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Pulmonary actinomycosis accounts for 15-20% of cases.
- may result from
- aspiration of oropharyngeal secretions
- oesophageal perforation
- local spread from cervicofacial or abdominal infection
- haematogenous spread.
- a higher incidence of pulmonary actinomycosis is seen in patients with underlying lung disease such as emphysema, chronic bronchitis, and bronchiectasis
- it may coexist with lung disease such as tuberculosis or malignancy making the diagnosis and treatment challenging
- initial clinical picture may be similar to pneumonia with a low-grade fever, cough, shortness of breath, and chest pain
- however, there is usually a longer history of illness and associated weight loss and haemoptysis.
- complications may include:
- empyema necessitans (a rare complication of empyema in which the pleural infection spreads to affect the soft tissues of the chest wall)
- pleural effusion
- mediastinal invasion
- can progress into the heart causing pericarditis (commonly)
- rib destruction
- less often myocarditis or endocarditis may occur either via extension from the pericardium or by haematogenous spread (1)
Last reviewed 01/2018