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Clinical aspects of abdominal actinomycosis: a systematic review

Abstract:

Background: Abdominal actinomycosis (AA) is a rare infection. The aim of this study was to summarize the evidence available on AA. Methods: A systematic review was conducted. Data sources included Trip Database, BIREME, SciELO, Cochrane Library, WoS, MEDLINE, EMBASE, SCOPUS, IBECS and LILACS. Eligibility criteria included: studies related to surgically treated AA, in adult population, without language and sex restriction, published between 1966 and 2019. The following variables were analysed: publication year, age, sex, geographical origin, location of lesions, clinical manifestations, risk factors, species isolated and treatments used. Results: A total of 1505 studies were initially identified. After scrutinizing titles and abstracts, and checking duplications, 221 articles including 406 subjects with AA were included. All were case reports or series. Mean age of subjects was 49.2 years and 56.2% were female. The highest proportion of articles was published between 2015 and 2019 (18.7%). Publications were predominantly from the USA (12.2%). Structures usually involved were abdominal wall, colon and appendix. The most common presentation was abdominal mass (39.2%). In 42.1% of patients, an associated factor was found, highlighting intrauterine devices (14.3%). The microbiology studies highlighted Actinomyces israelli. Morbidity, recurrence and verified mortality were 18.2%, 1.0% and 2.2%, respectively. Penicillin was the most used antibiotic. Conclusion: Evidence about AA is scarce and dispersed within a reduced range of articles and cases.