic aspects |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=300–13 |year=2004|pmid=15342974 |doi= 10.1097/01.md.0000141100.30871.39|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0025-7974&volume=83&issue=5&spage=300}}</ref><ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref><ref name="Humes2006">{{cite journal|last1=Humes|first1=D J|title=Acute appendicitis|journal=BMJ|volume=333|issue=7567|year=2006|pages=530–534|issn=0959-8138|doi=10.1136/bmj.38940.664363.AE}}</ref><ref name="pmid20375357">{{cite journal |vauthors=Saccente M, Woods GL |title=Clinical and laboratory update on blastomycosis |journal=Clin. Microbiol. Rev. |volume=23 |issue=2 |pages=367–81 |year=2010 |pmid=20375357 |pmc=2863359 |doi=10.1128/CMR.00056-09 |url=}}</ref><ref name="Kim2014">{{cite journal|last1=Kim|first1=Eun Ran|title=Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis|journal=World Journal of Gastroenterology|volume=20|issue=29|year=2014|pages=9872|issn=1007-9327|doi=10.3748/wjg.v20.i29.9872}}</ref><ref name=Hanauer>{{cite journal | last = Hanauer | first = Stephen B. | year = 1996 | title = Inflammatory bowel disease | journal = New England Journal of Medicine | volume = 334 | issue = 13 | pages = 841-848 | id = PMID 8596552 | url = http://content.nejm.org/cgi/content/extract/334/13/841 | accessdate = 2006-11-10}}</ref><ref name="pmid26366400">{{cite journal |vauthors=Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D |title=Lung abscess-etiology, diagnostic and treatment options |journal=Ann Transl Med |volume=3 |issue=13 |pages=183 |year=2015 |pmid=26366400 |pmc=4543327 |doi=10.3978/j.issn.2305-5839.2015.07.08 |url=}}</ref> <ref name="pmid20664404">{{cite journal |vauthors=Soper DE |title=Pelvic inflammatory disease |journal=Obstet Gynecol |volume=116 |issue=2 Pt 1 |pages=419–28 |year=2010 |pmid=20664404 |doi=10.1097/AOG.0b013e3181e92c54 |url=}}</ref> | *Actinomycosis most commonly involves face and oral cavity. | ||
*It rarely infects other organ systems. If involved it has a wide variety of presentation. | |||
*Most common symptoms of actinomycosis includes abscess with draining sinus tracts. | |||
*Other symptoms are mostly non-specific for actinomycosis. | |||
*Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:<ref name="pmid17560191">{{cite journal| author=Yiğiter M, Kiyici H, Arda IS, Hiçsönmez A| title=Actinomycosis: a differential diagnosis for [[appendicitis]]. A case report and review of the literature. | journal=J Pediatr Surg | year= 2007 | volume= 42 | issue= 6 | pages= E23-6 | pmid=17560191 | doi=10.1016/j.jpedsurg.2007.03.057 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560191 }} </ref><ref name="pmid19149697">{{cite journal |vauthors=Hasper D, Schefold JC, Baumgart DC |title=Management of severe abdominal infections |journal=Recent Pat Antiinfect Drug Discov |volume=4 |issue=1 |pages=57–65 |year=2009 |pmid=19149697 |doi= |url=}}</ref><ref name="pmid15342974">{{cite journal |author=Lederman ER, Crum NF |title=A case series and focused review of nocardiosis: clinical and microbiologic aspects |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=300–13 |year=2004|pmid=15342974 |doi= 10.1097/01.md.0000141100.30871.39|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0025-7974&volume=83&issue=5&spage=300}}</ref><ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref><ref name="Humes2006">{{cite journal|last1=Humes|first1=D J|title=Acute appendicitis|journal=BMJ|volume=333|issue=7567|year=2006|pages=530–534|issn=0959-8138|doi=10.1136/bmj.38940.664363.AE}}</ref><ref name="pmid20375357">{{cite journal |vauthors=Saccente M, Woods GL |title=Clinical and laboratory update on blastomycosis |journal=Clin. Microbiol. Rev. |volume=23 |issue=2 |pages=367–81 |year=2010 |pmid=20375357 |pmc=2863359 |doi=10.1128/CMR.00056-09 |url=}}</ref><ref name="Kim2014">{{cite journal|last1=Kim|first1=Eun Ran|title=Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis|journal=World Journal of Gastroenterology|volume=20|issue=29|year=2014|pages=9872|issn=1007-9327|doi=10.3748/wjg.v20.i29.9872}}</ref><ref name=Hanauer>{{cite journal | last = Hanauer | first = Stephen B. | year = 1996 | title = Inflammatory bowel disease | journal = New England Journal of Medicine | volume = 334 | issue = 13 | pages = 841-848 | id = PMID 8596552 | url = http://content.nejm.org/cgi/content/extract/334/13/841 | accessdate = 2006-11-10}}</ref><ref name="pmid26366400">{{cite journal |vauthors=Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D |title=Lung abscess-etiology, diagnostic and treatment options |journal=Ann Transl Med |volume=3 |issue=13 |pages=183 |year=2015 |pmid=26366400 |pmc=4543327 |doi=10.3978/j.issn.2305-5839.2015.07.08 |url=}}</ref> <ref name="pmid20664404">{{cite journal |vauthors=Soper DE |title=Pelvic inflammatory disease |journal=Obstet Gynecol |volume=116 |issue=2 Pt 1 |pages=419–28 |year=2010 |pmid=20664404 |doi=10.1097/AOG.0b013e3181e92c54 |url=}}</ref> | |||
Revision as of 15:48, 31 March 2017
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Actinomycosis Microchapters |
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Actinomycosis differential diagnosis On the Web |
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Risk calculators and risk factors for Actinomycosis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Based on the organ system involved and duration of sypmtoms differential diagnosis of actinomycosis consists of blastomycosis, brain abscess, colon cancer, crohn disease, diverticulitis, liver abscess, lung abscess, lymphoma, nocardiosis, pelvic inflammatory disease, pneumonia, tuberculosis and uterine cancer.
Differential Diagnosis
- Actinomycosis most commonly involves face and oral cavity.
- It rarely infects other organ systems. If involved it has a wide variety of presentation.
- Most common symptoms of actinomycosis includes abscess with draining sinus tracts.
- Other symptoms are mostly non-specific for actinomycosis.
- Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:[1][2][3][4][5][6][7][8][9] [10]
| System involved | Disease | Differentiating signs/symptoms | Differentiating tests |
|---|---|---|---|
| Abdomen | Abdominal Abscess | Features of sepsis and signs of an acute abdomen are generally prominent | Histology and culture for actinomycetes are negative.
Blood cultures positive for the causative organism. |
| Appendicitis | Rapid onset of symptoms
Positive for signs of appendicitis |
Ultrasound shows inflammation of appendix
Negative blood culture | |
| Colon cancer | Systemic findings like weight loss, night sweats present
Anemia Blood loss in stools |
Colonoscopy identifies the lesions, histopathology confirms the presence of the malignant cells. | |
| Whipple disease | An acute GI illness, with fever, diarrhea, and weight loss
Malabsorption such as steatorrhea. Abdominal lymphadenopathy and abdominal pain. Joint problems |
Anti-Tropheryma whipplei-positive macrophage.
PCR testing of duodenal biopsies positive for T whipplei | |
| Inflammatory bowel disease | Dysentery | Colonoscopy identifies the ulcerative lesions | |
| Pulmonary | Nocardiosis | Immunocompromised host
Predominant pulmonary |
Modified acid-fast staining of biopsy tissue or other samples allows distinction between Nocardia and Actinomyces |
| Blastomycosis | Self-limited
Cutaneous manifestations along with lung involvement. Endemic to Mississippi and Ohio river valley |
Sputum smear and culture using KOH preparations or specific stains can confirm diagnosis | |
| Lung abscess | Risk of aspiration
Cough with foul smelling sputum |
Polymicrobial infection | |
| Pulmonary tuberculosis | Cough >2 weeks | Acid fast bacilli positive on sputum examination
Tuberculin skin testing positive. | |
| Uro-genital system | Ovarian/Oviductal tumor | Systemic findings like weight loss ,night sweats present
No leukorrhea |
Histopathology shows malignancy. |
| Pelvic inflammatory disease | History of recent sexual contact or a sexually transmitted infection in the partner,
Past history of PID. |
laparoscopy with biopsy sampling followed by histology. |
- The clinical manifestations of actinomycosis and nocardiosis are similar. The following table helps in differentiating actinomycosis from nocardiosis.[11][12]
- Differentiation of actinomycosis from nocardiosis is very important in selection of appropriate antimicrobial therapy.[13][14]
| Actinomycosis | Nocardiosis |
|---|---|
| Gram positive anaerobic species | Gram positive aerobe |
| Decreasing incidence | Increasing incidence |
| Occurs primarily in immunocompetent host | Occurs primarily in immunocompromised host |
| Predominant cervicofacial | Predominant pulmonary |
| Chest wall involvement and bony erosions are common | Chest wall involvement is uncommon |
| Granuloma formation and intense fibrosis are common. Form characteristic sulfur granules | Granuloma formation and fibrosis are uncommon |
| Spread by direct invasion | Metastatic spread is common (especially to brain) |
| Diagnosis is made through cytologic or histologic examination | Diagnosis is made through BAL (bronchoalveolar lavage),
sputum, or pleural fluid culture |
| Treatment: Penicillin
Treatment with antibiotics alone |
Treatment: Sulfonamides
Often need surgical drainage |
References
- ↑ Yiğiter M, Kiyici H, Arda IS, Hiçsönmez A (2007). "Actinomycosis: a differential diagnosis for [[appendicitis]]. A case report and review of the literature". J Pediatr Surg. 42 (6): E23–6. doi:10.1016/j.jpedsurg.2007.03.057. PMID 17560191. URL–wikilink conflict (help)
- ↑ Hasper D, Schefold JC, Baumgart DC (2009). "Management of severe abdominal infections". Recent Pat Antiinfect Drug Discov. 4 (1): 57–65. PMID 19149697.
- ↑ Lederman ER, Crum NF (2004). "A case series and focused review of nocardiosis: clinical and microbiologic aspects". Medicine (Baltimore). 83 (5): 300–13. doi:10.1097/01.md.0000141100.30871.39. PMID 15342974.
- ↑ Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
- ↑ Humes, D J (2006). "Acute appendicitis". BMJ. 333 (7567): 530–534. doi:10.1136/bmj.38940.664363.AE. ISSN 0959-8138.
- ↑ Saccente M, Woods GL (2010). "Clinical and laboratory update on blastomycosis". Clin. Microbiol. Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMC 2863359. PMID 20375357.
- ↑ Kim, Eun Ran (2014). "Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis". World Journal of Gastroenterology. 20 (29): 9872. doi:10.3748/wjg.v20.i29.9872. ISSN 1007-9327.
- ↑ Hanauer, Stephen B. (1996). "Inflammatory bowel disease". New England Journal of Medicine. 334 (13): 841–848. PMID 8596552. Retrieved 2006-11-10.
- ↑ Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D (2015). "Lung abscess-etiology, diagnostic and treatment options". Ann Transl Med. 3 (13): 183. doi:10.3978/j.issn.2305-5839.2015.07.08. PMC 4543327. PMID 26366400.
- ↑ Soper DE (2010). "Pelvic inflammatory disease". Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.
- ↑ Sullivan DC, Chapman SW (2010). "Bacteria that masquerade as fungi: actinomycosis/nocardia". Proc Am Thorac Soc. 7 (3): 216–21. doi:10.1513/pats.200907-077AL. PMID 20463251.
- ↑ Warren NG (1996). "Actinomycosis, nocardiosis, and actinomycetoma". Dermatol Clin. 14 (1): 85–95. PMID 8821161.
- ↑ Smego RA (1987). "Actinomycosis of the central nervous system". Rev Infect Dis. 9 (5): 855–65. PMID 3317731.
- ↑ Bassiri-Jahromi S, Doostkam A (2011). "Actinomyces and nocardia infections in chronic granulomatous disease". J Glob Infect Dis. 3 (4): 348–52. doi:10.4103/0974-777X.91056. PMC 3249989. PMID 22223997.
de:Aktinomykose gl:Actinomicose hr:Aktinomikoza nl:Actinomycose sr:Актиномикоза fi:Aktinomykoosi uk:Актиномікоз