Actinomycosis in Cancer Patients: A Single-Center Chart Review Study

Introduction Actinomycosis is a condition characterized by chronic granulomatous infection, frequently with the formation of abscesses, tissue fibrosis, and draining sinuses. The most common presentation in the immunocompetent host is a cervicofacial form. However, this disease can affect any body site. Very little is known about actinomycosis features in immunocompromised patients. Materials and Methods We performed a retrospective chart review of 65 patients from an academic cancer hospital who had positive diagnostic testing for Actinomyces species. Of those 65 patients, 46 were ultimately diagnosed with frank actinomycosis and the remaining 19 patients were considered colonized. We reviewed patient characteristics, clinical and radiographic presentations, and response to antibiotic therapy. Results Pulmonary actinomycosis was the most common clinical presentation and, based on the radiological presentation, malignancy was often included in the differential diagnosis. A majority of the patients included in this report had a positive clinical response to prolonged antibiotic therapy. Discussion As expected, distinguishing clinically significant disease from colonization proves quite complex. As stated previously, 19 patients of 65 were thought to have colonization or contamination of the sample. The factors influencing clinicians to make the decision not to treat were not always clear in these cases. In some, the presence of abnormal imaging findings without symptoms appears to have been a major determinant in the decision to consider a positive culture as contamination instead of infection. Until more definitive criteria are delineated in the literature, diagnosis and treatment of actinomycosis rely on a combination of clinical and radiographic findings. Correspondence to: John N. Greene, MD, Infectious Diseases and Hospital Epidemiology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB-3, Tampa, FL. E-mail: John.Greene@moffitt.org. The authors have no funding or conflicts of interest to declare. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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