A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess

Yae Min Park; In Sik Won; Joo Il Kim; Hyon Joung Cho; Jong Goo Seo; Jin Yong Kim; Eun Young Kim; Sang Hui Park; Yoon Soo Park; Yiel-Hae Seo; Yong Kyun Cho

doi:10.3947/ic.2009.41.4.249

Journal List > Infect Chemother > v.41(4) > 1075473

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Won, Kim, Cho, Seo, Kim, Kim, Park, Park, Seo, and Cho: A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2009; 41(4): 249-252.

Published online: 31 August 2009

DOI: https://doi.org/10.3947/ic.2009.41.4.249

A Case of Central Nervous System Actinomycosis Presenting as Brain Abscess

Yae Min Park, M.D.¹, In Sik Won, M.D.¹, Joo Il Kim, M.D.¹, Hyon Joung Cho, M.D.¹, Jong Goo Seo, M.D.¹, Jin Yong Kim, M.D.¹, Eun Young Kim, M.D.², Sang Hui Park, M.D.³, Yoon Soo Park, M.D.¹, Yiel-Hae Seo, M.D.⁴, Yong Kyun Cho, M.D.¹

¹Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.

²Department of Neurosurgery, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.

³Department of Pathology, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.

⁴Department of Laboratory Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea.

Corresponding author: Yoon Soo Park, M.D. Department of Internal Medicine, Gachon University, Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon, 405-760, Korea. Tel: +82-32-460-8431, Fax: +82-32-472-1578, yspark@gilhospital.com

Received 30 April 2009 Accepted 17 June 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

Keywords: Actinomycosis, Brain abscess, Central nervous system

Figures and Tables

Figure 1

Initial magnetic resonance imaging. (A) 2.2×1.8cm sized mass lesion, iso-signal intensity on T1 weighted image and (B) peripheral low signal intensity on T2 weighted image with peripheral enhancement on right frontal lobe with internal non-enhancing necrotic portion is observed.

Figure 2

Microscopic finding shows sulfur granules from brain tissue (Hematoxylin-eosin stain. ×400).

Figure 3

Computed tomography after 13 weeks of antibiotic therapy. Brain abscess has nearly disappeared.

References

1. Smego RA Jr, Foglia G. Actinomycosis. Clin Infect Dis. 1998. 26:1255–1261. quiz 1262-3.

2. Puzzilli F, Salvati M, Bristot R, Bastianello S, Ruggeri A, Lunardi P. Actinomycosis of the central nervous system: surgical treatment of three cases. J Neurosurg Sci. 1998. 42:165–171.

3. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 2005. 6th ed. New York: Churchill Livingstone;2924–2931.

4. Sudhakar SS, Ross JJ. Short-term treatment of actinomycosis: two cases and a review. Clin Infect Dis. 2004. 38:444–447.

5. Song EH, Kwon HH, Jang EY, Kim MN, Lee SO, Kim YS, Woo JH. A case of brain abscess caused by Actinomyces meyeri and Haemophilus aphrophilus. Korean J Med. 2008. 74:Suppl 1. 144–148.

6. Maltby GL. Intracranial actinomycosis; report of an unusual case. J Neurosurg. 1951. 8:674–678.

7. Bolton CF, Ashenhurst EM. Actinomycosis of the Brain; Case Report and Review of the Literature. Can Med Assoc J. 1964. 90:922–928.

8. Smego RA Jr. Actinomycosis of the central nervous system. Rev Infect Dis. 1987. 9:855–865.

9. Chatwani A, Amin-Hanjani S. Incidence of actinomycosis associated with intrauterine devices. J Reprod Med. 1994. 39:585–587.

10. Schaal KP, Lee HJ. Actinomycete infections in humans--a review. Gene. 1992. 115:201–211.

11. Roberts JA, Paratz J, Paratz E, Krueger WA, Lipman J. Continuous infusion of beta-lactam antibiotics in severe infections: a review of its role. Int J Antimicrob Agents. 2007. 30:11–18.

12. Roberts JA, Webb S, Paterson D, Ho KM, Lipman J. A systematic review on clinical benefits of continuous administration of beta-lactam antibiotics. Crit Care Med. 2009. 37:2071–2078.

13. Chaudhry SI, Greenspan JS. Actinomycosis in HIV infection: a review of a rare complication. Int J STD AIDS. 2000. 11:349–355.

14. Adeyemi OA, Gottardi-Littell N, Muro K, Kane K, Flaherty JP. Multiple brain abscesses due to Actinomyces species. Clin Neurol Neurosurg. 2008. 110:847–849.

15. de Louvois J, Gortavai P, Hurley R. Bacteriology of abscesses of the central nervous system: a multicentre prospective study. Br Med J. 1977. 2:981–984.

16. Lewin W, Morgan AD. Actinomycosis of the brain. J Neurol Neurosurg Psychiatry. 1947. 10:163–170.

17. Dailey AT, LeRoux PD, Grady MS. Resolution of an actinomycotic abscess with nonsurgical treatment: case report. Neurosurgery. 1993. 32:134–136.

18. Rosenblum ML, Hoff JT, Norman D, Edwards MS, Berg BO. Nonoperative treatment of brain abscesses in selected high-risk patients. J Neurosurg. 1980. 52:217–225.

TOOLS

Similar articles