背景:放线菌很少引起人类临床相关感染。感染常被误诊为恶性肿瘤,结核病,或者诺卡心症,因此延误了正确的识别和治疗。在这里,我们报告了一例55岁的免疫功能正常的成年人,患有由A.turicensis引起的脑脓肿。对A.turicensis感染进行了系统评价。
方法:根据系统评价和荟萃分析(PRISMA)指南的首选报告项目对文献进行系统评价。MEDLINE数据库,Embase,WebofScience,CINAHL,搜索了Clinicaltrials.gov和加拿大卫生药物和技术机构(CADTH)的所有相关文献。
结果:搜索确定了47条符合条件的记录,共67名患者。A.turicensis感染最常见于肛门生殖器区域(n=21),引起急性细菌性皮肤和皮肤结构感染(ABSSSI),包括Fournier坏疽(n=12),肺部感染(n=8),妇科感染(n=6),颈面部感染(n=5),腹腔内或乳腺感染(n=8),尿路感染(n=3),脊柱感染(n=2)中枢神经系统感染(n=2),心内膜炎(n=1)。感染主要表现为脓肿(n=36),伴有或不伴有菌血症(n=7)。超过60%的病例存在发热和局部炎症症状。治疗通常包括手术引流,然后进行抗生素治疗(n=51)。最常见的抗菌治疗包括阿莫西林(+克拉维酸),氨苄西林/舒巴坦,甲硝唑或头孢菌素。百分之八十九的患者完全康复。报告了2例死亡病例。
结论:据我们所知,我们在此介绍首例由A.turicensis和P.mirabilis引起的脑脓肿。A.turicensis的脑受累很少见,可能是由于血源性传播或连续感染的传播所致。感染可能难以诊断,因此治疗可能会延迟。然而,病原体通常很容易治疗。放线菌病的诊断具有挑战性,需要迅速的微生物学鉴定。手术切除和引流以及抗生素治疗通常可以完全康复。
BACKGROUND: Actinomyces turicensis is rarely responsible of clinically relevant infections in human. Infection is often misdiagnosed as malignancy, tuberculosis, or nocardiosis, therefore delaying the correct identification and treatment. Here we report a case of a 55-year-old immunocompetent adult with brain abscess caused by A. turicensis. A systematic
review of A. turicensis infections was performed.
METHODS: A systematic
review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases MEDLINE, Embase, Web of Science, CINAHL, Clinicaltrials.gov and Canadian Agency for Drugs and Technology in Health (CADTH) were searched for all relevant literature.
RESULTS: Search identified 47 eligible records, for a total of 67 patients. A. turicensis infection was most frequently reported in the anogenital area (n = 21), causing acute bacterial skin and skin structure infections (ABSSSI) including Fournier\'s gangrene (n = 12), pulmonary infections (n = 8), gynecological infections (n = 6), cervicofacial district infections (n = 5), intrabdominal or breast infections (n = 8), urinary tract infections (n = 3), vertebral column infections (n = 2) central nervous system infections (n = 2), endocarditis (n = 1). Infections were mostly presenting as abscesses (n = 36), with or without concomitant bacteremia (n = 7). Fever and local signs of inflammation were present in over 60% of the cases. Treatment usually involved surgical drainage followed by antibiotic therapy (n = 51). Antimicrobial treatments most frequently included amoxicillin (+clavulanate), ampicillin/sulbactam, metronidazole or cephalosporins. Eighty-nine percent of the patients underwent a full recovery. Two fatal cases were reported.
CONCLUSIONS: To the best of our knowledge, we hereby present the first case of a brain abscess caused by A. turicensis and P. mirabilis. Brain involvement by A. turicensis is rare and may result from hematogenous spread or by dissemination of a contiguous infection. The infection might be difficult to diagnose and therefore treatment may be delayed. Nevertheless, the pathogen is often readily treatable. Diagnosis of
actinomycosis is challenging and requires prompt microbiological identification. Surgical excision and drainage and antibiotic treatment usually allow for full recovery.