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Læknablaðið - 15.06.2007, Síða 24

Læknablaðið - 15.06.2007, Síða 24
FRÆÐIGREIN / GEISLAGERLABÓLGA geislagerlabólgu er til fjöldi heimilda um árang- ursríka meðferð með erytrómýcíni, tetracýklínum og klindamýcini (7). Skurðaðgerð eða hreinsun á sýktum vef er talin vera mikilvægur þáttur í meðferð (62) en þó er til fjöldi tilfellalýsinga þar sem jafnvel útbreidd geislagerlabólga hefur verið meðhöndluð með sýklalyfjum einvörðungu (7). Lokaorð I þessari grein segir frá konu sem fékk getn- aðarvarnarlykkju uppsetta í kringum 1960 og hafði ekki verið í reglubundnu eftirliti um langt árabil. Af þessum sökum gleymdist lykkjan og var því í leginu í ríflega fjóra áratugi. Klínísk mynd okkar sjúklings er talsvert frábrugðin því sem lýst hefur verið í læknaritum þar sem hún hafði hvorki haft kviðverki, hita né fundið fyrir þyngdartapi sem eru algengustu einkenni geislagerlabólgu í grindarholi (51). Ekki var unnt að greina hvaða tegund Actinomyces var hér á ferðinni. Þar sem væg hækkun var á æxlisvísum var ekki hægt að útiloka illkynja sjúkdóm. Þess fundust þó engin merki við vefjarannsókn. Því er ljóst að bæta má geislagerlabólgu á lista yfir góðkynja sjúkdóma sem valdið geta hækkun á CA 125, CA 19-9 og CEA. Þetta tilfelli minnir einnig á nauðsyn þess að lykkjur séu fjarlægðar hjá konum sem komnar eru yfir tíðahvörf. Síðast en ekki síst sýnir það að árangur meðferðar er góður ef beitt er í senn skurðaðgerð og lyfjameðferð. Heimildir 1. Israel J. Neue beobachtungen auf dem gebiete der mykosen des Menschen. Archiv Path Anat Physiol Klin Med 1878; 74: 15-33. 2. Wolfe M, Israel J. Ueber Reincultur des Actinomyces and seine Uebertragbarkheit auf thiere. Virchows Arch Pathol Anatomie 1891;126:11-59. 3. Rippon JW. The Pathogenic Fungi and the Pathogenic Actinomycetes. In: Wonsiewicz M, editor. Medical Mycology. 3rd ed. W.B. Saunders Co; Philadelpia 1988:30-52. 4. PulvererG,Schutt-GerowittH,SchaalKP.Humancervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis 2003; 37:490-7. 5. Stackebrandt E, Rainey F, Ward-Rainey N. Proposal for a new hierarchic classifications system, Actinobacteria classis nov. Int J Syst Microbiol 1997; 47:479-91. 6. Smego RA, Jr., Foglia G. Actinomycosis. Clin Infect Dis 1998; 26:1255-61. 7. Russo TA. Agents of Actinomycosis. í: Mandell, Bennett & Dolin (ritstj.): Principles and Practice of Infectious Diseases 6th ed: Churchill Livingstone 2005:2246-53. 8. Laxdal P. Actinomycosis - 4 tilfelli af Barnadeild Landakotsspítala. Læknablaðið 1978: fylgirit 5:68-76. 9. Holm P. Studies on the etiology of human Actinomycosis. I. The „other microbes“ of actinomycosis and their importance. Acta Pathol Microbiol Scand 1950; 27:736-51. 10. Holm P. Studies on the etiology of human Actinomycosis. II. The „other microbes“ of actinomycosis and their importance. Acta Pathol Microbiol Scand 1951; 28:391-406. 11. Jordan HV, Kelly DM. Persistence of associated gram-negative bacteria in experimental actinomycotic lesions in mice. Infect Immun 1983;40:847-9. 12. Jordan HV, Kelly DM, Heeley JD. Enhancement of experimental actinomycosis in mice by Eikenella corrodens. Infect Immun 1984; 46:367-71. 13. Ochiai K, Kurita-Ochiai T, Kamino Y, Ikeda T. Effect of co-aggregation on the pathogenicity of oral bacteria. J Med Microbiol 1993; 39:183-90. 14. Simpson AJ, Das SS, Mitchelmore IJ. Polymicrobial brain abscess involving Haemophilus paraphrophilus and Actinomyces odontolyticus. Postgrad Med J 1996; 72:297-8. 15. Bennhoff DF. Actinomycosis: Diagnostic and therapeutic considerations and a review of 32 cases. Laryngoscope 1984; 94:1198-217. 16. Pulverer G, Schaal KP. Human Actinomycosis. Drugs Exp Clin Res 1984; 10:187-96. 17. Brown JR. Human actinomycosis. A study of 181 subjects. Hum Pathology 1973;4:319-30. 18. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur RespirJ 2003; 21:545-51. 19. Schaal KP, Lee HJ. Actinomycete infections in humans-a review. Gene 1992; 115:201-11. 20. Heffner JE. Pleuropulmonary manifestations of actinomycosis and nocardiosis. Semin Respir Infect 1988;3:352-61. 21. Apotheloz C, Regamey C. Disseminated infection due to Actinomyces meyeri: case report and review. Clin Infect Dis 1996; 22:621-5. 22. Makaryus AN, Latzman J, Yang R, Rosman D. A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man. Cardiology Rev 2005; 13:125-7. 23. KinnearWJ, MacFarlane JT.A survey ofthoracic actinomycosis. Respir Med 1990; 84:57-9. 24. Ariel I, Breuer R, Kamal NS, Ben-Dov I, Mogel P, Rosenmann E. Endobronchial actinomycosis simulating bronchogenic carcinoma. Diagnosis by bronchial biopsy. Chest 1991; 99:493- 5. 25. Coodley EL, Yoshinaka R. Pleural effusion as the major manifestation of actinomycosis. Chest 1994; 106:1615-7. 26. Bassiri AG, Girgis RE,Theodore J. Actinomyces odontolyticus thoracopulmonary infections.Two cases in lung and heart-lung transplant recipients and a review of the literature. Chest 1996; 109:1109-11. 27. Yeguez JF, Martinez SA, Sands LR, Hellinger MD. Pelvic actinomycosis presenting as malignant large bowel obstruction: a case report and a review of the literature. Am Surg 2000;66:85-90. 28. Cintron JR, Del Pino A, Duarte B, Wood D. Abdominal actinomycosis. Dis Colon Rectum 1996; 39:105-8. 29. Harris LA, DeCosse JJ, Dannenberg A. Abdominal actinomycosis: evaluation by computed tomography. Am J Gastroenterol 1989; 84:198-200. 30. Sharma M, Briski LE, Khatib R. Hepatic actinomycosis: an overview of salient features and outcome of therapy. Scand J Infect Dis 2002; 34:386-91. 31. Hadley DA, Porschen RK, Juler GL. Actinomycosis of the common bile duct presenting as chronic cholecystitis. Surgery 1981;90:117-9. 32. Deshmukh AS, Kropp KA. Spontaneous vesicocutaneous fistula caused by actinomycosis: case report. J Urol 1974; 112: 192-4. 33. Maeda H, Shichiri Y, Kinoshita H, Okubo K, Okada T, Aoki Y, et al. Urinary undiversion for pelvic actinomycosis: a long- term follow up. Int J Urol 1999; 6:111-3. 34. Ord J, Mishra V, Hudd C, Reginald P, Charig M. Ureteric obstruction caused by pelvic actinomycosis. Scand J Urol Nephrol 2002; 36:87-8. 35. Kayikcioglu F, Akif Akgul M, Haberal A, Faruk Demir O. Actinomyces infection in female genital tract. Eur J Obst Gynecol Reprod Biol 2005; 118:77-80. 36. Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol 1999; 180:265-9. 37. Henderson SR. Pelvic actinomycosis associated with an intrauterine device. Obstet Gynecol 1973;41:726-32. 38. Stringer MD, Cameron AE. Abdominal actinomycosis: a forgotten disease? Brit J Hosp Med 1987; 38:125-7. 39. JaniAN,CasibangV, Mufarrij WA. Disseminated actinomycosis presenting as a testicular mass: a case report. J Urol 1990; 143: 1012-4. 40. Sarosdy MF, Brock WA, Parsons CL. Scrotal actinomycosis. J Urol 1979; 121:256-7. 41. de Souza E, Katz DA, Dworzack DL, Longo G. Actinomycosis of the prostate. J Urol 1985; 133:290-1. 42. Bhagavan BS, Gupta PK. Genital actinomycosis and intrauterine contraceptive devices. Cytopathologic diagnosis and clinical significance. Hum Pathol 1978; 9:567-78. 43. Cleghorn AG, Wilkinson RG.The IUCD-associated incidence of Actinomyces israelii in the female genital tract. Aust NZ J Obstet Gynaecol 1989; 29:445-9. 484 Læknablaðið 2007/93

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