Periodontitis-associated septic pulmonary embolism caused by Actinomyces species identified by anaerobic culture of bronchoalveolar lavage fluid: a case report

BMC Infectious Diseases

Case Report

Takashi Ohi¹  Tasuku Nagasawa²  Yoichi Takeuchi²  Shun Endo²  Masatsugu Ishida³  Masaru Yanai³  Sadayoshi Ito⁴  Hideyasu Kiyomoto⁵  Eikan Mishima⁶ 

[1]Department of Dentistry, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan

[2]Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan

[3]Department of Internal Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan

[4]Department of Respiratory Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan

[5]Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

[6]Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan

[7]Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan

[8]Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

关键词: Septic pulmonary embolism;    Periodontitis;    Actinomyces species;    Dental infection;    Bronchoalveolar lavage;    Anaerobic culture;    Chest pain;   

DOI  :  10.1186/s12879-015-1286-0

 received in 2015-08-04, accepted in 2015-11-23,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPeriodontal disease is a less common but important cause of septic pulmonary embolism (SPE). However, the pathogens causing periodontal disease-associated SPE (PD-SPE) have been poorly understood. Actinomyces species are resident microbiota in the oral cavity. Here we report a case of PD-SPE caused by Actinomyces species, which was identified by anaerobic culture of bronchoalveolar lavage fluid (BAL).Case presentationA 64-year-old Asian man, complicated with severe chronic periodontitis, was admitted with chest pain and fever. Chest CT revealed multiple bilateral pulmonary nodules located subpleurally. We diagnosed the case as SPE associated with periodontitis. Although blood cultures were negative for the usual 5-day incubation, anaerobic culture of the BAL fluid sample yielded Actinomyces species. Antibacterial therapy alone did not ameliorate the symptoms; however, additional dental treatment, including tooth extraction, promptly did. The patient was discharged 23 days after admission. The 3-month follow-up revealed no recurrence of the symptoms and complete resolution of the lung lesions.ConclusionThis case demonstrated that Actinomyces species can cause PD-SPE. Additionally, clinicians should consider performing appropriate anaerobic culture of BAL fluid to identify the pathogen of SPE, and to ordering dental treatment, if necessary, in addition to antibiotics for the initial management of PD-SPE.

【 授权许可】

CC BY   
© Endo et al. 2015