Zusammenfassung
Wir berichten über zwei Fälle einer isolierten
abdominellen Aktinomykose. a) Ein 52-jähriger Patient mit einem
peripankreatisch gelegenen Abszess im Bereich des Pankreasschwanzes. Dieser
Abszess entstand in einem Zeitraum von zwei Jahren nach laparoskopischer
Cholezystektomie mit postoperativer Peritonitis und Relaparotomie. b) Ein
19-jähriger Patient mit perityphlitischem Abszess, der nach Appendektomie
wegen Appendizitis auftrat. Die definitive Diagnose der intraabdominellen
Aktinomykose erfolgte nach sonographiegesteuerter Feinnadelpunktion. In beiden
Fällen ergab die bakteriologische Untersuchung des Abszesssekretes
Actinomyces (A.) israelii. Als Begleitkeime ließen sich im Fall a)
Klebsiella und Actinobacter species, im Fall b) Hämophilus
(Actinobacillus) actinomycetem comitans nachweisen. Lichtmikroskopisch fanden
sich Aktinomyzeten-Drusen. Bei beiden Patienten konnte nach chirurgischer
Intervention und Antibiotikatherapie eine Kuration der Aktinomykose erreicht
werden.
Abstract
This report describes two cases of isolated abdominal actinomycosis.
a) A 52-year-old man developed a peripancreatic abscess in the course of two
years after laparoscopic cholecystectomy and repeated laparotomy because of
postoperative peritonitis. b) A 19-year-old man, who had a perityphlitic
abscess following appendectomy performed because of appendicitis. The
definitive diagnosis of abdominal actinomycosis was confirmed by percutaneous
ultrasound-guided fine-needle aspiration: In both cases culture of the
aspirated material yielded Actinomyces (A.) israelii. As concomitant microflora
we found Klebsiella and Actinobacter species in the first case and Haemophilus
(Actinobacillus) actinomycetem comitans in the other case. “Sulfur
granules” obtained from the pus showed histological aggregates of
Actinomyces in both cases. After surgical treatment and antibiotic therapy,
both patients recovered completely.
Schlüsselwörter
Abdominelle Aktinomykose - Abszess
Key words
Abdominal actinomycosis - Abscess
Literatur
-
1
Schaal K P, Lee H J.
Actinomycte infections in humans - a review.
Gene.
1992;
115
201-211
-
2
Piper M H, Schaberg D R, Ross M J, Shartsis J M, Orzechowski R W.
Endoscopic detection and therapy of colonic
actinomycosis.
Am J Gastroenterol.
1992;
87
1040-1042
-
3
Alvardo-Cerna R, Bradio-Riquelme R.
Actinomycosis - a complication of a fistula-in-ano.
Dis Colon Rectum.
1994;
37
378-380
-
4
Mueller R, Winkler R, Dunker H, Heusermann H.
Akutes Abdomen bei abdomineller Aktinomykose.
Leber Magen Darm.
1996;
26
109-112
-
5
Mueller-Holzner E, Ruth N R, Abfalter E.
IUD-associated pelvic actinomycosis: A report of five
cases.
Int J Gynecol Pathol.
1995;
14
70
-
6
Cintron J R, Del Pino A, Duarte B, Wood D.
Abdominal actinomycosis.
Dis Colon Rectum.
1996;
39
105-108
-
7
Granger J K, Houn-Yee D H.
Diagnosis of hepatic actinomycosis by fine needle
aspiration.
Diagnostic Cytology.
1991;
7
95-97
-
8
Lininger J R, Frable W J.
Diagnosis of pelvic actinomycosis by fine needle
aspiration.
Acta Cytol.
1984;
28
601-604
-
9
Pollock P G, Meyers D S, Frable W J, Valicenti J F, Koontz F P, Beavert C S.
Rapid diagnosis of actinomycosis by thin-needle aspiration
biopsy.
Am J Clin Pathol.
1978;
70
27-30
-
10
Shubaji M S, Gupta P K, Newman M M.
Hepatic atinomycosis diagnosed by fine needle
aspiration.
Acta Cytol.
1987;
31
751-755
-
11
Garcia-Corbeira P, Esteban-Moreno J.
Liver abscess due to Actinomyces meyeri.
Clinical Infectious Diseases.
1994;
18
491-492
-
12
Berchtenbreiter C, Bruning R, Auerhammer A, Reiser M.
Misleading diagnosis of retroperitoneal actinomycosis.
Eur Radiol.
1999;
9
1869-1872
-
13
Brown J R.
Human actinomycosis. A study of 181 subjects.
Hum Pathol.
1973;
4
319-330
-
14
Weese W C, Smith J IM.
A study of 57 cases of actinomycosis over a 36 year
period.
Arch Intern Med.
1975;
135
1562-1568
-
15 Mandell G L, Douglas R G, Bennett J E. Principles and practice of infectious diseases. 2nd ed. New York; John Wiley 1985
-
16 Fröhlich E, Krieglsteiner A, Frühmorgen P, Junghanns K. Ultraschallgezielte perkutane Abszess-Drainage. In: Otto RC, Schnaars P (Hrsg) Ultraschalldiagnostik 85. Stuttgart; Thieme 1986: 207-208
-
17
Gerzof S G, Johnson W C, Robbins A H, Nabseth D C.
Percutaneous catheter drainage of abdominal abscesses: A five
year experience.
N Engl J Med.
1981;
305
653-657
-
18
Olak J, Christou N V, Stein L A.
Operative versus percutaneous drainage of intraabdominal
abscesses: Comparison of morbidity and mortality.
Arch Surg.
1986;
121
141-146
-
19
Reuss J A, Seitz K.
Nicht-operative Therapie abdomineller und retroperitonealer
Abszesse.
Ultraschall.
1987;
8
142-146
-
20
Schwerk W B, Görg C, Görg K, Richter G, Beckh K.
Perkutane Drainagen von Leber- und Milzabszessen.
Z Gastroenterol.
1991;
29
146-152
-
21
Witzigmann H, Geissler F, Uhlmann D, Hauss J.
Intra-abdominal abscesses.
Chirurg.
1998;
69
813-820
-
22
Richard J F, Slim K, Alexandre M, Pezet D, Chipponi J.
Actinomycosis: value of percutaneous drainage of
intra-abdominal abscesses.
J Chir.
1995;
132
43-44
-
23
Goldwag S, Abbitt P L, Watts B.
Casereport: percutaneous drainage of periappendical
actinomycosis.
Clin Radiol.
1991;
44
422-424
-
24
Edelmann M, Cullmann W, Nowak K H, Kozuschek W.
Treatment of abdominothoracic actinomycosis with
imipenem.
Eur J Clin Microbiol.
1987;
6
194
-
25
Kinnear W, MacFarlane J.
A survey of thoracic actinomycosis.
Respir Med.
1990;
84
57-59
-
26
Skoutelis A, Petrochilow J, Bassaris H.
Successful treatment of thoracic actinomycosis with
ceftriaxone.
Clin Infect Dis.
1994;
19
161-162
-
27
Pavicic M JAMP, van Winkelhoff A J, de Graaff J.
In vitro susceptibilities of Actinobacillus actinomycetem
comitans to a number of antimicrobial combinations.
Antimicrob Ag Chemother.
1992;
36
2634
-
28
Forbes G M, Harvey F A, Philpott-Howard J N.
Nocardiosis in liver transplantation: variation in
presentation, diagnosis and therapy.
J Infect.
1990;
20
11
-
29
McNeil M M, Brown J M, Georghiou P R.
Infections due to nocardia transvalensis: Clinical spectrum
and antimicrobial therapy.
Clin Infect Dis.
1992;
15
453
PD Dr. Dr. H. Weiler
Medizinische Klinik · Klinikum Ludwigsburg
Posilipostraße 4 · 71640 Ludwigsburg
Telefon: 07141/996478
