American Journal of Infectious Diseases and Microbiology
ISSN (Print): 2328-4056 ISSN (Online): 2328-4064 Website: Editor-in-chief: Maysaa El Sayed Zaki
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American Journal of Infectious Diseases and Microbiology. 2018, 6(3), 66-71
DOI: 10.12691/ajidm-6-3-1
Open AccessCase Report

Human Actinomycosis: Report of a Rare Case of Disseminated Actinomycosis Presenting as Varicosities and Deep Vein Thrombosis

Venkataramana Kandi1, , Vikas Chennamaneni2, Suman Kaveti2, Ritu Vaish2, Padmavali Palange1, Sri Sandhya Koka1 and Mohan Rao Bhoomigari1

1Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, India

2Department of Radiology and Imaging, Prathima Institute of Medical Sciences, Karimnagar, India

Pub. Date: November 16, 2018

Cite this paper:
Venkataramana Kandi, Vikas Chennamaneni, Suman Kaveti, Ritu Vaish, Padmavali Palange, Sri Sandhya Koka and Mohan Rao Bhoomigari. Human Actinomycosis: Report of a Rare Case of Disseminated Actinomycosis Presenting as Varicosities and Deep Vein Thrombosis. American Journal of Infectious Diseases and Microbiology. 2018; 6(3):66-71. doi: 10.12691/ajidm-6-3-1


Introduction: Human actinomycosis is characterized by the development of chronic granulomatous lesions of the skin and subcutaneous connective tissues. The condition is also called as mycetoma, and typically presents as granulomatous skin with multiple draining sinuses usually affecting the lower limbs. The pus draining from these lesions show characteristic granules, and the laboratory diagnosis greatly depends on the identification of the causative microorganism from the crushed granules. Actinomycosis is a chronic infection and may cause severe complications when the treatment is not initiated at an appropriate time. In this case report we present a rare instance of disseminated actinomycosis in a patient who presented with varicosities and deep vein thrombosis. Case presentation: A-54-year-old male presented with complaints of swelling in the right lower limb, multiple inflammatory swelling like lesions on the thoracic region and chronic lower back pain. The patient started to notice dilated veins on the abdominal wall and around the umbilicus for one month. He was a known case of actinomycosis, who suffered from the complications of mycetoma and had the left leg amputated below the knee. Considering the previous history of the patient, a provisional diagnosis of disseminated actinomycosis was made. Due to the presence of dilated tortuous veins, and the edema varicosities and possible deep vein thrombosis was suspected. Pus was drained from the swelling like lesions, which on microscopy revealed gram-positive filamentous branching bacilli. Culture on Lowenstein-Jensen’s (LJ) medium revealed the growth of red colored non-acid-fast gram-positive filamentous branching bacilli which was identified as Actinomyces species. Conclusion: Human actinomycosis is an underdiagnosed microbial infection. Inadequate treatment could cause disseminated actinomycosis and severe complications as observed in the present case. Bacterial isolation can be hindered by prior antibiotic use and culture on LJ medium may improve the chances of isolation of Actinomyces.

human actinomycosis mycetoma disseminated actinomycosis varicosities deep vein thrombosis

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[1]  Hall V: Actinomyces--gathering evidence of human colonization and infection. Anaerobe. 2008, 14: 1-7.
[2]  Russo TA: Agents of actinomycosis. Principles and practice in infectious diseases. Mandell GL, Bennett JE, Dolin R (ed): Elsevier, Philadelphia, PA; 2009. 2:2864-2873.
[3]  Könönen E, Wade WG: Actinomyces and Related Organisms in Human Infections. Clin Microbiol Rev. 2015, 28: 419-442.
[4]  Vásquez J, Gómez C, Chiquillo A, et al.: [Disseminated actinomycosis with central nervous system involvement]. Rev ChilenaInfectol. 2017, 34:598-602.
[5]  Dieng MT, Sy MH, Diop BM, et al.: [Mycetoma: 130 cases]. Ann Dermatol Venereol. 2003, 130:16-9.
[6]  Kanthack AA: Madura disease (mycetoma) and actinomycosis. J Pathol. 1892, 1:140-162. 10.1002/path.1700010203
[7]  Al Gannass A: Chronic Madura foot mycetoma and/or Actinomyces spp or actinomycosis. BMJ Case Rep. 2018.
[8]  Venkatswami S, Sankarasubramanian A, Subramanyam S: The madura foot: looking deep. Int J Low Extrem Wounds. 2012, 11: 31-42.
[9]  Kandi V: Human Nocardia Infections: A Review of Pulmonary Nocardiosis. Cureus. 2015, 7.
[10]  Grzywa-Celińska A, Emeryk-Maksymiuk J, Szmygin-Milanowska K, et al.: Pulmonary actinomycosis - the great imitator. Ann Agric Environ Med. 2017, 3:211-212.
[11]  ChinnakkulamKandhasamy S, Rajendar B, Sahoo A, et al.: Rare Abdominopelvic Actinomycosis Causing an Intestinal Band Obstruction and Mimicking an Ovarian Malignancy. Cureus. 2018, 10:e2721.
[12]  Hwang CS, Lee H, Hong MP, et al.: Brain abscess caused by chronic invasive actinomycosis in the nasopharynx: A case report and literature review. NA., ed. Medicine. 2018, 97: e0406.
[13]  Jain A, Narula V, Alam K, et al.: Cervicofacial actinomycosis mimicking sebaceous cyst. BMJ Case Reports. 2013.
[14]  Jeong YJ, Suh HW, Shim HS: Cervicofacial Primary Cutaneous Actinomycosis: Surgical Treatment for Complete Remission of the Disease. J Craniofac Surg. 2017, 28: 269-271.
[15]  Bassiri-Jahromi S, Doostkam A: Actinomyces and Nocardia Infections in Chronic Granulomatous Disease. Journal of Global Infectious Diseases. 2011, 3:348-352.
[16]  Armendariz-Guezala M, Undabeitia-Huertas J, Samprón-Lebed N, et al.: [Actinomycotic brain abscess in immunocompetent patient]. Cir Cir. 2017, 85:103-107.
[17]  Abughanimeh O, Tahboub M, Zafar Y, et al.: Pylephlebitis Caused by Actinomyces Bacteremia. Cureus. 2018, 10:e2887.
[18]  Ishiguro T, Takayanagi T, Ikarashi H: Multiple metastatic liver abscesses and intravenous thrombosis due to pelvic actinomycosis. Eur J ObstetGynecolReprod Biol. 2016, 198: 166-7.
[19]  Kurihara N, Inoue Y, Iwai T, et al.: Oral bacteria are a possible risk factor for valvular incompetence in primary varicose veins. Eur J Vasc Endovasc Surg. 2007, 34: 102-6.
[20]  Weiand D, Barlow G: The rising tide of bloodstream infections with Actinomyces species: bimicrobial infection with Actinomyces odontolyticus and Escherichia coli in an intravenous drug user. Oxf Med Case Reports. 2014, 2014: 156-158.