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  • Title: [Tubo-ovarian actinomycosis].
    Author: Barres A, Criscuolo JL, Vilde F, Taurelle R.
    Journal: Rev Fr Gynecol Obstet; 1990; 85(7-9):479-82. PubMed ID: 2237158.
    Abstract:
    Pelvic actinomycosis is uncommon and usually represents a complication of an intrauterine device (IUD). This organism is very difficult to culture, and most actinomyces is actually identified by histologic features in pathologic specimens or by cytologic features on Papanicolaou smears. A specific fluorescent antibody stain is also available. Tubo ovarian abscess is usually polymicrobial with a preponderance of anaerobic organisms and the exact role of actinomyces in abscess formation remains unclear. The case is described of a 43-year-old women who developed tubo-ovarian actinomycosis while using an IUD. The patient was hospitalized with right abdominal pain and fever. She had a history of appendectomy and right pulmonary lobectomy for tuberculosis. A pelvic mass about 8 cm in diameter was observed on examination. Emergency laparoscopy and laparotomy were performed. In the course of the laparotomy a voluminous, very irregular, necrotic ovarian tumor was observed. The contralateral tube was highly inflamed and had numerous adhesions. An annexectomy was performed, and the diagnosis of tubo-ovarian abscess was made during histological examination. The woman was placed on antibiotic therapy with penicillin, gentalline, and flagyl, and the postoperative course was uneventful. Bacteriological examination of the IUD showed a group of streptococci, rare colonies of a staphylococcus, and absence of strict anaerobic germs. Macroscopic examination showed the ovary to be almost destroyed by yellowish necrotic masses. The tube was swollen. Actinomycosis is a rare cause of tubo-ovarian abscess and usually is found in women using IUDs. 80% of cases of pelvic actinomycosis in IUD users have been reported in women not changing IUDs for at least 3 years. It is more common in plastic IUDs. Most cases are diagnosed histologically by identification of an actinomycotic grain in the center of the abscess or by cytologic features on Papanicolaou smears. A fluorescent antibody stain is also available. The exact role of actinomyces in tubo-ovarian abscess formation is unclear, since such abscesses are usually polymicrobial. Actinomyces should always be systematically ruled out in the event of serious genital tract infection. Treatment consists of high-dose antibiotics over a sufficiently long period.
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