Two cases report of pulmonary actinomycosis and review of the literature

Objective To improve the understandings of the pathogenesis, diagnosis, clinical features and treatments of pulmonary actinomycosis. Methods We retrospectively reported two typical cases in our hospital and review related literatures. Results Two middle-aged patients were admitted to hospital due to cough and fever.Chest computed tomography (CT) revealed pneumonia in the unilateral or bilateral lung.They were treated with surgery because of the poor effect of antibiotics and repeated recurrence.Pathological examination revealed the diagnosis of actinomycetes infection.Through reviewing another 205 cases of pulmonary actinomycosis, we found that the common clinical presentations included cough, sputum, hemoptysis, chest pain and fever.The incidence of women was higher and presented approximately 2.8 times than that of men.Most common pulmonary radiological appearance was left lower lung and right upper lung involvement, and might presented with consolidation, nodular appearance, cavitation, with(or without) pleural effusions or thickening and hilar/mediastinal lymphadenopathy.Histopathological examination was the gold standard for diagnosis of actinomycosis.High dose penicillin was the mainly treatment for pulmonary actinomycosis, but surgery might be a good choice when drug treatment was not effective. Conclusions pulmonary actinomycosis is rare to see and the diagnosis is difficult because the clinical manifestations and imaging performance lack of specificity.Patients even die before getting proper treatments.Therefore, comprehensive analysis of the characteristics of the case is significant in early diagnosis.The prognosis is good after early diagnosis and treatment. Key words: Actinomycosis; Tomography, spiral computed; Diagnosis; Signs and symptoms