Actinomycosis differential diagnosis: Difference between revisions

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{{CMG}}; {{AE}}{{ADG}}
{{CMG}}; {{AE}}{{ADG}}
==Overview==
==Overview==
Based on the organ system involved and duration of sypmtoms differential diagnosis of [[actinomycosis]] consists of [[blastomycosis]], [[brain abscess]], [[colon cancer]], [[crohn disease]], [[diverticulitis]], [[liver abscess]], [[lung abscess]], [[lymphoma]], [[nocardiosis]], [[pelvic inflammatory disease]], [[pneumonia]], [[tuberculosis]] and [[uterine cancer]].
Based on the organ system involved and duration of symptoms, differential diagnosis of [[actinomycosis]] consists of [[blastomycosis]], [[brain abscess]], [[colon cancer]], [[crohn disease]], [[diverticulitis]], [[liver abscess]], [[lung abscess]], [[lymphoma]], [[nocardiosis]], [[pelvic inflammatory disease]], [[pneumonia]], [[tuberculosis]] and [[uterine cancer]].


==Differential Diagnosis==
==Differential Diagnosis==
*[[Actinomycosis]] is a chronic pyogenic bacterial infection caused by [[Actinomyces]]species and most commonly involves oro-cervicofacial region  
*[[Actinomycosis]] is a chronic [[pyogenic]] [[bacterial infection]] caused by [[Actinomyces]]species and most commonly involves orocervicofacial region  
*It rarely infects other organ systems. If involved it has a wide variety of presentation.
*It rarely infects other organ systems. If involved it has a wide variety of presentation.
*Most common symptoms of actinomycosis includes abscess with draining sinus tracts.  
*Most common symptoms of actinomycosis includes [[abscess]] with draining [[sinus]] tracts.  
*Other symptoms are mostly non-specific for actinomycosis.  
*Other symptoms are mostly non-specific for actinomycosis.  
*Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:<ref name="pmid17560191">{{cite journal| author=Yiğiter M, Kiyici H, Arda IS, Hiçsönmez A| title=Actinomycosis: a differential diagnosis for [[appendicitis]]. A case report and review of the literature. | journal=J Pediatr Surg | year= 2007 | volume= 42 | issue= 6 | pages= E23-6 | pmid=17560191 | doi=10.1016/j.jpedsurg.2007.03.057 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560191  }} </ref><ref name="pmid19149697">{{cite journal |vauthors=Hasper D, Schefold JC, Baumgart DC |title=Management of severe abdominal infections |journal=Recent Pat Antiinfect Drug Discov |volume=4 |issue=1 |pages=57–65 |year=2009 |pmid=19149697 |doi= |url=}}</ref><ref name="pmid15342974">{{cite journal |author=Lederman ER, Crum NF |title=A case series and focused review of nocardiosis: clinical and microbiologic aspects |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=300–13 |year=2004|pmid=15342974 |doi= 10.1097/01.md.0000141100.30871.39|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0025-7974&volume=83&issue=5&spage=300}}</ref><ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref><ref name="Humes2006">{{cite journal|last1=Humes|first1=D J|title=Acute appendicitis|journal=BMJ|volume=333|issue=7567|year=2006|pages=530–534|issn=0959-8138|doi=10.1136/bmj.38940.664363.AE}}</ref><ref name="pmid20375357">{{cite journal |vauthors=Saccente M, Woods GL |title=Clinical and laboratory update on blastomycosis |journal=Clin. Microbiol. Rev. |volume=23 |issue=2 |pages=367–81 |year=2010 |pmid=20375357 |pmc=2863359 |doi=10.1128/CMR.00056-09 |url=}}</ref><ref name="Kim2014">{{cite journal|last1=Kim|first1=Eun Ran|title=Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis|journal=World Journal of Gastroenterology|volume=20|issue=29|year=2014|pages=9872|issn=1007-9327|doi=10.3748/wjg.v20.i29.9872}}</ref><ref name=Hanauer>{{cite journal | last = Hanauer | first = Stephen B. | year = 1996 | title = Inflammatory bowel disease | journal = New England Journal of Medicine | volume = 334 | issue = 13 | pages = 841-848 | id = PMID 8596552 | url = http://content.nejm.org/cgi/content/extract/334/13/841 | accessdate = 2006-11-10}}</ref><ref name="pmid26366400">{{cite journal |vauthors=Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D |title=Lung abscess-etiology, diagnostic and treatment options |journal=Ann Transl Med |volume=3 |issue=13 |pages=183 |year=2015 |pmid=26366400 |pmc=4543327 |doi=10.3978/j.issn.2305-5839.2015.07.08 |url=}}</ref> <ref name="pmid20664404">{{cite journal |vauthors=Soper DE |title=Pelvic inflammatory disease |journal=Obstet Gynecol |volume=116 |issue=2 Pt 1 |pages=419–28 |year=2010 |pmid=20664404 |doi=10.1097/AOG.0b013e3181e92c54 |url=}}</ref>
*Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:<ref name="pmid17560191">{{cite journal| author=Yiğiter M, Kiyici H, Arda IS, Hiçsönmez A| title=Actinomycosis: a differential diagnosis for [[appendicitis]]. A case report and review of the literature. | journal=J Pediatr Surg | year= 2007 | volume= 42 | issue= 6 | pages= E23-6 | pmid=17560191 | doi=10.1016/j.jpedsurg.2007.03.057 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560191  }} </ref><ref name="pmid19149697">{{cite journal |vauthors=Hasper D, Schefold JC, Baumgart DC |title=Management of severe abdominal infections |journal=Recent Pat Antiinfect Drug Discov |volume=4 |issue=1 |pages=57–65 |year=2009 |pmid=19149697 |doi= |url=}}</ref><ref name="pmid15342974">{{cite journal |author=Lederman ER, Crum NF |title=A case series and focused review of nocardiosis: clinical and microbiologic aspects |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=300–13 |year=2004|pmid=15342974 |doi= 10.1097/01.md.0000141100.30871.39|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0025-7974&volume=83&issue=5&spage=300}}</ref><ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref><ref name="Humes2006">{{cite journal|last1=Humes|first1=D J|title=Acute appendicitis|journal=BMJ|volume=333|issue=7567|year=2006|pages=530–534|issn=0959-8138|doi=10.1136/bmj.38940.664363.AE}}</ref><ref name="pmid20375357">{{cite journal |vauthors=Saccente M, Woods GL |title=Clinical and laboratory update on blastomycosis |journal=Clin. Microbiol. Rev. |volume=23 |issue=2 |pages=367–81 |year=2010 |pmid=20375357 |pmc=2863359 |doi=10.1128/CMR.00056-09 |url=}}</ref><ref name="Kim2014">{{cite journal|last1=Kim|first1=Eun Ran|title=Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis|journal=World Journal of Gastroenterology|volume=20|issue=29|year=2014|pages=9872|issn=1007-9327|doi=10.3748/wjg.v20.i29.9872}}</ref><ref name=Hanauer>{{cite journal | last = Hanauer | first = Stephen B. | year = 1996 | title = Inflammatory bowel disease | journal = New England Journal of Medicine | volume = 334 | issue = 13 | pages = 841-848 | id = PMID 8596552 | url = http://content.nejm.org/cgi/content/extract/334/13/841 | accessdate = 2006-11-10}}</ref><ref name="pmid26366400">{{cite journal |vauthors=Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D |title=Lung abscess-etiology, diagnostic and treatment options |journal=Ann Transl Med |volume=3 |issue=13 |pages=183 |year=2015 |pmid=26366400 |pmc=4543327 |doi=10.3978/j.issn.2305-5839.2015.07.08 |url=}}</ref> <ref name="pmid20664404">{{cite journal |vauthors=Soper DE |title=Pelvic inflammatory disease |journal=Obstet Gynecol |volume=116 |issue=2 Pt 1 |pages=419–28 |year=2010 |pmid=20664404 |doi=10.1097/AOG.0b013e3181e92c54 |url=}}</ref>
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| rowspan="5" |Abdomen
| rowspan="5" |Abdomen
|'''Abdominal Abscess'''
|'''Abdominal Abscess'''
|Features of [[sepsis]] and signs of an acute abdomen are generally prominent
|Features of [[sepsis]] and signs of an [[acute abdomen]] are generally prominent
|Histology and culture for [[actinomycetes]] are negative.
|Histology and culture for [[actinomycetes]] are negative.


Blood cultures positive for the causative organism.
[[Blood]] cultures positive for the causative [[organism]].
|-
|-
|'''[[Appendicitis]]'''
|'''[[Appendicitis]]'''
Line 31: Line 31:


Positive for signs of [[appendicitis]]
Positive for signs of [[appendicitis]]
|Ultrasound shows inflammation of appendix
|Ultrasound shows [[inflammation]] of [[appendix]]


Negative blood culture  
Negative [[blood]] culture  
|-
|-
|'''[[Colon cancer]]'''
|'''[[Colon cancer]]'''
|Systemic findings like [[weight loss]], [[night sweats]] present
|Systemic findings like [[weight loss]], [[night sweats]] present


Anemia  
[[Anemia]]


Blood loss in stools
Blood loss in [[stools]]
|Colonoscopy identifies the lesions, histopathology confirms the presence of the malignant cells.
|Colonoscopy identifies the lesions, [[histopathology]] confirms the presence of the [[malignant]] cells.
|-
|-
|'''[[Whipple disease]]'''
|'''[[Whipple disease]]'''
Line 48: Line 48:
[[Malabsorption]] such as [[steatorrhea]].
[[Malabsorption]] such as [[steatorrhea]].


Abdominal lymphadenopathy and [[abdominal pain]].
[[Abdominal]] [[lymphadenopathy]] and [[abdominal pain]].


Joint problems  
Joint problems  


[[Anemia]].
[[Anemia]].
|Anti-Tropheryma whipplei-positive macrophage.
|Anti-Tropheryma whipplei-positive [[macrophage]].


[[PCR]] testing of duodenal biopsies positive for [[T whipplei]]
[[PCR]] testing of duodenal biopsies positive for [[T whipplei]]
Line 61: Line 61:


[[Weight loss]]
[[Weight loss]]
|Colonoscopy identifies the ulcerative lesions
|[[Colonoscopy]] identifies the ulcerative [[lesions]]
|-
|-
| rowspan="4" |Pulmonary
| rowspan="4" |Pulmonary
Line 67: Line 67:
|[[Immunocompromised]] host
|[[Immunocompromised]] host


Predominant pulmonary
Predominant [[pulmonary]]
|Modified [[acid-fast]] staining of biopsy tissue or other samples allows distinction between [[Nocardia]] and [[Actinomyces]]
|Modified [[acid-fast]] staining of biopsy tissue or other samples allows distinction between [[Nocardia]] and [[Actinomyces]]
|-
|-
Line 73: Line 73:
|Self-limited  
|Self-limited  


Cutaneous manifestations along with lung involvement.
[[Cutaneous]] manifestations along with [[lung]] involvement.


Endemic to Mississippi and Ohio river valley  
Endemic to Mississippi and Ohio river valley  
|Sputum smear and culture using [[KOH test|KOH]] preparations or specific stains can confirm diagnosis
|[[Sputum]] smear and culture using [[KOH test|KOH]] preparations or specific stains can confirm diagnosis
|-
|-
|'''[[Lung abscess]]'''
|'''[[Lung abscess]]'''
Line 82: Line 82:


[[Cough]] with foul smelling sputum
[[Cough]] with foul smelling sputum
|[[Polymicrobial infection]]  
|Polymicrobial [[infection]]  
|-
|-
|'''[[Pulmonary tuberculosis]]'''
|'''[[Pulmonary tuberculosis]]'''
Line 90: Line 90:


[[Night sweats]], [[weight loss]]
[[Night sweats]], [[weight loss]]
|[[Acid fast bacilli]] positive on sputum examination  
|Acid fast [[bacilli]] positive on sputum examination  


Tuberculin skin testing positive.  
[[Tuberculin skin test|Tuberculin skin]] testing positive.  
|-
|-
| rowspan="2" |Uro-genital system
| rowspan="2" |Uro-genital system
Line 99: Line 99:


No [[leukorrhea]]
No [[leukorrhea]]
|Histopathology shows malignancy.
|Histopathology shows [[malignancy]].
|-
|-
|'''[[Pelvic inflammatory disease]]'''
|'''[[Pelvic inflammatory disease]]'''
Line 105: Line 105:


Past history of [[PID]].
Past history of [[PID]].
|laparoscopy with biopsy sampling followed by histology.
|Laparoscopy with [[biopsy]] sampling followed by histology.
|}
|}
* The clinical manifestations of actinomycosis and nocardiosis are similar. The following table helps in differentiating actinomycosis from nocardiosis.<ref name="pmid20463251">{{cite journal| author=Sullivan DC, Chapman SW| title=Bacteria that masquerade as fungi: actinomycosis/nocardia. | journal=Proc Am Thorac Soc | year= 2010 | volume= 7 | issue= 3 | pages= 216-21 | pmid=20463251 | doi=10.1513/pats.200907-077AL | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20463251  }} </ref><ref name="pmid8821161">{{cite journal| author=Warren NG| title=Actinomycosis, nocardiosis, and actinomycetoma. | journal=Dermatol Clin | year= 1996 | volume= 14 | issue= 1 | pages= 85-95 | pmid=8821161 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8821161  }} </ref>
* The clinical manifestations of actinomycosis and [[nocardiosis]] are similar. The following table helps in differentiating actinomycosis from nocardiosis.<ref name="pmid20463251">{{cite journal| author=Sullivan DC, Chapman SW| title=Bacteria that masquerade as fungi: actinomycosis/nocardia. | journal=Proc Am Thorac Soc | year= 2010 | volume= 7 | issue= 3 | pages= 216-21 | pmid=20463251 | doi=10.1513/pats.200907-077AL | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20463251  }} </ref><ref name="pmid8821161">{{cite journal| author=Warren NG| title=Actinomycosis, nocardiosis, and actinomycetoma. | journal=Dermatol Clin | year= 1996 | volume= 14 | issue= 1 | pages= 85-95 | pmid=8821161 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8821161  }} </ref>
* Differentiation of actinomycosis from nocardiosis is very important in selection of appropriate antimicrobial therapy.<ref name="pmid3317731">{{cite journal| author=Smego RA| title=Actinomycosis of the central nervous system. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 5 | pages= 855-65 | pmid=3317731 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3317731  }} </ref><ref name="pmid22223997">{{cite journal |vauthors=Bassiri-Jahromi S, Doostkam A |title=Actinomyces and nocardia infections in chronic granulomatous disease |journal=J Glob Infect Dis |volume=3 |issue=4 |pages=348–52 |year=2011 |pmid=22223997 |pmc=3249989 |doi=10.4103/0974-777X.91056 |url=}}</ref>
* Differentiation of actinomycosis from nocardiosis is very important in selection of appropriate antimicrobial therapy.<ref name="pmid3317731">{{cite journal| author=Smego RA| title=Actinomycosis of the central nervous system. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 5 | pages= 855-65 | pmid=3317731 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3317731  }} </ref><ref name="pmid22223997">{{cite journal |vauthors=Bassiri-Jahromi S, Doostkam A |title=Actinomyces and nocardia infections in chronic granulomatous disease |journal=J Glob Infect Dis |volume=3 |issue=4 |pages=348–52 |year=2011 |pmid=22223997 |pmc=3249989 |doi=10.4103/0974-777X.91056 |url=}}</ref>


Line 120: Line 120:
|Increasing incidence
|Increasing incidence
|-
|-
|Occurs primarily in [[immunocompetent host]]
|Occurs primarily in [[immunocompetent]] host
|Occurs primarily in [[immunocompromised host]]
|Occurs primarily in [[immunocompromised host]]
|-
|-
Line 129: Line 129:
|Chest wall involvement is uncommon
|Chest wall involvement is uncommon
|-
|-
|Granuloma formation and intense fibrosis are common. Form characteristic sulfur granules
|[[Granuloma]] formation and intense [[fibrosis]] are common. Form characteristic sulfur granules
|Granuloma formation and fibrosis are uncommon
|Granuloma formation and fibrosis are uncommon
|-
|-
|Spread by direct invasion
|Spread by direct invasion
|Metastatic spread is common (especially to brain)
|[[Metastatic]] spread is common (especially to brain)
|-
|-
|Diagnosis is made through cytologic or histologic examination
|Diagnosis is made through cytologic or histologic examination
|Diagnosis is made through BAL (bronchoalveolar lavage),
|Diagnosis is made through BAL (bronchoalveolar lavage),
sputum, or pleural fluid culture
sputum, or [[pleural]] [[fluid]] culture
|-
|-
|Treatment: [[Penicillin]]
|Treatment: [[Penicillin]]

Revision as of 13:51, 7 April 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Based on the organ system involved and duration of symptoms, differential diagnosis of actinomycosis consists of blastomycosis, brain abscess, colon cancer, crohn disease, diverticulitis, liver abscess, lung abscess, lymphoma, nocardiosis, pelvic inflammatory disease, pneumonia, tuberculosis and uterine cancer.

Differential Diagnosis

  • Actinomycosis is a chronic pyogenic bacterial infection caused by Actinomycesspecies and most commonly involves orocervicofacial region
  • It rarely infects other organ systems. If involved it has a wide variety of presentation.
  • Most common symptoms of actinomycosis includes abscess with draining sinus tracts.
  • Other symptoms are mostly non-specific for actinomycosis.
  • Based on the organ system involved and duration of symptoms it should be differentiated from other conditions:[1][2][3][4][5][6][7][8][9] [10]


System involved Disease Differentiating signs/symptoms Differentiating tests
Abdomen Abdominal Abscess Features of sepsis and signs of an acute abdomen are generally prominent Histology and culture for actinomycetes are negative.

Blood cultures positive for the causative organism.

Appendicitis Rapid onset of symptoms

Positive for signs of appendicitis

Ultrasound shows inflammation of appendix

Negative blood culture

Colon cancer Systemic findings like weight loss, night sweats present

Anemia

Blood loss in stools

Colonoscopy identifies the lesions, histopathology confirms the presence of the malignant cells.
Whipple disease An acute GI illness, with fever, diarrhea, and weight loss

Malabsorption such as steatorrhea.

Abdominal lymphadenopathy and abdominal pain.

Joint problems

Anemia.

Anti-Tropheryma whipplei-positive macrophage.

PCR testing of duodenal biopsies positive for T whipplei

Inflammatory bowel disease Dysentery

Weight loss

Colonoscopy identifies the ulcerative lesions
Pulmonary Nocardiosis Immunocompromised host

Predominant pulmonary

Modified acid-fast staining of biopsy tissue or other samples allows distinction between Nocardia and Actinomyces
Blastomycosis Self-limited

Cutaneous manifestations along with lung involvement.

Endemic to Mississippi and Ohio river valley

Sputum smear and culture using KOH preparations or specific stains can confirm diagnosis
Lung abscess Risk of aspiration

Cough with foul smelling sputum

Polymicrobial infection
Pulmonary tuberculosis Cough >2 weeks

Hemoptysis

Night sweats, weight loss

Acid fast bacilli positive on sputum examination

Tuberculin skin testing positive.

Uro-genital system Ovarian/Oviductal tumor Systemic findings like weight loss ,night sweats present

No leukorrhea

Histopathology shows malignancy.
Pelvic inflammatory disease History of recent sexual contact or a sexually transmitted infection in the partner,

Past history of PID.

Laparoscopy with biopsy sampling followed by histology.
  • The clinical manifestations of actinomycosis and nocardiosis are similar. The following table helps in differentiating actinomycosis from nocardiosis.[11][12]
  • Differentiation of actinomycosis from nocardiosis is very important in selection of appropriate antimicrobial therapy.[13][14]
Actinomycosis Nocardiosis
Gram positive anaerobic species Gram positive aerobe
Decreasing incidence Increasing incidence
Occurs primarily in immunocompetent host Occurs primarily in immunocompromised host
Predominant cervicofacial Predominant pulmonary
Chest wall involvement and bony erosions are common Chest wall involvement is uncommon
Granuloma formation and intense fibrosis are common. Form characteristic sulfur granules Granuloma formation and fibrosis are uncommon
Spread by direct invasion Metastatic spread is common (especially to brain)
Diagnosis is made through cytologic or histologic examination Diagnosis is made through BAL (bronchoalveolar lavage),

sputum, or pleural fluid culture

Treatment: Penicillin

Treatment with antibiotics alone

Treatment: Sulfonamides

Often need surgical drainage

References

  1. ↑ Yiğiter M, Kiyici H, Arda IS, Hiçsönmez A (2007). "Actinomycosis: a differential diagnosis for [[appendicitis]]. A case report and review of the literature". J Pediatr Surg. 42 (6): E23–6. doi:10.1016/j.jpedsurg.2007.03.057. PMID 17560191. URL–wikilink conflict (help)
  2. ↑ Hasper D, Schefold JC, Baumgart DC (2009). "Management of severe abdominal infections". Recent Pat Antiinfect Drug Discov. 4 (1): 57–65. PMID 19149697.
  3. ↑ Lederman ER, Crum NF (2004). "A case series and focused review of nocardiosis: clinical and microbiologic aspects". Medicine (Baltimore). 83 (5): 300–13. doi:10.1097/01.md.0000141100.30871.39. PMID 15342974.
  4. ↑ Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
  5. ↑ Humes, D J (2006). "Acute appendicitis". BMJ. 333 (7567): 530–534. doi:10.1136/bmj.38940.664363.AE. ISSN 0959-8138.
  6. ↑ Saccente M, Woods GL (2010). "Clinical and laboratory update on blastomycosis". Clin. Microbiol. Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMC 2863359. PMID 20375357.
  7. ↑ Kim, Eun Ran (2014). "Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis". World Journal of Gastroenterology. 20 (29): 9872. doi:10.3748/wjg.v20.i29.9872. ISSN 1007-9327.
  8. ↑ Hanauer, Stephen B. (1996). "Inflammatory bowel disease". New England Journal of Medicine. 334 (13): 841–848. PMID 8596552. Retrieved 2006-11-10.
  9. ↑ Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D (2015). "Lung abscess-etiology, diagnostic and treatment options". Ann Transl Med. 3 (13): 183. doi:10.3978/j.issn.2305-5839.2015.07.08. PMC 4543327. PMID 26366400.
  10. ↑ Soper DE (2010). "Pelvic inflammatory disease". Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.
  11. ↑ Sullivan DC, Chapman SW (2010). "Bacteria that masquerade as fungi: actinomycosis/nocardia". Proc Am Thorac Soc. 7 (3): 216–21. doi:10.1513/pats.200907-077AL. PMID 20463251.
  12. ↑ Warren NG (1996). "Actinomycosis, nocardiosis, and actinomycetoma". Dermatol Clin. 14 (1): 85–95. PMID 8821161.
  13. ↑ Smego RA (1987). "Actinomycosis of the central nervous system". Rev Infect Dis. 9 (5): 855–65. PMID 3317731.
  14. ↑ Bassiri-Jahromi S, Doostkam A (2011). "Actinomyces and nocardia infections in chronic granulomatous disease". J Glob Infect Dis. 3 (4): 348–52. doi:10.4103/0974-777X.91056. PMC 3249989. PMID 22223997.

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