We will draw attention to Actinomyces spp. as causative agents for invasive disease seen in two children with atypical clinical presentation. In both children there was an abrupt onset of symptoms and no evidence of infection elsewhere. Actinomycotic diseases are endogenous infections arising from the mucous membranes, primarily involving the cervicofacial regions, the chest, abdomen, and pelvis but extremely rarely causing central nervous system (CNS) infection. We isolated Actinomyces spp.: A. israelii and A. odontolyticus, respectively, from the paranasal sinuses following hematopoietic stem cell transplantation (HSCT) in two children, leading in one of them to CNS-involvement most probably due to haematogenous dissemination. Patient FD is a 12 yrs-old-boy with acute Ph’ ALL grafted with sib-PBSC after RIC in CR1. One year later, while receiving high dose corticosteroids for GvHD, he developed bilateral chronic pyogeneic sinusitis. Cultures revealed A. israelii and surgical drainage was necessitated on 4 occasions (endoscopic antrostomy, ethmoidectomy and sphenoidectomy). This infection could be cured with iv Benzyl-Penicillin after 20 months’ treatment, but pulmonary complications occurred caused by Candida rugosa and aspergillus fumigatus. The boy is a/w. Patient MO is a 10 yrs-old-boy with Dyskeratosis Congenita, a syndrome of late onset congenital bone marrow failure. Bilateral endoscopic maxillar antrostomy was performed in order to drain the obstructed sinuses 4 weeks after grafting while on CsA immunosuppression following RIC and allogeneic MUD HSCT. He developed meningoencephalitis two weeks later on and A. odontolyticus was identified as causative agent both from the sinuses and cerebrospinal fluid. An appropriate, but far too short antimicrobial coverage most probably facilitated a hematogenous spread of the infection to the CNS. Immunosuppression is probably playing a major role in the etiology of these infections. The proper diagnosis will be overlooked unless pathological specimens are routinely examined for the organism. Actinomyces seems an emerging problem in HSCT patients and further studies would be appropriate to evaluate its incidence as well as possible mechanisms of invasive infection.
Full conference title:
30th Annual Meeting of the European Group for Blood and Marrow Transplantation
- EBMT 2004