Pulmonary actinomycosis associated with poor oral hygiene: A case report

Yıl 2025, Cilt: 3 Sayı: 1, 29 - 31, 01.02.2025

Burcu Nur Gülbahar , Beste Atabek

https://doi.org/10.61845/agrimedical.1602000

Öz

Pulmonary actinomycosis, a rare and chronic infection caused by Actinomyces species, involves anaerobic gram-positive bacteria that are part of the oral cavity’s normal flora. Thoracic involvement, accounting for approximately 15% of all actinomycosis cases, typically results from aspiration of oropharyngeal secretions. We report the case of a 36-year-old man with poor oral hygiene and severe dental decay who presented with a month-long history of chronic cough, hemoptysis, malodorous sputum, weight loss, and pleuritic chest pain. Imaging identified a cavitary lesion in the left upper lobe, initially raising concern for infectious or malignant etiologies. Bronchoscopic sampling confirmed pulmonary actinomycosis through histological identification of sulfur granules. The patient responded favorably to high-dose intravenous penicillin followed by oral antibiotics. This case underscores the diagnostic challenges of pulmonary actinomycosis, the importance of oral hygiene as a modifiable risk factor, and the need for a multidisciplinary management approach.

Anahtar Kelimeler

Pulmonary actinomycosis, cavitary lung disease, sulfur granules, oral hygiene, thoracic infections, penicillin therapy

Kötü ağız hijyeni ile ilişkili pulmoner aktinomikoz: Olgu sunumu

Öz

Pulmoner aktinomikoz, Actinomyces türlerinin neden olduğu nadir ve kronik bir enfeksiyon olup, ağız boşluğunun normal florasında bulunan anaerobik gram-pozitif bakterilerden kaynaklanır. Tüm aktinomikoz vakalarının yaklaşık %15'ini oluşturan torasik tutulum, genellikle orofaringeal sekresyonların aspirasyonu sonucu meydana gelir. Bu yazıda, kötü ağız hijyenine ve ciddi diş çürümesine sahip 36 yaşındaki bir erkek hastanın bir aydır devam eden kronik öksürük, hemoptizi, kötü kokulu balgam, kilo kaybı ve plöretik göğüs ağrısı şikayetleri ile başvurduğu bir vaka sunulmaktadır. Görüntülemede sol üst lobda kaviteli bir lezyon saptanmış ve bu durum başlangıçta enfeksiyöz veya malign etiyolojiler açısından endişe yaratmıştır. Bronkoskopik örnekleme sonucunda histolojik olarak sülfür granüllerinin tespitiyle pulmoner aktinomikoz tanısı doğrulanmıştır. Hasta, yüksek doz intravenöz penisilin tedavisi ve ardından oral antibiyotiklerle olumlu yanıt vermiştir. Bu vaka, pulmoner aktinomikozun tanısal zorluklarını, modifiye edilebilir bir risk faktörü olarak ağız hijyeninin önemini ve multidisipliner bir yönetim yaklaşımının gerekliliğini vurgulamaktadır.

Anahtar Kelimeler

Pulmoner aktinomikoz, kaviter akciğer hastalığı, sülfür granülleri, ağız hijyeni, torasik enfeksiyon, penisilin tedavisi

Kaynakça

• 1. Canan A, Batra K, Saboo SS, Landay M, Kandathil A. Radiological approach to cavitary lung lesions. Postgrad Med J. 2021;97(1150):521-31.
• 2. Boot M, Archer J, Ali I. The diagnosis and management of pulmonary actinomycosis. J Infect Public Health. 2023;16(4):490-500.
• 3. Gafoor K, Patel S, Girvin F, Gupta N, Naidich D, Machnicki S, et al. Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach. CHEST. 2018;153(6):1443-65.
• 4. Hoca N, Berktaş M, Söyler Y, Celep C, Tanrikulu F. Clinical features and treatment outcomes of pulmonary actinomycosis. European Review for Medical & Pharmacological Sciences. 2022;26(21).
• 5. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J. 2003;21(3):545-51.
• 6. Gupta A, Saleena LM, Kannan P, Shivachandran A. The Impact of Oral Diseases on Respiratory Health and the Influence of Respiratory Infections on the Oral Microbiome. Journal of Dentistry. 2024:105213.
• 7. Fahim A, Teoh R, Kastelik J, Campbell A, McGivern D. Case series of thoracic actinomycosis presenting as a diagnostic challenge. Respiratory Medicine CME. 2009;2(1):47-50.
• 8. Khoshbayan A, Amirmozafari N, Mirkalantari S. An overview of case reports and case series of pulmonary actinomycosis mimicking lung cancer: a scoping review. Frontiers in Medicine.2024;11:1356390.
• 9. Sökücü SN, Akyel R, Tokgöz Akyıl F, Tural Önür S, Kara K, Şimşek Veske N, et al. Clinical characteristics and diagnostic challenges of patients with pulmonary actinomycosis: A 10-year experience at a tertiary referral hospital. Eurasian Journal of Pulmonology. 2024;26(3):173.
• 10. Heo SH, Shin SS, Kim JW, Lim HS, Seon HJ, Jung S-I, et al. Imaging of actinomycosis in various organs: a comprehensive review. Radiographics. 2014;34(1):19-33.
• 11. Cuzzani G, Fortunati E, Zanoni L, Nanni C, Antonacci F, Giunchi F, et al. Case Report: Pulmonary Actinomyces Infection Mimics Lung Cancer on [68Ga] Ga-FAPI PET/CT. Journal of Nuclear Medicine. 2024.
• 12. Kim SR, Jung LY, Oh I-J, Kim Y-C, Shin K-C, Lee MK, et al. Pulmonary actinomycosis during the first decade of 21st century: cases of 94 patients. BMC Infectious Diseases. 2013;13(1):216.
• 13. Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-97.