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Year : 2022  |  Volume : 11  |  Issue : 1  |  Page : 97-98

Actinomyces in vault smear


Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

Date of Submission22-Jan-2021
Date of Decision01-Dec-2021
Date of Acceptance05-Dec-2021
Date of Web Publication23-May-2022

Correspondence Address:
Dr. Rashmi Patnayak
Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_9_21

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How to cite this article:
Patnayak R, Naik S, Bulusu D, Dash P. Actinomyces in vault smear. J NTR Univ Health Sci 2022;11:97-8

How to cite this URL:
Patnayak R, Naik S, Bulusu D, Dash P. Actinomyces in vault smear. J NTR Univ Health Sci [serial online] 2022 [cited 2022 Jul 2];11:97-8. Available from: https://www.jdrntruhs.org/text.asp?2022/11/1/97/345812



A 34-year-old woman visited the outpatient gynaecology department with complaint of on and off bleeding for one week. Her obstetric history was P2 L2. She had delivered her youngest child 14 years ago. She gave history of Intrauterine contraceptive device (IUCD) insertion. The duration of IUCD use was for 6 years. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO) 8 years ago. The detail of this operation was not available. Her routine haematological investigation showed Hb 11.6 gm/dl, TLC 7.73 × 103 μl, TPC 253 × 103 μl. Peripheral smear showed microcytic, hypochromic red blood cells with anisocytosis. HIV, HCV, HBs Ag test were non-reactive. Microscopic examination of urine showed pus cells (70--75/HPF), and red blood cells (3+). Per speculum finding showed vault granuloma of size 0.5 × 0.5 cm, positive for contact bleeding. Papanicolaou (PAP) smear was prepared from the vault and was sent for cytopathology examination.

The  Pap smear More Details fulfilled the Bethesda adequacy criteria. It showed superficial squamous cells and colonies of actinomyces. It was interpreted as Negative for intraepithelial lesion or malignancy with organism actinomyces according to 2014 system of Bethesda reporting. [Figure 1]a, [Figure 1]b.
Figure 1: (a) Vault smear showing presence of Actinomyces (Papanicolaou stain × 200). (b) Actinomyces organism (Papanicolaou stain × 400)

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She was treated with amoxicillin for 4 weeks, followed by erythromycin for 6 months. Currently, she is under follow-up and is well.

Actinomyces is a Gram-positive, branching, filamentous bacteria. Actinomycosis results in chronic suppurative inflammation of the organs involved.[1]

Actinomycosis is caused by different species of Actinomyces bacteria. Recently many novel species termed Actinomyces-like organisms (ALOs) have been introduced. There is scant data regarding the role of these novel bacterial species in various infectious processes in human.[2]

Female genital tract is colonized by Actinomyces species like: A. meyeri, A. neuii, Actinomyces radingae, Actinomyces turicensis, and Actinomyces urogenitalis by the long-term use of IUCD. IUCDs are known to have a permanent irritating effect followed by trauma, which may facilitate the invasion of bacteria. In IUCD-associated actinomycosis, abscess formation in the genital tract is frequent. The spread of bacteria from pelvic sites to the abdominal region or vice versa can cause abdomino-pelvic actinomycosis. This leads to complications like dense adhesions with contiguous structures, including the small bowel, causing fibrosis, fistulas, and peritonitis. Earlier A. israelii was one of the most common species involved in pelvic actinomycosis. Later on the pathogenic role of many novel species has been described.[2],[3] Fiorino had stated in a review way back in 1996 that the risk of pelvic actinomycosis in relation to the use of IUDs is very low.[2],[3]

According to Fiorino, detection rates of actinomyces on Papanicolaou smear were somewhat variable.[3] Meri-Feld et al.[4] have opined that Actinomyces-like organisms (ALOs) are a common finding in Papanicolaou-stained cervico-vaginal smears (PAP smears) of women using an IUCD.

Pelvic actinomycosis is a severe disease.[4] Pelvic actinomycosis associated with the use of IUCDs can mimic pelvic malignancy; for that reason, it is often treated surgically.[3],[4] Most of these patients undergo operative procedures, usually hysterectomy and salpingo-oophorectomy.[3] The present case might have undergone surgical procedure for this cause.

High-dose penicillin is an effective antibiotic in the treatment of actinomycosis. If the diagnosis of actinomycosis can be obtained preoperatively, then antibiotic treatment may lead to complete resolution. The Papanicolaou smear may be useful in evaluating such patients.[3]

Gajdács M suggested that in addition to the administration of antibiotics, surgical procedures should also be included in the therapeutic protocols associated with Actinomyces infections. Surgical procedures play a role in the healing process in mild cases and they increase the possibility of clinical success like reducing the formation of scar tissue, abscess drainage, excision of necrotic tissue and fistulas. Surgical intervention may also reduce the duration and dose of antibiotic treatment. It is important to remove the IUCDs in patients with IUCD-associated actinomycosis.[2]

In the present case, the patient had vault granuloma which showed presence of actinomycotic organism, eight years after hysterectomy. So, it is very important to identify the organism so as to administer appropriate treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patnayak R, Jena A, Rukmangadha N, Chowhan AK, Phaneendra BV, Reddy MK, et al. Reactive actinomycotic tonsillar lesion. J Clin Sci Res 2012;2:39-41.  Back to cited text no. 1
    
2.
Gajdács M, Urbán E. The pathogenic role of Actinomyces spp. and related organisms in genitourinary infections: Discoveries in the new, modern diagnostic era. Antibiotics (Basel) 2020;9:524.  Back to cited text no. 2
    
3.
Fiorino AS. Intrauterine contraceptive device-associated actinomycotic abscess and Actinomyces detection on cervical smear. Obstet Gynecol 1996;87:142-9.  Back to cited text no. 3
    
4.
Merki-Feld GS, Lebeda E, Hogg B, Keller PJ. The incidence of actinomyces-like organisms in papanicolaou-stained smears of copper- and levonorgestrel-releasing intrauterine devices. Contraception 2000;61:365-8.  Back to cited text no. 4
    


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