Comment on “Other causes of intestinal obstruction actino-mycetoma—A case report and literature review”

Comentário sobre “Outras causas de obstrução intestinal por actinomicetoma—relato de caso e revisão da literatura”

Recently, Dr. Marin et al have published their own clinical case report on “Other causes of intestinal obstruction actino-mycetoma—a case report and literature review.”¹ We thank them for this valuable paper.

The genus Actinomycetes is anaerobic, gram-positive coccobacilli which causative agent of Actinomycosis; this group of bacteria is normal human micro-flora in anaerobic sites particularly oral cavity and abdominal region as well as enter to the human body throughout inhalation, oral-fecal, traumatic inclusions, urogenital and contaminated medical equipment.² Actinomycetes is rare chronic suppurative inflammation which affected various sites particularly cervico-facial, abdominal cavity and respiratory system.^2,3 Nowadays, there are slight increasing of actinomycosis due to improvement of diagnostic technique, the raise numbers of immune disorder patients, history of surgery or trauma and numerous medical interventions such as endoscopy, Urinary catheter or Intrauterine Device (IUD) etc. unfortunately, diagnosis of the actinomycosis is difficult due to its various clinical presentation, rare incidence and actinomycosis infections usually have no specific symptoms, therefore its misidentified as malignancy.^1-4 Actinomycosis is characterized by multiple abscesses, sinus formation, draining sinuses, tissue destruction and particularly presence of sulphur granules.^4,5 One of the most important things to consider in Sulphur granules, this inclusion was not specific marker as actinomycetes infection; we can have formed this granules during other members of actinomycetales infection such as nocardiosis, Streptomyces, Dermatophilus, Rhodococcus as well as fungal infection particularly in Botryomycosis.^4,6 According to review of the literatures, clinically isolates of actinomycosis should be identified to the species level for appropriate treatment, patient management and epidemiological goals.^4-6

We requesting authors to attend following questions:

1. Although, the culture and conventional microbiology test is known as the gold standard method for confirmation of actinomycosis infection; the authors have not mentioned the details of this process particularly in the case one of this report. Please declare that actinomycetes how was identified to the species level? Microscopic evaluation is not enough for confirmation of microbiologic diagnosis without culture and conventional microbiological process.

2. The authors was implied in diagnosis of actinomycosis from the present case but they implied that the case will be improved spontaneously without antibiotic therapy. It’s possible to this lesion may not have been caused by active actinomycosis. Please give more detail about the count blood cell results or Erythrocyte Sedimentation Rate (ESR) and C - reactive protein blood level.

References

• ¹
  Marin JC, Llano JD, Gomez AP. Other causes of intestinal obstruction actino-mycetoma—a case report and literature review. J Coloproctol. 2019, http://dx.doi.org/10.1016/j.jcol.2019.05.004 [in press].
  » http://dx.doi.org/10.1016/j.jcol.2019.05.004
• ²
  Kandhasamy SC, Rajendar B, Sahoo AK, Ganesh RN, Goneppanavar M, Ramakrishnaiah VP, et al. Rare abdominopelvic actinomycosis causing an intestinal band obstruction and mimicking an ovarian malignancy. Cureus. 2018;10:e2721.
• ³
  García-Zúñiga B, Jiménez-Pastrana MT. Acute abdomen with actinomycosis of the colon: a case report. Cir Cir. 2016;84:240-4.
• ⁴
  Keikha M. Comment on “Intra-abdominal actinomycosis resulting in a difficult-to-diagnose intraperitoneal mass: a case study report”. Int J Surg Case Rep. 2018;53:522.
• ⁵
  McFarlane ME, Coard KC. Actinomycosis of the colon with invasion of the abdominal wall: an uncommon presentation of a colonic tumour. Int J Surg Case Rep. 2010;1:9-11.
• ⁶
  Prescott JF. Actinomyces, Nocardia, Streptomyces, Dermatophilus, and Rhodococcus. In: Diagnostic Procedure in Veterinary Bacteriology and Mycology. Academic Press; 1990. p. 271–85. Jan 1.

Publication Dates

• Publication in this collection
  05 Dec 2019
• Date of issue
  Oct-Dec 2019

History

• Accepted
  4 Aug 2019