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hubo mejor&#237;a cl&#237;nica y se cerr&#243; la fistula&#46; Se decidi&#243; continuar con amoxicilina oral hasta completar 12<span class="elsevierStyleHsp" style=""></span>meses de tratamiento&#46; La TC de control despu&#233;s de 5<span class="elsevierStyleHsp" style=""></span>meses de antibi&#243;tico mostr&#243; disminuci&#243;n del derrame con estabilidad del engrosamiento pleural&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Actinomyces israelii</span> habita en la cavidad oral y el tracto gastrointestinal superior&#46; La infecci&#243;n se produce por destrucci&#243;n de la barrera mucosa debido a manipulaci&#243;n endosc&#243;pica&#44; cirug&#237;a o inmunosupresi&#243;n&#46; Histol&#243;gicamente&#44; los gr&#225;nulos de azufre son caracter&#237;sticos&#46; El diagn&#243;stico definitivo se realiza con el aislamiento microbiol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Suele afectar a varones de mediana edad con mala higiene dental&#46; La localizaci&#243;n m&#225;s frecuente es el &#225;rea cervicofacial &#40;50&#37;&#41;&#44; seguida del abdomen &#40;20&#37;&#41; y el t&#243;rax &#40;15-20&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La causa m&#225;s frecuente de afectaci&#243;n tor&#225;cica es aspiraci&#243;n de secreciones<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; y puede presentarse como empiema&#44; neumon&#237;a que evoluciona a cavitaci&#243;n&#44; afectaci&#243;n peric&#225;rdica o diafragm&#225;tica<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas son variables e inespec&#237;ficos&#44; pudiendo estar asintom&#225;tico&#46; Suele haber elevaci&#243;n de reactantes de fase aguda<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El tratamiento inicial es i&#46;v&#46;&#44; con dosis m&#225;xima durante 4-6<span class="elsevierStyleHsp" style=""></span>semanas y luego tratamiento oral durante 6 a 12<span class="elsevierStyleHsp" style=""></span>meses m&#225;s&#46; El f&#225;rmaco de elecci&#243;n es penicilina&#44; y para pacientes al&#233;rgicos se puede utilizar tetraciclina&#44; eritromicina o clindamicina&#46; La afectaci&#243;n tor&#225;cica suele requerir tratamiento m&#225;s prolongado que la afectaci&#243;n a otro nivel&#46; Existen indicaciones espec&#237;ficas para cirug&#237;a&#44; y siempre debe ir asociada a antibi&#243;tico prolongado con altas dosis&#44; ya que por s&#237; sola no es curativa<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Cuando se diagnostica e inicia tratamiento de forma temprana tiene buen pron&#243;stico&#44; con baja mortalidad<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Por tanto&#44; un derrame pleural asociado a compromiso de pared tor&#225;cica en un paciente con antecedente de colecistectom&#237;a laparosc&#243;pica puede ser secundario a infecci&#243;n abdominal por <span class="elsevierStyleItalic">Actinomyces</span>&#46;</p></span>"
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Carta al Director
Derrame pleural secundario a infección por Actinomyces como complicación tardía de una colecistectomía laparoscópica
Pleural Effusion Secondary to Actinomyces Infection as a Late Complication of Laparoscopic Cholecystectomy
Rocío Magdalena Díaz Camposa,
Corresponding author
rociomdc80@gmail.com

Autor para correspondencia.
, Francisco López-Medranob, Antonio Laluezab, Fernando Granados Caballeroc, Victoria Villena Garridoa
a Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
b Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
c Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Existen casos descritos de actinomicosis intraabdominal despu&#233;s de a&#241;os de realizada una colecistectom&#237;a&#44; aunque es una complicaci&#243;n infrecuente&#46; Debido al lento crecimiento del <span class="elsevierStyleItalic">Actinomyces</span>&#44; los s&#237;ntomas pueden presentarse meses o a&#241;os despu&#233;s de la cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos el caso de un paciente de 71<span class="elsevierStyleHsp" style=""></span>a&#241;os que tuvo una colecistitis aguda con realizaci&#243;n de colecistectom&#237;a laparosc&#243;pica diferida&#46; Cuatro a&#241;os despu&#233;s consult&#243; por disnea&#44; tos&#44; astenia y dolor pleur&#237;tico en hemit&#243;rax derecho&#46; En la exploraci&#243;n f&#237;sica destacaba un aumento de volumen&#44; de consistencia dura y dolorosa en la regi&#243;n lateral de hemit&#243;rax derecho &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41; y abolici&#243;n del murmullo vesicular en dicho hemit&#243;rax&#46; Se evidenci&#243; elevaci&#243;n de reactantes de fase aguda&#44; y la radiograf&#237;a de t&#243;rax mostr&#243; derrame pleural derecho&#46; La tomograf&#237;a computarizada &#40;TC&#41; revel&#243; engrosamiento de la pleura del seno costofr&#233;nico posterolateral derecho&#44; de 2&#44;5<span class="elsevierStyleHsp" style=""></span>cm de espesor y una zona hipodensa en su interior con afectaci&#243;n de grasa extrapleural&#44; engrosamiento de m&#250;sculos y derrame pleural &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; Se realiz&#243; toracocentesis&#44; obteni&#233;ndose l&#237;quido compatible con exudado polimorfonuclear que despu&#233;s vir&#243; a linfomononuclear&#46; Microbiolog&#237;a y citolog&#237;a negativas&#46; Se realiz&#243; punci&#243;n-aspiraci&#243;n del engrosamiento pleural informada como inflamaci&#243;n abscesificada&#46; La ecograf&#237;a de la regi&#243;n costal mostr&#243; una colecci&#243;n hipoecoica de 3<span class="elsevierStyleHsp" style=""></span>cm&#44; con m&#250;ltiples ecos&#44; compatible con absceso que se puncion&#243; y se extrajo material purulento&#44; donde se cultiv&#243; <span class="elsevierStyleItalic">Actinomyces israelii</span> y <span class="elsevierStyleItalic">Escherichia coli</span>&#46; Desde entonces present&#243; una f&#237;stula a pared tor&#225;cica&#46; Se inici&#243; tratamiento intravenoso &#40;i&#46;v&#46;&#41; con amoxicilina&#47;clavul&#225;nico durante 14<span class="elsevierStyleHsp" style=""></span>d&#237;as y posteriormente 4<span class="elsevierStyleHsp" style=""></span>semanas m&#225;s con penicilina<span class="elsevierStyleHsp" style=""></span>G i&#46;v&#46;&#46; Tras 6<span class="elsevierStyleHsp" style=""></span>semanas de antibi&#243;tico i&#46;v&#46;&#44; hubo mejor&#237;a cl&#237;nica y se cerr&#243; la fistula&#46; Se decidi&#243; continuar con amoxicilina oral hasta completar 12<span class="elsevierStyleHsp" style=""></span>meses de tratamiento&#46; La TC de control despu&#233;s de 5<span class="elsevierStyleHsp" style=""></span>meses de antibi&#243;tico mostr&#243; disminuci&#243;n del derrame con estabilidad del engrosamiento pleural&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Actinomyces israelii</span> habita en la cavidad oral y el tracto gastrointestinal superior&#46; La infecci&#243;n se produce por destrucci&#243;n de la barrera mucosa debido a manipulaci&#243;n endosc&#243;pica&#44; cirug&#237;a o inmunosupresi&#243;n&#46; Histol&#243;gicamente&#44; los gr&#225;nulos de azufre son caracter&#237;sticos&#46; El diagn&#243;stico definitivo se realiza con el aislamiento microbiol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Suele afectar a varones de mediana edad con mala higiene dental&#46; La localizaci&#243;n m&#225;s frecuente es el &#225;rea cervicofacial &#40;50&#37;&#41;&#44; seguida del abdomen &#40;20&#37;&#41; y el t&#243;rax &#40;15-20&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La causa m&#225;s frecuente de afectaci&#243;n tor&#225;cica es aspiraci&#243;n de secreciones<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; y puede presentarse como empiema&#44; neumon&#237;a que evoluciona a cavitaci&#243;n&#44; afectaci&#243;n peric&#225;rdica o diafragm&#225;tica<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas son variables e inespec&#237;ficos&#44; pudiendo estar asintom&#225;tico&#46; Suele haber elevaci&#243;n de reactantes de fase aguda<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El tratamiento inicial es i&#46;v&#46;&#44; con dosis m&#225;xima durante 4-6<span class="elsevierStyleHsp" style=""></span>semanas y luego tratamiento oral durante 6 a 12<span class="elsevierStyleHsp" style=""></span>meses m&#225;s&#46; El f&#225;rmaco de elecci&#243;n es penicilina&#44; y para pacientes al&#233;rgicos se puede utilizar tetraciclina&#44; eritromicina o clindamicina&#46; La afectaci&#243;n tor&#225;cica suele requerir tratamiento m&#225;s prolongado que la afectaci&#243;n a otro nivel&#46; Existen indicaciones espec&#237;ficas para cirug&#237;a&#44; y siempre debe ir asociada a antibi&#243;tico prolongado con altas dosis&#44; ya que por s&#237; sola no es curativa<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Cuando se diagnostica e inicia tratamiento de forma temprana tiene buen pron&#243;stico&#44; con baja mortalidad<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Por tanto&#44; un derrame pleural asociado a compromiso de pared tor&#225;cica en un paciente con antecedente de colecistectom&#237;a laparosc&#243;pica puede ser secundario a infecci&#243;n abdominal por <span class="elsevierStyleItalic">Actinomyces</span>&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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2019 March 61 19 80
2019 February 58 17 75
2019 January 60 5 65
2018 December 51 21 72
2018 November 66 27 93
2018 October 120 19 139
2018 September 51 8 59
2018 May 48 2 50
2018 April 48 2 50
2018 March 56 4 60
2018 February 45 8 53
2018 January 31 5 36
2017 December 42 5 47
2017 November 45 5 50
2017 October 39 5 44
2017 September 37 7 44
2017 August 36 11 47
2017 July 31 9 40
2017 June 52 19 71
2017 May 46 9 55
2017 April 30 7 37
2017 March 40 9 49
2017 February 23 2 25
2017 January 27 5 32
2016 December 53 15 68
2016 November 92 12 104
2016 October 78 18 96
2016 September 88 14 102
2016 August 74 30 104
2016 July 71 10 81
2016 June 83 21 104
2016 May 73 13 86
2016 April 42 1 43
2016 March 40 2 42
2016 February 59 3 62
2016 January 67 25 92
2015 December 81 24 105
2015 November 88 18 106
2015 October 22 5 27
2015 September 5 0 5
2015 August 41 0 41
2015 July 3 0 3
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