Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
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J. Infect. Chemother. · Jun 2004
Review Case ReportsThoracic actinomycosis with mainly pleural involvement.
A 61-year-old man, who had been diagnosed with pleuritis 5 months earlier, was admitted to our hospital to determine if a tumor shadow that appeared in his right lower lung field on March 2002 was a localized pleural mesothelioma. Although a CT-guided lung biopsy was performed, no definite diagnosis was made. However, because the tumor shadow continued to increase in size, we could not rule out the possibility of a malignant thoracic tumor, and performed video-assisted thoracoscopic surgery (VATS). ⋯ Because the recurrence of pulmonary actinomycosis was also suspected after surgical treatment, penicillin G was administered intravenously and afterward amoxicillin was administered intraorally. Subsequently, the patient's clinical status improved. We considered a case of thoracic actinomycosis that was suspected to have spread directly from the lung to the chest wall with complicating pleural effusion and remained with organization because there was a pulmonary infiltration shadow in the right upper lobe on chest CT at the first admission.
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Substantial progress has been made in the management of febrile episodes in neutropenic patients, largely by the prompt administration of potent, broad-spectrum antimicrobial agents. During the past several decades, the spectrum of organisms has changed from a predominance of gram-negative pathogens to a predominance of gram-positive pathogens. In recent years, some hospitals have experienced an increase of infections caused by multi-drug-resistant pathogens. ⋯ Novel approaches to therapy include outpatient antibiotics, and use of growth factors as adjunctive therapy. There also has been a renewed interest in white blood cell transfusions. Although the prognosis for infection in neutropenic patients has improved greatly, new infectious problems have emerged that limit our successful management of these complications.