SpringerLink
Log in

Actinomycosis, A Rare and Unsuspected Cause of Anal Fistulous Abscess: Report of Three Cases and Review of the Literature

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

.

Primary perianal actinomycosis is rare. Sporadic cases, with lesions varying in extent have been reported. The infection is caused by the bacterium Actinomyces, which often is a saprophyte. Male gender and diabetes are risk factors, but the exact pathogenic mechanism remains speculative. The diagnosis is a challenge and often delayed, with a protracted history of masses and sinuses extending into the gluteal and genital region. The treatment, a combination of surgery and antibiotics, is poorly standardized. We report three cases and compare their characteristics to those of published cases, found by a computerized literature search (1968–2002).

The lesions, a simple fistula-in-ano or a mass, were diagnosed in an early stage in all three patients. The infection always spread into the scrotum. There were no risk factors other than gender, except in one patient. The diagnosis was suspected by the observation of draining sulfur granules and promptly confirmed by histology in the three cases. All patients healed with antibiotics in addition to simple surgical procedures. Treatment consisted of amoxicillin for two weeks in two cases and more extended antimicrobial treatment in the third. These findings are contrasting with the classic picture of perianal actinomycosis.

It is concluded that perianal actinomycosis can occur in the absence of risk factors and that early diagnosis requires a high degree of suspicion. An infection with Actinomyces should be suspected in the presence of lesions containing watery purulent material with sulfur granules. The indication for extended antibiotherapy combined with sphincter damaging surgery may need to be revised in the presence of early detection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Thailand)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

REFERENCES

  1. ST Ross (1988) ArticleTitleFistula in ano Surg Clin North Am 68 1417–26 Occurrence Handle1:STN:280:BiaD2MfnvVM%3D Occurrence Handle3194823

    CAS  PubMed  Google Scholar 

  2. C Ratto E Gentile M Merico et al. (2000) ArticleTitleHow can the assessment of fistula-in-ano be improved? Dis Colon Rectum 43 1375–82 Occurrence Handle1:STN:280:DC%2BD3crgtl2ltg%3D%3D Occurrence Handle11052514

    CAS  PubMed  Google Scholar 

  3. PA Gunawardhana KI Deen (2001) ArticleTitleComparison of hydrogen peroxide instillation with Goodsall’s rule for fistula-in-ano ANZ J Surg 71 472–4 Occurrence Handle1:STN:280:DC%2BD3MvlslOlsA%3D%3D Occurrence Handle11504291

    CAS  PubMed  Google Scholar 

  4. J Garcia-Aguilar C Belmonte WD Wong SM Goldberg RD Madoff (1996) ArticleTitleAnal fistula surgery. Factors associated with recurrence and incontinence Dis Colon Rectum 39 723–9 Occurrence Handle1:STN:280:BymB1M%2FlsFM%3D Occurrence Handle8674361

    CAS  PubMed  Google Scholar 

  5. IT Jones VW Fazio DG Jagelman (1987) ArticleTitleThe use of transanal rectal advancement flaps in the management of fistulas involving the anorectum Dis Colon Rectum 30 919–23 Occurrence Handle1:STN:280:BieD1c7psFE%3D Occurrence Handle3691261

    CAS  PubMed  Google Scholar 

  6. P Pare (2001) ArticleTitleManagement of fistulas in patients with Crohn’s disease: antibiotic to antibody Can J Gastroenterol 15 751–6 Occurrence Handle1:STN:280:DC%2BD3MnotVarsg%3D%3D Occurrence Handle11727005

    CAS  PubMed  Google Scholar 

  7. CC Chung CL Choi SP Kwok KL Leung WY Lau AK Li (1997) ArticleTitleAnal and perianal tuberculosis: a report of three cases in 10 years J R Coll Surg Edinb 42 189–90 Occurrence Handle1:STN:280:ByiA3sbisF0%3D Occurrence Handle9195814

    CAS  PubMed  Google Scholar 

  8. HS Shukla SC Gupta G Singh PA Singh (1988) ArticleTitleTubercular fistula in ano Br J Surg 75 38–9 Occurrence Handle1:STN:280:BieC3cflsF0%3D Occurrence Handle3337948

    CAS  PubMed  Google Scholar 

  9. YS Shan JJ Yan ED Sy YT ** JC Lee (2002) ArticleTitleNested polymerase chain reaction in the diagnosis of negative Ziehl-Neelsen stained Mycobacterium tuberculosis fistula-in-ano: report of four cases Dis Colon Rectum 45 1685–8 Occurrence Handle12473896

    PubMed  Google Scholar 

  10. CM Lynch TL Felder RA Schwandt RG Shashy (1999) ArticleTitleLymphogranuloma venereum presenting as a rectovaginal fistula Infect Dis Obstet Gynecol 7 199–201 Occurrence Handle1:STN:280:DyaK1Mzns1Gjuw%3D%3D Occurrence Handle10449269

    CAS  PubMed  Google Scholar 

  11. HL Kazal N Sohn JI Carrasco JG Robilotti WE Delaney (1976) ArticleTitleThe gay bowel syndrome: clinico-pathologic correlation in 260 cases Ann Clin Lab Sci 6 184–92 Occurrence Handle1:STN:280:CSmC3svnt1c%3D Occurrence Handle946385

    CAS  PubMed  Google Scholar 

  12. J Israel (1878) ArticleTitleNeue Beobachtungen auf dem Gebiete der Mycosen des Menschen Virchow Arch fur Pathol An 74 15–53

    Google Scholar 

  13. Russo TA. Agents of actinomycosis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious disease. 5th ed. New York: Churchill Livingstone, 2000:2645–54.

  14. M Punyamurthy BV Shenoi (1968) ArticleTitleMultiple perianal fistulae due to actinomycosis J Indian Med Assoc 51 396–7 Occurrence Handle1:STN:280:CCaD1M%2FislI%3D Occurrence Handle5705528

    CAS  PubMed  Google Scholar 

  15. NS Brewer RJ Spencer DR Nichols (1974) ArticleTitlePrimary anorectal actinomycosis JAMA 228 1397–400 Occurrence Handle1:STN:280:CSuC28bmsl0%3D Occurrence Handle4406616

    CAS  PubMed  Google Scholar 

  16. D Grigoriu J Delacretaz (1981) ArticleTitleActinomycose péri-anale primitive Ann Dermatol Venereol 108 159–61 Occurrence Handle1:STN:280:Bi6B3s%2Fnt1w%3D Occurrence Handle7247218

    CAS  PubMed  Google Scholar 

  17. M Shimada T Kotani S Ohtaki S Tateno H Tanigawa T Katsuki (1986) ArticleTitlePrimary perianal actinomycosis over a thirty year period Jpn J Surg 16 3202–4

    Google Scholar 

  18. GJ Harris AM Metcalf (1988) ArticleTitlePrimary perianal actinomycosis: report of a case and review of the literature Dis Colon Rectum 31 311–2 Occurrence Handle1:STN:280:BieC1MrnsVc%3D Occurrence Handle3282841

    CAS  PubMed  Google Scholar 

  19. RD Fry EH Birnbaum DL Lacey (1992) ArticleTitleActinomyces as a cause of recurrent perianal fistula in the immunocompromised patient Surgery 111 591–4 Occurrence Handle1:STN:280:By2B1crosVc%3D Occurrence Handle1598681

    CAS  PubMed  Google Scholar 

  20. R Alvarado-Cerna R Bracho-Riquelme (1994) ArticleTitlePerianal actinomycosis – a complication of a fistula-in-ano: report of a case Dis Colon Rectum 37 378–80 Occurrence Handle1:STN:280:ByuB387psFw%3D Occurrence Handle8168418

    CAS  PubMed  Google Scholar 

  21. MR Posnik I Potesman J Abrahamson (1996) ArticleTitlePrimary perianal actinomycosis Eur J Surg 162 153–4 Occurrence Handle1:STN:280:BymB3snmvVw%3D Occurrence Handle8639731

    CAS  PubMed  Google Scholar 

  22. A Gayraud C Grosieux-Dauger A Durlach et al. (2000) ArticleTitleCutaneous actinomycosis in the perineal area and buttocks Ann Dermatol Venereol 127 393–6 Occurrence Handle1:STN:280:DC%2BD3czptVCqtg%3D%3D Occurrence Handle10844260

    CAS  PubMed  Google Scholar 

  23. RA Smego G Foglia (1998) ArticleTitleActinomycosis. State-of-the-art clinical article Clin Infect Dis 26 1255–63 Occurrence Handle9636842

    PubMed  Google Scholar 

  24. E Stein KP Schaal (1987) ArticleTitleHuman actinomycosis. Current views Coloproctology 9 37–42

    Google Scholar 

  25. JR Brown (1973) ArticleTitleHuman actinomycosis. A study of 181 subjects Hum Pathol 4 319–30 Occurrence Handle1:STN:280:CSuD2c7ks1I%3D Occurrence Handle4756858

    CAS  PubMed  Google Scholar 

  26. Z Cope (1949) ArticleTitleActinomycosis involving the colon and rectum J Int Coll Surg 12 401–4

    Google Scholar 

  27. DA Ratliff N Carr JP Cochrane (1986) ArticleTitleRectal stricture due to actinomycosis Br J Surg 73 589–90 Occurrence Handle1:STN:280:BimB2s%2FotFE%3D Occurrence Handle3730797

    CAS  PubMed  Google Scholar 

  28. GA Fry WJ Martin WH Dearing CE Culp (1965) ArticleTitlePrimary actinomycosis of the rectum with multiple perianal and perineal fistulae Mayo Clin Proct 40 296–9 Occurrence Handle1:STN:280:CCqD1crht1Q%3D

    CAS  Google Scholar 

  29. B Samenius (1970) ArticleTitleActinomycosis of the anorectal region Proc R Soc Med 63 108–11 Occurrence Handle5525472

    PubMed  Google Scholar 

  30. B Varkey (1982) ArticleTitleSulfur granules JAMA 248 3025 Occurrence Handle1:STN:280:BiyD28%2FgvVA%3D Occurrence Handle7143677

    CAS  PubMed  Google Scholar 

  31. NG Warren (1996) ArticleTitleActinomycosis, nocardiosis and actinomycetoma Dermatol Clin 14 85–95 Occurrence Handle1:STN:280:BymH3MfjslI%3D Occurrence Handle8821161

    CAS  PubMed  Google Scholar 

  32. G Koshi MK Lalitha T Samraj KV Mathai (1981) ArticleTitleBrain abscess and other protean manifestations of actinomycosis Am J Trop Med Hyg 30 139–44 Occurrence Handle1:STN:280:Bi6C2MjnsVM%3D Occurrence Handle7212161

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium

    G. Coremans Ph.D., V. Margaritis M.D., J. Wyndaele M.D. & J. Janssens Ph.D.

  2. Department of Surgery, University Hospital Gasthuisberg, Leuven, Belgium

    H. P. Van Poppel Ph.D., M. R. Christiaens M.D. & J. Gruwez (Hon.) F.R.C.S. (Engl.), (Edinb.)

  3. Department of Pathology, University Hospital Gasthuisberg, Leuven, Belgium

    K. Geboes Ph.D.

  4. Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium

    D. Vanbeckevoort M.D.

Authors
  1. G. Coremans Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Margaritis M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. P. Van Poppel Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. R. Christiaens M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Gruwez (Hon.) F.R.C.S. (Engl.), (Edinb.)
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Geboes Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Wyndaele M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D. Vanbeckevoort M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Janssens Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Coremans Ph.D..

About this article

Cite this article

Coremans, G., Margaritis, V., Van Poppel, H. et al. Actinomycosis, A Rare and Unsuspected Cause of Anal Fistulous Abscess: Report of Three Cases and Review of the Literature. Dis Colon Rectum 48, 575–581 (2005). https://doi.org/10.1007/s10350-004-0809-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0809-3

Keywords

Search

Navigation