Discussion
Actinomyces species were first identified in Israel during 1878
from human necropsy tissue. [6] Ponfick reported the first case of
thoracic actinomycosis in 1882. [7]
Several species of Actinomyces have been identified in humans
with at least 21 species identified with the use of 16S rRNA sequencing.
[8] Actinomyces israelii remains the predominant species
causing cervicofacial, abdominopelvic, and thoracic actinomycosis.
Diagnosis of paediatric pulmonary actinomycosis remains a challenge
because it is a rare disease (even in resource limited settings) with no
specific features on imaging. CT findings that have been described
include airspace consolidation, lobar consolidation, ground glass
opacification, pleural effusions, pleural thickening, hilar
lymphadenopathy and a necrotic mass. [9] Both the CXR and CT-scan
findings may mimic TB, which can lead to misdiagnosis in settings with a
high TB burden. In addition to the diagnostic difficulties, this patient
experienced a delay in referral for nearly a year due to the SARS-CoV-2
pandemic. Diagnosis was further delayed due to limited chest x-rays
during the pandemic.
In cases of endobronchial involvement, a follow-up bronchoscopy is
essential after treatment has started and imaging has shown improvement
in order to exclude a foreign body. Foreign body-induced endobronchial
actinomycosis have been reported in 45% of adult cases and in most
cases the foreign body was detected only after starting antibiotic
therapy. In these cases, the foreign body should always be removed.
[10]
Patients with thoracic actinomycosis may be candidates for
individualized courses of therapy depending on the initial burden of
disease, whether resection surgery was performed, and the clinical and
radiologic responses to therapy. The traditional recommendation of IV
antibiotic therapy for 2 to 6 weeks followed by oral antibiotic therapy
for 6 to 12 months is not always necessary. [11]