Læknablaðið - 15.06.2007, Blaðsíða 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.
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