Actinomicose do sistema nervoso central: uma rara complicação da actinomicose cervicofacial

Ferraz, A. C.; Melo, C. V. M.; Pereira, E. L. R.; Stávale, J. N.; Nogueira, R. G.; Gabbai, A. A.; Malheiros, S. M. F.; Prandini, M. N.; Braga, F. M.

doi:10.1590/S0004-282X1993000300012

Resumos

A actinomicose do sistema nervoso central (SNC) é afecção rara, caracterizada pela formação de abscesso único e de evolução crônica. Os autores descrevem o caso de um paciente jovem, imunocompetente, com actinomicose cerebral oriunda de foco primário cervicofacial, submetido a ressecção cirúrgica e antibioticoterapia. Ressalta-se a importância do conhecimento da entidade e de suas principais formas de acometimento, como a base do diagnóstico precoce dessa enfermidade potencialmente curável e de bom prognóstico.

actinomicose; abscesso cerebral; diagnóstico; tratamento

Central nervous system actinomycosis is a rare but treatable chronic suppurative bacterial infection. The case of a young immunocompetent male with actinomycosis of the CNS is presented. The abscess originated from a primary cervico-facial infection and was located in the left parasellar region. After excision of the mass, that showed Actinomyces colonies, the patient was treated with intravenous Penicillin for 42 days followed by oral administration of the drug for 30 days. After surgery the patient was left with mild sequelae that had improved by the last follow-up, 7 months later. A new CT scan at that time revealed no residual disease or recurrence. The early diagnosis of cerebral actinomycosis relies essentially on a clinical suspicion. Hence it is imperative to be aware of the natural history of this infection and its various modes of presentation.

actinomycosis; brain abscess; diagnostics; treatment

A. C. Ferraz^I; C. V. M. Melo^II; E. L. R. Pereira^II; J. N. Stávale^III; R. G. Nogueira^IV; A. A. Gabbai^I; S. M. F. Malheiros^I; M. N. Prandini^II; F. M. Braga^II

^IDisciplina de Neurologia. Escola Paulista de Medicina

^IIDisciplina de Neurocirurgia. Escola Paulista de Medicina

^IIIDepartamento de Anatomia Patológica. Escola Paulista de Medicina

^IVDisciplina de Neuro-Radiologia. Escola Paulista de Medicina

RESUMO

A actinomicose do sistema nervoso central (SNC) é afecção rara, caracterizada pela formação de abscesso único e de evolução crônica. Os autores descrevem o caso de um paciente jovem, imunocompetente, com actinomicose cerebral oriunda de foco primário cervicofacial, submetido a ressecção cirúrgica e antibioticoterapia. Ressalta-se a importância do conhecimento da entidade e de suas principais formas de acometimento, como a base do diagnóstico precoce dessa enfermidade potencialmente curável e de bom prognóstico.

Palavras-chave: actinomicose, abscesso cerebral, diagnóstico, tratamento.

SUMMARY

Central nervous system actinomycosis is a rare but treatable chronic suppurative bacterial infection. The case of a young immunocompetent male with actinomycosis of the CNS is presented. The abscess originated from a primary cervico-facial infection and was located in the left parasellar region. After excision of the mass, that showed Actinomyces colonies, the patient was treated with intravenous Penicillin for 42 days followed by oral administration of the drug for 30 days. After surgery the patient was left with mild sequelae that had improved by the last follow-up, 7 months later. A new CT scan at that time revealed no residual disease or recurrence. The early diagnosis of cerebral actinomycosis relies essentially on a clinical suspicion. Hence it is imperative to be aware of the natural history of this infection and its various modes of presentation.

Key words: actinomycosis, brain abscess, diagnostics, treatment.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Aceite: 22-janeiro-1993.

Dr. João Norberto Stávale Departamento de Anatomia Patológica, Escola Paulista de Medicina - 04023-900 São Paulo SP - Brasil.

1. Birley HDL, Teare EL, Utting JA. Actinomycotic osteomyelitis of the thoracic spine in a penicillin-sensitive patient. J Infect 1989, 19:193-194.
2. Bolton CF, Ashenhurst EM. Actinomycosis of the brain. Can Med Ass J 1964, 90:922-938.
3. Burden P. Actinomycosis. J Infect 1989, 19:95-99.
4. Fewes LA, Laing RFC. Acute actinomycotic osteomyelitis of the skull with subdural empyema. J Infect 1990, 20:266-267.
5. Gady HE, Prager DA, Paix FS, Nash M. Actinomycotic granuloma masquerading as an infraorbital nerve neoplasm. Head Neck 1990, 12:261-263.
6. Hotchi M, Schwarz J. Characterization of actinomycotic granules by architecture and staining methods. Arch Path 1972, 93:392-400.
7. Ingham HR, Kalbag RM, Tharanmet D, High AS, Sengupta RP, Selkon JB. Abscesses of the frontal lobe of the brain secondary to covert dental sepsis. Lancet 1978, 2:497-499.
8. Khosla VK, Banerjee AK, Chopra JS. Intracranial actinomycoma with osteomyelitis simulating meningioma. J Neurosurg 1984, 60:204-207.
9. Lerner PI. The lumpy jaw. Cervicofacial actinomycosis. Infect Dis Clin North Am 1988, 2:203-220.
10. Louie JA, Kusske JA, Rush JL, Pribram HW, Actinomycotic subdural empyema. J Neurosurg 1979, 51:852-855.
11. McGinnis MR, Fader RC. Mycetoma: a contemporary concept. Infect Dis Clin North Am 1988, 2:939-954.
12. ORR TG Jr. Actinomycoma of the third ventricle, probably primary. JAMA 1945, 127: 757-758.
13. Peabody JW Jr, Seabury JH. Actinomycosis and nocardiosis. J Chron Dis 1957, 5:374-403.
14. Powers JM, Dodds HM. Primary actinomycoma of the third ventricle, the colloid cyst: a histochemieal and ultrastructural study. Acta Neuropathol 1977, 37:21-26.
15. Robboy SJ, Vickery AL Jr. Tinctorial and morphologic properties distinguishing actinomycosis and nocardiosis. N Engl J Med 1970, 282:593-5%.
16. Smego RA, Actinomycosis of the central nervous system. Rev Infect Dis 1987, 9:855-865.
17. Waksman SA, Henrici AT. The nomenclature and classification of the Actinomycetes. J Bact 1943, 46:337-341.
18. Weese W, Smith IM. A study of 57 cases of actinomycosis over a 36-year period. Arch Intern Med 1975, 135:1562-1568.
19. Yager BA, Hoxie J, Weisman RA, Greenberg MS, Bilaniuk LT. Actinomycosis in the acquired immunodeficiency syndrome-related complex. Arch Otolaryngol Head Neck Surg 1986, 112:1293-1295.

Actinomicose do sistema nervoso central: uma rara complicação da actinomicose cervicofacial

Actinomycosis of the central nervous system: a rare complication of cervicofacial actinomycosis

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Set 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Birley HDL, Teare EL, Utting JA. Actinomycotic osteomyelitis of the thoracic spine in a penicillin-sensitive patient. J Infect 1989, 19:193-194.

[2] 2. Bolton CF, Ashenhurst EM. Actinomycosis of the brain. Can Med Ass J 1964, 90:922-938.

[3] 3. Burden P. Actinomycosis. J Infect 1989, 19:95-99.

[4] 4. Fewes LA, Laing RFC. Acute actinomycotic osteomyelitis of the skull with subdural empyema. J Infect 1990, 20:266-267.

[5] 5. Gady HE, Prager DA, Paix FS, Nash M. Actinomycotic granuloma masquerading as an infraorbital nerve neoplasm. Head Neck 1990, 12:261-263.

[6] 6. Hotchi M, Schwarz J. Characterization of actinomycotic granules by architecture and staining methods. Arch Path 1972, 93:392-400.

[7] 7. Ingham HR, Kalbag RM, Tharanmet D, High AS, Sengupta RP, Selkon JB. Abscesses of the frontal lobe of the brain secondary to covert dental sepsis. Lancet 1978, 2:497-499.

[8] 8. Khosla VK, Banerjee AK, Chopra JS. Intracranial actinomycoma with osteomyelitis simulating meningioma. J Neurosurg 1984, 60:204-207.

[9] 9. Lerner PI. The lumpy jaw. Cervicofacial actinomycosis. Infect Dis Clin North Am 1988, 2:203-220.

[10] 10. Louie JA, Kusske JA, Rush JL, Pribram HW, Actinomycotic subdural empyema. J Neurosurg 1979, 51:852-855.

[11] 11. McGinnis MR, Fader RC. Mycetoma: a contemporary concept. Infect Dis Clin North Am 1988, 2:939-954.

[12] 12. ORR TG Jr. Actinomycoma of the third ventricle, probably primary. JAMA 1945, 127: 757-758.

[13] 13. Peabody JW Jr, Seabury JH. Actinomycosis and nocardiosis. J Chron Dis 1957, 5:374-403.

[14] 14. Powers JM, Dodds HM. Primary actinomycoma of the third ventricle, the colloid cyst: a histochemieal and ultrastructural study. Acta Neuropathol 1977, 37:21-26.

[15] 15. Robboy SJ, Vickery AL Jr. Tinctorial and morphologic properties distinguishing actinomycosis and nocardiosis. N Engl J Med 1970, 282:593-5%.

[16] 16. Smego RA, Actinomycosis of the central nervous system. Rev Infect Dis 1987, 9:855-865.

[17] 17. Waksman SA, Henrici AT. The nomenclature and classification of the Actinomycetes. J Bact 1943, 46:337-341.

[18] 18. Weese W, Smith IM. A study of 57 cases of actinomycosis over a 36-year period. Arch Intern Med 1975, 135:1562-1568.

[19] 19. Yager BA, Hoxie J, Weisman RA, Greenberg MS, Bilaniuk LT. Actinomycosis in the acquired immunodeficiency syndrome-related complex. Arch Otolaryngol Head Neck Surg 1986, 112:1293-1295.