Scientific Letter
Diagnosis of Actinomyces graevenitzii Lung Infection Using Linear EBUS
Diagnóstico mediante EBUS lineal de infección pulmonar por Actinomyces graevenitzii
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class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "<span class="elsevierStyleItalic">Strongyloides stercoralis</span> Infection with a Diffuse Miliary Pattern" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "352" "paginaFinal" => "353" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección por <span class="elsevierStyleItalic">Strongyloides stercoralis</span> con patrón miliar difuso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1250 "Ancho" => 1500 "Tamanyo" => 317534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial (A) and coronal (B) reformatted CT images show numerous bilateral small nodules, with some confluence in the posterior and lower lung regions. (C) Physical examination demonstrated a purpuric serpiginous rash on the patient's abdomen. (D) Bronchoalveolar lavage revealed the presence of <span class="elsevierStyleItalic">Strongyloides stercoralis</span> filariform larvae.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bruno Hochhegger, Gláucia Zanetti, Edson Marchiori" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Bruno" "apellidos" => "Hochhegger" ] 1 => array:2 [ "nombre" => "Gláucia" "apellidos" => "Zanetti" ] 2 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616303295" "doi" => "10.1016/j.arbres.2016.10.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616303295?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300137?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000006/v2_201707150125/S1579212917300137/v2_201707150125/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212917301106" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.04.003" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1457" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:349-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1247 "formatos" => array:3 [ "EPUB" => 142 "HTML" => 746 "PDF" => 359 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Bronchiolitis Obliterans Following Hematopoietic Stem Cell Transplantation: Importance of Expiratory Computed Tomography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "351" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bronquiolitis constrictiva tras trasplante de progenitores hematopoyéticos: importancia de la tomografía computarizada espiratoria" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1228 "Ancho" => 1500 "Tamanyo" => 211381 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) minIP coronal reconstruction of the chest inspiratory CT showing homogeneous pulmonary parenchyma with uniform attenuation. 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She is a native of Morocco, and last visited the country in September 2013. She lives in an urban environment, and has 2 dogs which are regularly seen by the veterinarian. No other significant epidemiological data, family history, known drug allergies, toxic habits, or occupational exposure were reported. She attended the respiratory medicine department in February 2015, referred by her primary care physician, 6–8 weeks after onset of a clinical picture of dysthermia, with undocumented fever, dyspnea on moderate exertion, cough with sparse, thick, whitish expectoration, loss of appetite, and asthenia. Physical examination revealed mild tachypnea, septic mouth with several teeth missing, no mouth ulcers, rhythmic heart sounds with no murmur, and generally reduced breath sounds with fine crackles in both lung bases. No other data of interest. Laboratory tests showed a slight increase in C-reactive protein and mild leukocytosis. No pathological findings were reported in repeat sputum samples (sputum smear and culture). Chest radiography showed general cardiomegaly and right basal interstitial-alveolar infiltrate. Chest computed tomography (CT) showed bilateral hilar and mediastinal lymphadenopathies of significant size, the latter in the lower paratracheal and subcarinal region, and alveolar infiltrate in the right lower lobe. Given the CT findings, a positron emission tomography (PET) study was performed, which confirmed increased metabolism in the lower right paratracheal region (standardized uptake value [SUV] 4.7) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), bilateral hilar region (SUV 2.2), and in the area of the right basal alveolar infiltrate (SUV 2.3), consistent with an infectious/inflammatory process. Flexible bronchoscopy was performed, revealing no endobronchial changes, and microbiological and cytological results were normal. Linear endobronchial ultrasound (EBUS) was subsequently performed, showing enlarged lymph nodes in level 4R, measuring 12 mm in the short axis, which was aspirated in 3 passes with a 22G cytology needle. Cytology <span class="elsevierStyleItalic">in situ</span> revealed ramified structures in part of the material studied. The samples were sent for cytological and microbiological analysis, and ciprofloxacin-resistant <span class="elsevierStyleItalic">Actinomyces graevenitzii</span> (<span class="elsevierStyleItalic">A. graevenitzii</span>) was isolated from all samples submitted for microbiological study. After administration of targeted antibiotic treatment with amoxicillin-clavulanate and clindamycin, the patient's clinical situation improved.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Actinomycosis is a chronic, slow-progressing granulomatous disease, caused by Gram-positive filamentous anaerobic or microaerophilic bacteria of the <span class="elsevierStyleItalic">Actinomycetaceae</span> family (genus <span class="elsevierStyleItalic">Actinomyces</span>). <span class="elsevierStyleItalic">A. graevenitzii</span>, specifically, was first described in 1997 by Ramos et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Like other actinomycetes, <span class="elsevierStyleItalic">A. graevenitzii</span> forms part of the oropharyngeal flora and was initially isolated from the surface of dental implants. However, little is known about the clinical characteristics and pathogenesis of this bacteria. Pulmonary involvement occurs in up to 15% of cases of actinomycosis, thought to be mainly due to inhalation or aspiration of gastrointestinal or oropharygeal material. Infection can involve the pulmonary parenchyma, airways, pleura, mediastinum, and chest wall, causing clinical complications, such as bronchial obstruction, pleural empyema, fistulae, rib destruction, and superior vena cava syndrome.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The most important risk factors for developing pulmonary actinomycosis include poor oropharygeal hygiene (as was the case with our patient), pre-existing dental disease, and alcoholism. Moreover, lung diseases, such as chronic obstructive pulmonary disease, bronchiectasis, chronic myobacterial disease, and aspergilloma are also considered to be risk factors due to the creation of an anaerobic environment in damaged lung tissue, which favors the growth of this bacteria.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Immunosuppressed patients or those admitted to intensive care units are equally vulnerable to infection by opportunistic pathogens. Diagnosis can be reached with the help of endoscopic ultrasound techniques. Given the non-specific nature of the clinical and radiological characteristics of this entity, differential diagnosis with other diseases, such as lung cancer, tuberculosis,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> pneumonia, granulomatous diseases, and pulmonary abscesses, must be considered. Very few cases describing <span class="elsevierStyleItalic">A. graevenitzii</span> infection have been published, and this is the first known case in which diagnosis was established by linear EBUS-guided lymph node aspiration.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Caballero Vázquez A, Cruz Rueda JJ, Ceballos Gutierrez JA. Diagnóstico mediante EBUS lineal de infección pulmonar por <span class="elsevierStyleItalic">Actinomyces graevenitzii</span>. Arch Bronconeumol. 2017;53:351–352.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 633 "Ancho" => 1000 "Tamanyo" => 73676 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET/CT with hypermetabolic focus in the right lower paratracheal lymph node station (4R).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Actinomyces graevenitzii</span> sp. nov. isolated from human clinical specimens" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.P. 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Figueroa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.43.6.3017-3022.2005" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2005" "volumen" => "43" "paginaInicial" => "3017" "paginaFinal" => "3022" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15956450" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary bronchopulmonary actinomycosis masquerading as lung cancer: apropos of two cases and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Katsenos" 1 => "I. Galinos" 2 => "P. Styliara" 3 => "N. Galanopoulou" 4 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 72 | 27 | 99 |
| 2024 September | 95 | 25 | 120 |
| 2024 August | 97 | 43 | 140 |
| 2024 July | 104 | 23 | 127 |
| 2024 June | 114 | 28 | 142 |
| 2024 May | 127 | 41 | 168 |
| 2024 April | 70 | 30 | 100 |
| 2024 March | 64 | 19 | 83 |
| 2024 February | 42 | 27 | 69 |
| 2023 March | 19 | 4 | 23 |
| 2023 February | 73 | 24 | 97 |
| 2023 January | 70 | 34 | 104 |
| 2022 December | 69 | 24 | 93 |
| 2022 November | 80 | 25 | 105 |
| 2022 October | 68 | 51 | 119 |
| 2022 September | 113 | 51 | 164 |
| 2022 August | 97 | 50 | 147 |
| 2022 July | 112 | 65 | 177 |
| 2022 June | 100 | 51 | 151 |
| 2022 May | 106 | 34 | 140 |
| 2022 April | 138 | 44 | 182 |
| 2022 March | 135 | 48 | 183 |
| 2022 February | 123 | 44 | 167 |
| 2022 January | 129 | 53 | 182 |
| 2021 December | 93 | 55 | 148 |
| 2021 November | 93 | 50 | 143 |
| 2021 October | 125 | 87 | 212 |
| 2021 September | 86 | 62 | 148 |
| 2021 August | 62 | 58 | 120 |
| 2021 July | 58 | 29 | 87 |
| 2021 June | 68 | 39 | 107 |
| 2021 May | 75 | 56 | 131 |
| 2021 April | 166 | 117 | 283 |
| 2021 March | 76 | 29 | 105 |
| 2021 February | 48 | 35 | 83 |
| 2021 January | 46 | 15 | 61 |
| 2020 December | 47 | 26 | 73 |
| 2020 November | 74 | 29 | 103 |
| 2020 October | 56 | 23 | 79 |
| 2020 September | 76 | 15 | 91 |
| 2020 August | 59 | 24 | 83 |
| 2020 July | 59 | 36 | 95 |
| 2020 June | 60 | 13 | 73 |
| 2020 May | 46 | 9 | 55 |
| 2020 April | 49 | 23 | 72 |
| 2020 March | 40 | 12 | 52 |
| 2020 February | 75 | 26 | 101 |
| 2020 January | 49 | 19 | 68 |
| 2019 December | 58 | 25 | 83 |
| 2019 November | 39 | 23 | 62 |
| 2019 October | 53 | 12 | 65 |
| 2019 September | 72 | 26 | 98 |
| 2019 August | 42 | 17 | 59 |
| 2019 July | 36 | 15 | 51 |
| 2019 June | 42 | 8 | 50 |
| 2019 May | 69 | 25 | 94 |
| 2019 April | 64 | 32 | 96 |
| 2019 March | 56 | 26 | 82 |
| 2019 February | 57 | 25 | 82 |
| 2019 January | 46 | 12 | 58 |
| 2018 December | 38 | 16 | 54 |
| 2018 November | 63 | 20 | 83 |
| 2018 October | 101 | 14 | 115 |
| 2018 September | 63 | 30 | 93 |
| 2018 May | 23 | 0 | 23 |
| 2018 April | 45 | 8 | 53 |
| 2018 March | 90 | 8 | 98 |
| 2018 February | 40 | 12 | 52 |
| 2018 January | 93 | 8 | 101 |
| 2017 December | 94 | 8 | 102 |
| 2017 November | 24 | 9 | 33 |
| 2017 October | 23 | 10 | 33 |
| 2017 September | 36 | 15 | 51 |
| 2017 August | 4 | 1 | 5 |
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