Actinomycosis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The 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 should be differentiated from other conditions with similar presentation:[1][2]
| Disease | Differentiating signs/symptoms | Differentiating tests |
|---|---|---|
| Abdominal Abscess | Features of sepsis and signs of an acute abdomen are generally prominent | Histology and culture for actinomycetes are negative.
Blood or site cultures identify etiologic organism. |
| Nocardiosis | Immunocompromised host
Predominant pulmonary |
Modified acid-fast staining of biopsy tissue or other samples allows distinction between Nocardia and Actinomyces |
| Ovarian/Oviductal tumor | Systemic findings like weight loss ,night sweats present
No leukorrhea |
Histopathology shows malignancy. |
| Appendicitis | Rapid onset of symptoms
Positive for signs of appenidicitis |
Ultrasound shows inflammation of appendix
Negative blood culture |
| 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 |
| 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. |
| Inflammatory bowel disease | Dysentery
Weight loss |
Colonoscopy identifies the ulcerative lesions |
| Lung abscess | Risk of aspiration
Cough with foul smelling sputum |
Polymicrobial infection |
| 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. |
| Pulmonary tuberculosis | Cough >2 weeks
Hemoptyisis Night sweats, weight loss |
Acid fast bacilli positive on sputum examination
Tuberculin skin testing positive. |
| Whipple disease | An acute GI illness, with fever, diarrhea, and weight loss
Malabsorption such as steatorrhea. Abdominal lymphadenopathy and abdominal pain. Joint problems Anemia. |
Anti-Tropheryma whipplei-positive macrophage.
PCR testing of duodenal biopsies positive for T whipplei |
- The clinical manifestations of actinomycosis and nocardiosis are similar. The following table helps in differentiating actinomycosis from nocardiosis.[3][4]
- Differentiation of actinomycosis from nocardiosis is very important in selection of appropriate antimicrobial therapy.[5]
| 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.
- ↑ Hasper D, Schefold JC, Baumgart DC (2009). "Management of severe abdominal infections". Recent Pat Antiinfect Drug Discov. 4 (1): 57–65. PMID 19149697.
- ↑ 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.
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