Pulmonary actinomycosis during the first decade of 21st century: cases of 94 patients

Abstract

Background: Pulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces. Both improving oral hygiene and early application of antibiotics to the case of suspicious pulmonary infections result in changes in incidences and presentations of pulmonary actinomycosis. However, there are little reports dealt with the recent clinical characteristics of pulmonary actinomycosis. This study aimed to review the characteristics of pulmonary actinomycosis occurred during the first decade of 21st century.

Methods: This retrospective study was performed on 94 subjects with pulmonary actinomycosis diagnosed pathologically from January 2000 to December 2010 in 13 hospitals in Korea.

Results: The data of the study showed that pulmonary actinomycosis occurs frequently in middle to old-aged males (mean age; 57.7 years old) and that the most common symptoms are cough, hemoptysis, and sputum production. Various radiologic features such as the consolidation with central low attenuation (74.5%) and no regional predominance were also observed. Most of patients recovered completely with medical and/or surgical treatment, reaching approximately 98% cure rate.

Conclusions: The results demonstrate that pulmonary actinomycosis is one of the cautious pulmonary diseases. More importantly, in cases of persistent hemoptysis or for differential diagnosis from lung malignancy, our data have revealed that surgical resection appears to be a useful intervention and that radiologic diagnosis may not provide decisive information. These findings indicate that it is important for the clinicians to include pulmonary actinomycosis as one of differential diagnoses for refractory pulmonary abnormal lesions to the current usual management.

Figure 1

Clinical manifestation of pulmonary actinomycosis. The most common presenting symptoms were cough (77.7%), hemoptysis (64.9%), and sputum (61.7%).

Figure 2

CT findings of pulmonary actinomycosis. The most common chest CT finding was consolidation (74.5%), followed by mediastinal or hilar lymph node enlargement (29.8%), atelectasis (28.7%), cavitation (23.4%), and ground-glass opacity (14.9%). GGO: ground glass opacity, LN: lymph node.