Macedonian Journal of Medical Sciences. 2012 Oct 15; 5(3):324-327. http://dx.doi.org/10.3889/MJMS.1857-5773.2012.0242
Case Report Actinomyces Odontolyticus - Associated Bacteremia
Anika Považan1, Anka Vukelic1, Nevena Secen2, 3, Danica Sazdanic-Velikic2, Daliborka Bursac2
1Institute for Pulmonary Diseases of Vojvodina, Center for Microbiology, Immunology and Virology, Sremska Kamenica, Serbia; 2Institute forPulmonary Diseases of Vojvodina, Pulmonary Oncology Clinic, Sremska Kamenica, Serbia; 3Faculty of Medicine, University of Novi Sad,Department of Internal Medicine, Novi Sad, SerbiaAbstract Citation: Považan A, Vukelic A, Secen N,
Many Actinomyces speciesare part of the oral microflora of humans. Actinomyces odontolyticus -
Sazdanic-Velikic D, Bursac D. Actinomyces
associated infections are exceptionally rare, presenting an endogenous infection originating from
Odontolyticus - Associated Bacteremia. Maced JMed Sci. 2012 Oct 15; 5(3):324-327. http://
mucous membranes. Immunodeficiency is often complicated by severe opportunistic bacterial infections
leading to critical condition of the patient. We report a case of an immunosuppressed patient with fever
Key words: Actinomyces odontolyticus;
and Actinomyces odontolyticus bacteremia. The patient poorly responded to the applied antimicrobial
Correspondence: Dr. Anika Považan. Institute for Pulmonary Diseases of Vojvodina, Center for Microbiology, Immunology and Virology, Put doktora Goldmana 4, Sremska Kamenica 21204, Serbia. Phone: +381/21/4805348. Fax: +381/21/ 527960. E-Mail: firstname.lastname@example.org
Received: 03-Apr-2012; Revised: 08-May-2012;Accepted: 09-May-2012; Online first:23-Sep-2012
Copyright: 2012 Považan A. This is an open- access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Competing Interests: The author have declared that no competing interests exist. Introduction
[1, 3]. Most frequently, Actinomyces israelii enters thebody either through a damaged skin or mucosa, or via
Actinomyces odontolyticus is a Gram-positive,
inhalation . Actinomyces odontolyticus infections are
facultative anaerobic bacterium [1, 2]. It was initially
exceptionally rare, presenting an endogenous infection
isolated from dental caries in 1958. As other Actinomyces
arising most frequently from mucous membranes.
species, this organism colonizes the oral cavity . The
Clinically the disease caused by Actinomyces
most significant pathogen of the genus Actinomyces is
odontolyticus closely resembles to the disease caused
Actinomyces israelii, which causes actinomycosis of the
by Actinomyces israelii and other representatives of the
cervico-facial, thoraco-pulmonary and abdominal region
genus. Pulmonary infections , bacteremia  and
Považan et al. Actinomyces Odontolyticus - Associated Bacteremia
abscess of various organs [1, 5-7] caused by thispathogen have been reported. Case presentation
A 62-year male patient was admitted to hospital
to enlighten the etiology of the lesion presented on hischest X-ray, localized in the right upper lobe. He reporteda two-month history of back pains, fatigue, exhaustion,appetite and body mass losses (8 kg in two months). Having noticed a tumorous lesion on the patient’s chestX-ray (Figure 1, 2), chest computed tomography (CT)was performed delineating an infiltration of 27 mm in
histopathological finding of the biopsy samples takenfrom the right upper lobe confirmed adenocarcinoma. Due to the right jaw and right lower leg pains, scintigraphyof the skeleton was performed, detecting pathologicalhyperfixation foci in the projection of the right parietalbone, along all spinal column segments, bilaterally in theribs, shoulder region bones, left humerus diaphysis,sacroiliac joint and proximal femur tips. Due to theadvanced stage of the disease, the chemotherapy
Figure 1: PA chest X-ray at the first day of hospitalization.
regimen with paclitaxel/carboplatin was recommended,accompanied with bisphosphonate administration.
diameter localized in the right upper lobe, with adjacent
However, on the 10th hospital day, the patient’s condition
reactive pneumonitis and a few micronodular subpleural
deteriorated, developing fever (390C) and blood
lesions contralaterally, the 9th rib fracture with infiltrated
leukocytosis (35.5 x 109/L), with predominating
pleura and subpleural fat tissue, as well as enlarged
granulocytes (96.5); procalcitonin levels also increased
retrocaval, bronchopulmonary lymph nodes on the right,
(2.58 ng/ml), as well as nitrogenous substances in the
and those in the subcarinal region (Figure 3).
blood (blood urea 28.2 mmol/l, creatinine 311 ìmol/L). Gas analysis of the arterial blood at rest revealed asevere partial respiratory insufficiency (SaO2 81.7%,PaO2 6.16 kPa, PaCO2 5.41kPa, pH 7.396). The chestX-ray finding was presented with a bronchopneumonicinfiltration paracardially on the right (Figure 4).
Parenteral antibiotic treatment was initiated,
amoxicillin with clavulanic acid. After two days, due toelevated procalcitonin levels (138.24 ng/ml) andworsened medical condition, the therapy was switchedto ceftazidime and ciprofloxacin, according to the NCCN(National Comprehensive Cancer Network) guidelinesfor immunosuppressed patients and hospital-acquiredpneumonia. In the mean time, one set of blood cultures
Figure 2: Profile chest X-ray at the first day of hospitalization.
Maced J Med Sci. 2012 Oct 15; 5(3):324-327.
result. The identification was performed by anaerobicbacterial identification systems (BBL Crystal IdentificationSystems Gram Anaerobe Kit, Beckton Dickinskon, USA)and Actinomyces odontolyticus was identified. Antimicrobial susceptibility testing could not be donedue to technical difficulties. Similar cases ofimmunocompromised patients with Actinomycesodontolyticus infection suggested the efficiency oftetracyclines besides penicillin and cephalosporins inthe treatment of such infection . It was decided to
Figure 4: PA chest X-ray with pneumonic shadow.
include doxycycline in the treatment.
Procalcitonin level and white blood count tended
was sent for microbiological examination. Blood cultures
to decrease, and the control chest X-ray finding showed
where cultivated in the automated BacT/Alert system
an initial regression of the pneumonic infiltration in the
using both anaerobe and aerobe liquid media. The
instrument indicated positive cultures after the 24 hour-incubation. Gram staining of the liquid cultures revealed
However, on the 10th day of antimicrobial therapy,
short Gram-positive bacilli. The blood cultures were
the medical state of the patient worsened, developing
subcultured on the blood agar and MacConkey agar in
the symptoms of endogenous intoxication, resulting in a
aerobic conditions and on Shaedler agar in anaerobic
lethal outcome on the same day. The patient’s dental
conditions. After 48h of incubation on the blood and
status was normal, did not reveal any possible infection
Shaedler agar, a noticeable growth was registered.
Colonies were small, smooth and slightly whitish. Gramstain of the culture revealed Gram-positive short rodsresembling diphteroids in pattern. The oxidase and
catalase tests were performed, producing a negative
Actinomyces odontolyticus is a Gram-positive
facultative anaerobic, non sporulating, non-motilebacterium [1, 2]. The Gram-smear may be presentedwith shorter bacilli resembling diphteroids in pattern. Small, whitish, smooth or slightly granular colonies appearon the blood agar, developing dark red pigment in 2-14days [1, 4]. Pigmentation is best recognized when thecultures, following the primary anaerobic isolation, areleft on the room temperature. Actinomyces odontolyticusalsogrows well on the CDC and Brucella agar . Actinomyces odontolyticus shows negative
catalase and oxidase tests, reduces nitrates to nitrites,and does not grow at pH 5.5 . The final identificationcan be done by identification systems based onbiochemical reactions , or by polymerase chain reaction(PCR), analyzing the 16S rRNA gene sequence . Moreover, the 16S rRNA gene sequence is recomendedin final identification of Actinomyces species , but it isstill not routinely used in clinical microbiology laboratories. Actinomyces odontolyticus is susceptible to penicillin,cephalosporins, tetracycline, clindamycin,chloramphenicol and erythromycin .
The identification of Actinomyces odontolyticus
in blood cultures of the patient with advanced lung
Figure 5: Control PA chest X-ray after antibiotics.Považan et al. Actinomyces Odontolyticus - Associated Bacteremia
malignancy was made according to microscopic, cultural
and biochemical characteristics of the subculture grown
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Maced J Med Sci. 2012 Oct 15; 5(3):324-327.
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