Clinical characteristics, diagnostic challenges, and management of pulmonary actinomycosis: a 10-year retrospective cohort study
4 affiliations
- 1Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye
- 2Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Chest Diseases Department, Istanbul, 34020 Türkiye
- 3Department of Infectious Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye
- 4Department of Pulmonology, Nişantaşı University, Istanbul, Türkiye
Abstract
Background: Pulmonary actinomycosis (PA) is a rare and diagnostically challenging infection because its clinical and radiological manifestations are nonspecific and often mimic malignancy and other chronic pulmonary diseases. This study aimed to evaluate the clinical, radiological, diagnostic, and treatment characteristics of patients with PA and to assess real-world treatment outcomes.
Methods: We retrospectively reviewed the medical records of adult patients diagnosed with histopathologically confirmed PA between January 2013 and December 2023 at a tertiary referral center.
Results: A total of 69 patients were included. The median age was 56 years (IQR25–75: 44–60), and 66.7% were male. Overall, 78.3% of patients had at least one comorbidity, most commonly structural lung diseases. The most frequent presenting symptoms were cough (43.5%) and hemoptysis (36.2%). Thoracic CT most commonly demonstrated consolidation, bronchiectasis, mediastinal lymphadenopathy, cavitary lesions, and pulmonary nodules. PET-CT frequently showed high FDG uptake, with a mean SUVmax of 9.07 ± 4.40, thereby limiting its specificity in differentiating PA from malignancy. Bronchoscopic procedures represented the most common diagnostic method. The median interval from initial presentation to treatment initiation was 82 days (IQR25–75: 42–164). The median duration of oral antibiotic treatment was 105 days (IQR25–75: 57–180). Compared with medically treated patients, those undergoing surgical intervention more frequently presented with cavitary lesions and hemoptysis and tended to have a longer interval before treatment initiation. During follow-up, no deaths were directly attributable to PA, and no recurrence was observed among evaluable patients.
Conclusions: PA remains a major diagnostic challenge because of its heterogeneous clinical and radiological presentation. PET-CT appears to provide limited additional diagnostic value because of the high FDG uptake frequently observed in PA lesions. Management strategies should be individualized according to clinical presentation, radiological findings, comorbidities, and the potential need for surgical intervention. Larger multicenter studies are needed to better define optimal diagnostic and treatment approaches for this rare disease.
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BibTeX
@article{gul2026clinical,
title = {{Clinical characteristics, diagnostic challenges, and management of pulmonary actinomycosis: a 10-year retrospective cohort study}},
author = {Şule Gül and Nihan Kurt Gürer and Derya Hırçın Cenger and Esra Çörekli Çölgecen and Mehmet Atilla Uysal},
journal = {BMC Infectious Diseases},
year = {2026},
month = jul,
doi = {10.1186/s12879-026-14124-6},
url = {https://doi.org/10.1186/s12879-026-14124-6},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical characteristics, diagnostic challenges, and management of pulmonary actinomycosis: a 10-year retrospective cohort study
AU - Şule Gül
AU - Nihan Kurt Gürer
AU - Derya Hırçın Cenger
AU - Esra Çörekli Çölgecen
AU - Mehmet Atilla Uysal
PY - 2026
DA - 2026/07/31
JO - BMC Infectious Diseases
DO - 10.1186/s12879-026-14124-6
UR - https://doi.org/10.1186/s12879-026-14124-6
AB - Background: Pulmonary actinomycosis (PA) is a rare and diagnostically challenging infection because its clinical and radiological manifestations are nonspecific and often mimic malignancy and other chronic pulmonary diseases. This study aimed to evaluate the clinical, radiological, diagnostic, and treatment characteristics of patients with PA and to assess real-world treatment outcomes. Methods: We retrospectively reviewed the medical records of adult patients diagnosed with histopathologically confirmed PA between January 2013 and December 2023 at a tertiary referral center. Results: A total of 69 patients were included. The median age was 56 years (IQR25–75: 44–60), and 66.7% were male. Overall, 78.3% of patients had at least one comorbidity, most commonly structural lung diseases. The most frequent presenting symptoms were cough (43.5%) and hemoptysis (36.2%). Thoracic CT most commonly demonstrated consolidation, bronchiectasis, mediastinal lymphadenopathy, cavitary lesions, and pulmonary nodules. PET-CT frequently showed high FDG uptake, with a mean SUVmax of 9.07 ± 4.40, thereby limiting its specificity in differentiating PA from malignancy. Bronchoscopic procedures represented the most common diagnostic method. The median interval from initial presentation to treatment initiation was 82 days (IQR25–75: 42–164). The median duration of oral antibiotic treatment was 105 days (IQR25–75: 57–180). Compared with medically treated patients, those undergoing surgical intervention more frequently presented with cavitary lesions and hemoptysis and tended to have a longer interval before treatment initiation. During follow-up, no deaths were directly attributable to PA, and no recurrence was observed among evaluable patients. Conclusions: PA remains a major diagnostic challenge because of its heterogeneous clinical and radiological presentation. PET-CT appears to provide limited additional diagnostic value because of the high FDG uptake frequently observed in PA lesions. Management strategies should be individualized according to clinical presentation, radiological findings, comorbidities, and the potential need for surgical intervention. Larger multicenter studies are needed to better define optimal diagnostic and treatment approaches for this rare disease.
SN - 1471-2334
ER -