Echocardiographic manifestations of cardiac actinomycosis include: pericardial effusion, endocarditis, and intracardiac, or pericardial masses.
Historical case report from 1951 with an extensive discussion of previously reported cases.
J Am Soc Echocardiogr. 2006 Dec;19(12):1530.e7-11.
Cardiac actinomycosis: an unusual cause of an intracardiac mass.
Peters GL, Davies RA, Veinot JP, Burwash IG.
Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
Actinomycosis is a chronic disease characterized by abscess formation, tissue fibrosis, and draining sinuses that may involve the cervicofacial area, thorax, abdominopelvic region, or central nervous system. We describe a patient with cardiac actinomycosis presenting with pericardial disease and an intracardiac mass. The diagnosis failed to be obtained by pericardiocentesis, but was obtained after echocardiographically guided biopsy of the intracardiac mass. The patient recovered with long-term penicillin therapy. A review of the literature highlights the frequent pericardial presentation of cardiac actinomycosis, the potential difficulty in making the diagnosis, and the remarkable clinical response and good prognosis that can result when the correct diagnosis is made and appropriate antibiotic therapy administered.
J Infect. 2005 May;50(4):359-62.
Actinomyces viscosus endocarditis requiring aortic valve replacement.
Julian KG, de Flesco L, Clarke LE, Parent LJ.
Division of Infectious Diseases, BMR Bldg, Room C6833, Mailcode H036, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 USA. firstname.lastname@example.org
We report a case of primary Actinomyces viscosus endocarditis, an unusual manifestation of actinomycosis, in a 43-year-old farmer with an indolent febrile illness. As has occurred in previous cases, diagnosis was delayed in part because blood isolates were misidentified. Months later when she required aortic valve and root replacement, histologic exam of the diseased valve revealed branching filamentous organisms and the original blood isolates were retrospectively confirmed to be Actinomyces viscosus.
Cardiol Rev. 2005 May-Jun;13(3):125-7.
A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man.
Makaryus AN, Latzman J, Yang R, Rosman D.
Division of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA.
Actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.
Heart. 2004 May;90(5):e27.
Cardiac actinomycosis in a patient presenting with acute cardiac tamponade and a mass mimicking pericardial tumour
Janoskuti L, Lengyel M, Fenyvesi T.
III Department of Internal Medicine, Semmelweis University, Budapest, Hungary. email@example.com
A case of pericardial actinomycosis mimicking a pericardial tumour is reported. After the appearance of non-specific subpleural pulmonary nodules, a 48 year old woman presented with fever and clinical signs of pericardial tamponade. Subxiphoid pericardiotomy yielded a culture negative fluid and inflammatory reactive histopathology in the pericardial biopsy specimen. Because of suspected infection cefamandole was administered for 10 days and the patient became afebrile. The pericardial effusion recurred with no clinical signs two weeks later. Steroid medication resulted in rapid regression of the pericardial effusion. Subsequent echocardiography controls showed a tumour-like pericardial mass, confirmed by cardiac magnetic imaging. Surgical exploration led to the final histological diagnosis of actinomycosis. After high dose and long term penicillin G treatment the patient recovered fully with no recurrence during two years' follow up.
Scand J Infect Dis. 2002;34(3):206-7.
Tricuspid valve endocarditis caused by a new species of actinomyces: Actinomyces funkei.
Westling K, Lidman C, Thalme A.
Department of Infectious Diseases, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
We present a case of tricuspid valve endocarditis in a 40-y-old woman with a history of heroin abuse. Blood cultures yielded a Gram-positive rod, preliminarily identified as "Actinomyces turicensis-like", but subsequently formally described as Actinomyces funkei sp. nov. The patient was cured by prolonged treatment with 10 weeks of i.v. antibiotics followed by oral antibiotic treatment for 12 weeks.
Intern Med. 2002 Apr;41(4):319-22.
Pulmonary actinomycosis followed by pericarditis and intractable pleuritis.
Shinagawa N, Yamaguchi E, Takahashi T, Nishimura M.
First Department of Medicine, Hokkaido University, School of Medicine, Sapporo.
A case of pleuropericarditis caused by Actinomyces israelli is described. The patient first underwent left upper lobectomy because of pulmonary actinomycosis. Seven months later, cardiac tamponade developed. Culture of the bloody pericardial effusion resulted in positive growth of Actinomyces israeli. He was successfully treated with penicillin G, ampicillin, and minocyclin. However, right pleural effusion appeared two months later. Cultures of the effusion again yielded positive growth of the same bacteria. However, the strain had gained resistance to any antibiotics that had been effective before. Accordingly, pleurodesis with minocyclin was undertaken, which was fortunately effective for controlling the pleural effusion.
Rev Pneumol Clin. 1990;46(3):91-7.
Thoracic actinomycosis. Report of 8 cases
Patey O, Huguet T, Breuil J, Poubeau P, Dublanchet A, Lafaix C.
Service de Medecine interne, Centre hospitalier intercommunal, Faculte de Medecine de Creteil.
We report 8 cases of thoracic actinomycosis, a disease which is now uncommon owing to the widespread use of antibiotics and which is caused by anaerobic filamentous bacteria living as saprophytes in natural cavities. Recent pathogenetic data, such as propagation by continuity or blood stream, as well as bacteriological and clinical data (mediastino-pulmonary, pleural, parietal, cardiac and disseminated lesions) are reviewed. Diagnostic problems are due to the difficulties encountered in trying to isolate the saprophytic organism, and pathological examination is often required for the diagnosis. Treatment is basically medical and consists of penicillin G or A administered for prolonged periods. Nitroimidazoles are ineffective against these anaerobic bacteria.
Arch Inst Cardiol Mex. 1988 May-Jun;58(3):243-5.
Chronic cardiac actinomycosis. Case report and review of the literature
Sandoval V, Orea T A, Garcia ML, Vargas MA, Camacho B.
Del Hospital Central Sur de Concentracion Nacional de Petroleos Mexicanos, Mexico, D.F.
We report the case of a young man in whom a right paracardiac mass was resected. The histopathologic study was compatible with actinomycosis. He developed severe cardiac failure, pulmonary edema and pericardial effusion. He was treated with penicillin, during 12 months. He did well afterwards, however, the echocardiographic follow-up revealed chronic pericardial effusion and thickening and fusion of the pericardium to the epicardial wall.
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