Central Nervous System Actinomycosis- A Clinico-Radiological and Histopathological Analysis.

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Central Nervous System Actinomycosis- A Clinico-Radiological and Histopathological Analysis.

World Neurosurg. 2018 May 08;:

Authors: Ravindra N, Sadashiva N, Mahadevan A, Bhat DI, Saini J

Abstract
INTRODUCTION: Actinomycosis is an uncommon chronic suppurative infection that rarely affects the central nervous system(CNS). It is caused by filamentous Gram-positive anaerobic bacteria that is a normal commensal but causes suppurative and granulomatous inflammation following disruption of anatomical barriers. We report the largest series of 17histologically confirmed cases of CNS actinomycosis and review clinical, imaging and histopathological features.
METHODS: All histologically confirmed cases of CNS actinomycosis diagnosed between January 2010 and June 2016 were retrieved from the neuropathology records. The demographic profile, clinical, radiological, microbiologic and histological features, treatment and clinical outcomes were reviewed.
RESULTS: Seventeen cases were histopathologically diagnosed to have CNS actinomycosis. Nine of these were primarily admitted and managed in our institute while the remaining eight were referred to us for histopathological diagnosis. Mean age at presentation was 31.4years, with male predilection(3.25:1). Mean duration of symptoms was 2.95months. Systemic symptoms were noted in 5patients though no systemic focus was detectable. Pachymeningitis was most common type[9(52.94%)] and chronic abscess in 7. History of prior surgery for osteomyelitis was forthcoming in 3. All patients underwent surgical excision/aspiration of the lesions. Histologically, lesions revealed characteristic suppurative granulomatous response with giant cells and Actinomycotic colonies were detected within necrotic centres. Cultures failed to grow Actinomyces in all. Follow-up data was available in nine patients managed in our institute, and all had good outcome at the median follow-up period of 32months after antibiotic treatment for mean period of 8.4weeks.
CONCLUSION: Histopathology remains the cornerstone for diagnosis of actinomycosis as on culture confirmation is very rare.

PMID: 29751182 [PubMed - as supplied by publisher]

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