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A rarest case of actinomycosis induced pericardial & pleural effusion

Session Poster session 1

Speaker Naresh Sen

Event : EuroHeartCare 2016

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care
  • Session type : Poster Session

Authors : N Sen (BANGALORE,IN), SONAL Tanwar (Jaipur,IN)

Authors:
N Sen1 , SONAL Tanwar2 , 1NARAYANA HRUDAYALAYA INSTITUTE OF MEDICAL SCIENCE - BANGALORE - India , 2Rajasthan University of Health Sciences, Cardiology - Jaipur - India ,

Citation:
European Journal of Cardiovascular Nursing ( 2016 ) 15 ( Supplement ), S42

Background- Actinomycosis is caused by Actinomyces sp., Gram positive, anaerobic or microaerobes colonize the human mouth, GIT and genital tracts. It represent as cervicofacial following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and rarely cardio-pulmonary actinomycosis in smokers may mimic tuberculosis & malignancy.
Method- Bacterial cultures and pathology are the diagnostic tools, but particular conditions are required get the correct diagnosis. Prolonged cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous fungal-like pathogens.
clinical case- 27 yrs old male smoker presented with right lower chest pain, shortness of breath & fever last 6 days. O/E dental caries, right chest bulging with diminished breath sounds,leukocytosis, normal ECG, Chest X-Ray - right sided pleural effusion and bilateral opacity & pericardial effusion and confirmed by CT chest. Initially he was suspected as tuberculsis or malignancy based on pleural fluid but ruled out for same due to normal range of ADA & gama-interferon or cytology. finally he was diagnosed as actinomycosis israelii on based of culture. As per antibiotic senstivity he was treated with imipenum + cilastin inj for 2 wks & support of pericardial & pleural drain followed by oral amoxycilin-clav for 3 wks & other supportives. No surgical interventions were required. After 5 wks follow-up he recoverd clinically & radiologically.
Conclusion- actinomycosis require prolonged high doses of penicillin G or amoxicillin and other sensitives. physician should consider the rarest possibility of cardiopulmonary actinomycosis. Early diagnosis will reduce the hospital stay or mortality.

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