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{\title Title: Actinomyces naeslundii/Pseudomonas aeruginosa sepsis in a patient with ulcerative colitis \'96 has the colonoscopy iniciated development of abdominal actinomycosis}{\author Korisnik}{\operator Korisnik}{\creatim\yr2013\mo10\dy3\hr20\min46}
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\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 Title: }{\fs20\lang1033\langfe1025\langnp1033\insrsid1706428\charrsid11367659 The polymicrobial }{\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid13059146 
Actinomyces naeslundii}{\fs20\lang1033\langfe1025\langnp1033\insrsid1706428\charrsid11367659  and }{\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid13059146 Pseudomonas aeruginosa}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659  sepsis in a patient with ulcerative colitis }{\fs20\lang1033\langfe1025\langnp1033\insrsid1706428\charrsid11367659 two mont}{
\fs20\lang1033\langfe1025\langnp1033\insrsid12343438\charrsid11367659 h}{\fs20\lang1033\langfe1025\langnp1033\insrsid1706428\charrsid11367659 s after colonoscopy}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 
\par 
\par }{\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 Authors: }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 Mirjana Balen Topi\'e6, Bo\'9ako Desnica, Ninoslava Vickovi\'e6, Tomislava Skuhala, Suzana Bukovski}
{\fs20\lang1033\langfe1025\langnp1033\insrsid5133269\charrsid11367659 , Kristijan Bayer}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 
\par 
\par }\pard \ql \li0\ri249\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin249\lin0\itap0\pararsid10361740 {\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 Institution: }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 University of Zagreb School of Medicine, 
\par }\pard \ql \li0\ri249\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin249\lin0\itap0\pararsid10361740 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 University Hospital for Infectious Diseases \'93
Dr. Fran Mihaljevi\'e6\'94, Mirogojska 8, 10 000 Zagreb, Croatia
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin252\lin0\itap0\pararsid10361740 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin252\lin0\itap0\pararsid10361740 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid11367659 Mirjana Balen Topi\'e6
, MD, PhD, infectious disease specialist
\par Bo\'9ako Desnica, MD, infectious disease specialist
\par Ninoslava Vickovi\'e6, MD, MSc, infectious disease specialist
\par Tomislava Skuhala, MD, infectious disease specialist
\par }{\fs20\lang1045\langfe1025\langnp1045\insrsid13513218\charrsid11367659 Suzana Bukovski, MD, PhD, microbiologist
\par }{\fs20\lang1033\langfe1025\langnp1033\insrsid1706428\charrsid11367659 Kristijan Bayer, MD, radiologist
\par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10361740 {\fs20\lang1045\langfe1025\langnp1045\insrsid11536015\charrsid11367659 
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin252\lin0\itap0\pararsid10361740 {\b\fs20\lang2057\langfe1025\langnp2057\insrsid13513218\charrsid11367659 
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin252\lin0\itap0\pararsid10361740 {\b\fs20\lang1033\langfe1025\langnp1033\insrsid15101503\charrsid11367659 Contact address:
\par }{\fs20\lang1033\langfe1025\langnp1033\insrsid15101503\charrsid11367659 Mirjana Balen Topi\'e6, MD, PhD
\par University Hospital for Infectious Diseases \'93Dr. Fran Mihaljevi\'e6\'94
\par }{\fs20\lang1045\langfe1025\langnp1045\insrsid15101503\charrsid11367659 Mirogojska 8
\par 10 000 Zagreb, Croatia
\par Tel: +385 1 2826 174; Fax: +385 1 }{\fs20\lang1045\langfe1025\langnp1045\insrsid16453900 2826}{\fs20\lang1045\langfe1025\langnp1045\insrsid15101503\charrsid11367659  235
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin252\lin0\itap0\pararsid10361740 {\fs20\lang2057\langfe1025\langnp2057\insrsid15101503\charrsid11367659 e-mail: mbalen@bfm.hr
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid10686197\charrsid11367659 
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid15101503\charrsid11367659 
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid10686197\charrsid11367659 
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\par 
\par 
\par 
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid8480918\charrsid11367659 
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid8480918 
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid11367659 
\par 
\par 
\par 
\par 
\par 
\par }{\b\fs20\lang2057\langfe1025\langnp2057\insrsid11367659\charrsid11367659 
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin252\lin0\itap0\pararsid10686197 {\b\fs20\lang2057\langfe1025\langnp2057\insrsid13513218\charrsid5914940 Abstract
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin252\lin0\itap0\pararsid10686197 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 We describe a case of an abrupt onset of polymicrobial }{
\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Actinomyces naeslundii/Pseudomonas aeruginosa}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  sepsis }{
\fs20\lang1033\langfe1025\langnp1033\insrsid14312560\charrsid5914940 in a patient with }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 a previously silent abdominal actinomycosis, }{
\fs20\lang1033\langfe1025\langnp1033\insrsid14312560\charrsid5914940 developed two months after }{\fs20\lang1033\langfe1025\langnp1033\insrsid14295055\charrsid5914940 colonoscopy}{\fs20\lang1033\langfe1025\langnp1033\insrsid421118 ,}{
\fs20\lang1033\langfe1025\langnp1033\insrsid14295055\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid14312560\charrsid5914940 when }{\fs20\lang1033\langfe1025\langnp1033\insrsid13258369\charrsid5914940 the diagnosis of}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  a left-sided ulcerative colitis}{\fs20\lang1033\langfe1025\langnp1033\insrsid13258369\charrsid5914940  was established}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . Prolonged high-dose ceftriaxone t}{\fs20\lang1033\langfe1025\langnp1033\insrsid10094803\charrsid5914940 herapy was clinically effective, }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 albeit accompanied by the development of a reversible pseudocholelithiasis that has persisted for five months. 
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin252\lin0\itap0\pararsid10686197 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
\par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8480918 {\b\fs20\lang2057\langfe1025\langnp2057\insrsid8480918\charrsid5914940 Key-words: }{
\fs20\lang2057\langfe1025\langnp2057\insrsid8480918\charrsid5914940 actinomyces sepsis, ulcerative colitis, colonoscopy, ceftriaxone, pseudocholelithiasis.
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin252\lin0\itap0\pararsid10686197 {\fs20\lang2057\langfe1025\langnp2057\insrsid8480918\charrsid5914940 
\par }{\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Introduction
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin252\lin0\itap0\pararsid10686197 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Actinomyces, anaerobic}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13122805\charrsid5914940 /}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 microae
rophilic Gram-positive higher bacteria, colonize the human digestive and female genital tract, and after invasion through the mucous membranes, spreading mostly by contiguity, can cause a chronic infection of any site of the body. }{
\fs20\lang1033\langfe1025\langnp1033\insrsid7483778\charrsid5914940 N}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 on-specific, slowly progressive symptoms usually reflect the slow growth of a}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  mass-like lesion that is often misdiagnosed as an invasive tumor.}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  Most actinomycotic lesions see}{
\fs20\lang1033\langfe1025\langnp1033\insrsid7483778\charrsid5914940 m to be polymicrobial in nature}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . However, a prolonged high-dose antibiotic therapy cures the infection in 
most cases.
\par 
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A 59-year-old patient was admitted with a 12-hour history of fever up to 39.9\'baC, vomiting, watery stools, and abdominal pain localized in the }{\fs20\lang1033\langfe1025\langnp1033\insrsid8257824\charrsid5914940 ileocecal region}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . Two months }{\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 earlier}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  the }{
\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 patient was diagnosed with }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 a left-sided ulcerative colitis }{
\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 by}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  total colonoscopy and histopatholog}{\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 y}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ; the remission was achieved by peroral and rectal mesalazine therapy. }{\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 T}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 he positive physical }{\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 and laboratory }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
findings included}{\fs20\lang1033\langfe1025\langnp1033\insrsid13250147\charrsid5914940 :}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  axillar temperature of 39.0\'b0C, tachycardia of 112 beats/minute, blood pressure of 90/6}{
\fs20\lang1033\langfe1025\langnp1033\insrsid5397562\charrsid5914940 0}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 mmHg, }{\fs20\lang1033\langfe1025\langnp1033\insrsid14765467\charrsid5914940 rigid}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  ileocecal region painful to palpation}{\fs20\lang1033\langfe1025\langnp1033\insrsid5209164\charrsid5914940 , }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
a leukocyte count of 26.2x10}{\fs20\lang1033\langfe1025\super\langnp1033\insrsid13513218\charrsid5914940 9}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 /L (neutrophils 89%), and elevated C-reactive protein of 45.9mg/L. }{
\fs20\lang1033\langfe1025\langnp1033\insrsid7483778\charrsid5914940 From the blood culture}{\fs20\lang1033\langfe1025\langnp1033\insrsid16336441 ,}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  }{
\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 P. aeruginosa}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  and }{\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 A. naeslundii}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid7483778\charrsid5914940 w}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ere isolated}{
\fs20\lang1033\langfe1025\langnp1033\insrsid7483778\charrsid5914940 , b}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 oth sensitive to all tested antibiotics, as was proven by MIC-testing. }{
\fs20\lang1033\langfe1025\langnp1033\insrsid7894306\charrsid5914940 E}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 chosonography (ESG) and computer tomography (CT) revealed a }{
\fs20\lang1033\langfe1025\langnp1033\insrsid10044375\charrsid5914940 12x8cm }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 expansive mass, which affected the gut wall in the ileocecal region. }{
\fs20\lang1033\langfe1025\langnp1033\insrsid8864763\charrsid5914940 Co}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 lonoscopy revealed a sessile polypoid mass in 
the cecum (histopathology: granulation tissue) with normal remaining colonic mucosa. The initial}{\fs20\lang1033\langfe1025\langnp1033\insrsid7894306\charrsid5914940  10-day }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
parenteral treatment with ciprofloxacin and metronidazole}{\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 re}{
\fs20\lang1033\langfe1025\langnp1033\insrsid7894306\charrsid5914940 veal}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid421118\charrsid16336441 ed}{\fs20\lang1033\langfe1025\langnp1033\insrsid7894306\charrsid5914940  poor clinical improvement}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . }{\fs20\lang1033\langfe1025\langnp1033\insrsid7894306\charrsid5914940 The }{\fs20\lang1033\langfe1025\langnp1033\insrsid15938636\charrsid5914940 s}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 witch to ceftriaxone }{\fs20\lang1033\langfe1025\langnp1033\insrsid7894306\charrsid5914940 therapy }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
(two grams every 12 hours) has led to a prompt resolution of all symptoms within }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid16336441\charrsid16336441 a}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  week}{
\fs20\lang1033\langfe1025\langnp1033\insrsid8864763\charrsid5914940 . A}{\fs20\lang1033\langfe1025\langnp1033\insrsid9713152\charrsid5914940 fter two months }{\fs20\lang1033\langfe1025\langnp1033\insrsid10044375\charrsid5914940 of therapy}{
\fs20\lang1033\langfe1025\langnp1033\insrsid16336441 ,}{\fs20\lang1033\langfe1025\langnp1033\insrsid10044375\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid11421936\charrsid5914940 n}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ausea and a dull pain in the right upper abdominal quadrant}{\fs20\lang1033\langfe1025\langnp1033\insrsid7492668\charrsid5914940  developed}{
\fs20\lang1033\langfe1025\langnp1033\insrsid11421936\charrsid5914940 ; a }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 control CT showed }{\fs20\lang1033\langfe1025\langnp1033\insrsid11421936\charrsid5914940 
the formation of pseudolithiasis in the gallbladder, }{\fs20\lang1033\langfe1025\langnp1033\insrsid13725177\charrsid5914940 and}{\fs20\lang1033\langfe1025\langnp1033\insrsid11421936\charrsid5914940  }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 a complete resolution of the ileocecal mass. During the following six months of peroral amoxicillin therapy there were no signs of a relapse of abdominal actinomycosis}{
\fs20\lang1033\langfe1025\langnp1033\insrsid16336441 ,}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  neither by colonoscopy nor ESG; however, a slowly resorptive pseudocholelithiasis remai
ned visible even five months after discontinuation of the ceftriaxone therapy. 
\par }{\fs20\lang1033\langfe1025\langnp1033\insrsid11367659\charrsid5914940 
\par }{\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Discussion
\par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10686197 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
Abdominal actinomycosis is present on average in 20% of all reported cases of actinomycosis, and it is }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 usually preceded by conditions that result in the loss of mucosal integrity}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  [}{\fs20\lang1033\langfe1025\langnp1033\insrsid734822\charrsid5914940 1}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ]}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . Although mucosal integrity can be severely disrupted in patients with inflammatory bowel diseases, }{\fs20\lang1033\langfe1025\langnp1033\insrsid13701272\charrsid5914940 only t}{
\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 h}{\fs20\lang1033\langfe1025\langnp1033\insrsid13701272\charrsid5914940 ree }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 case}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13701272\charrsid5914940 s}{\fs20\lang1033\langfe1025\langnp1033\insrsid12395016\charrsid5914940  of abdominal actinomycosis in patients with Crohn}{
\fs20\lang1033\langfe1025\langnp1033\insrsid12395016\charrsid5914940 's disease}{\fs20\lang1033\langfe1025\langnp1033\insrsid13701272\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid13701272\charrsid5914940 can be found}{
\fs20\lang1033\langfe1025\langnp1033\insrsid9966934\charrsid5914940  in }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid16336441 (}{\fs20\lang1033\langfe1025\langnp1033\insrsid9966934\charrsid5914940 the }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13396361\charrsid5914940 back}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid16336441 -\'9ato ho\'e8ete time kazati \endash  literatura koju ste naveli }{
\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid9393254 ??? }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid16336441 \endash  ako da}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid9393254 ,}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid16336441 
 onda napi\'9aite \'85\'85\'85..the listed\'85\'85.}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid9393254  = in the listed literature)}{\fs20\lang1033\langfe1025\langnp1033\insrsid13396361\charrsid5914940  }{
\fs20\lang1033\langfe1025\langnp1033\insrsid9966934\charrsid5914940 literature}{\fs20\lang1033\langfe1025\langnp1033\insrsid13701272\charrsid5914940 .}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940  }{
\fs20\lang1033\langfe1025\langnp1033\insrsid12274704\charrsid5914940 T}{\fs20\lang1033\langfe1025\langnp1033\insrsid16531549\charrsid5914940 he t}{\fs20\lang1033\langfe1025\langnp1033\insrsid12274704\charrsid5914940 ansmural }{
\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid9393254 (sve druge stru\'e8ne nazive nisam niti gledao, jer ih Vi uvijek pravilno napi\'9aete, no, \'e8ini mi se da ovdje fali slovo \'93r\'94 = transmural) }{
\fs20\lang1033\langfe1025\langnp1033\insrsid12274704\charrsid5914940 character of inflammation in pa}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 tients with }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
Crohn}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 's disease}{\fs20\lang1033\langfe1025\langnp1033\insrsid12274704\charrsid5914940 , as compared with only mucosal inflammation in patients with ulcerative colitis,}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  may be }{\fs20\lang1033\langfe1025\langnp1033\insrsid12274704\charrsid5914940 favorable in the }{\fs20\lang1033\langfe1025\langnp1033\insrsid1473398\charrsid5914940 initiation }{
\fs20\lang1033\langfe1025\langnp1033\insrsid12274704\charrsid5914940 of abdominal actinomycosis}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . 
\par Colonoscopy is an often performed invasive procedure, and according to a review of 57,742 }{\fs20\lang1033\langfe1025\langnp1033\insrsid15093176\charrsid5914940 screening }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
colonoscopies, the overall serious adverse event rate was 2.8}{\fs20\lang1033\langfe1025\langnp1033\insrsid13396361\charrsid5914940 /}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
1000 procedures, and over 85% among them were reported in patients undergoing colonoscopy with polypectomy [}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 2}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ]}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . Although transient bacteremia after colonoscopy, occurs in approximately 4% of procedures}{\fs20\lang1033\langfe1025\langnp1033\insrsid13725177\charrsid5914940 ,}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  signs or symptoms of infection are rare }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 [}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 3}
{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ], and }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid8085593 (}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 therefore}{
\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid8085593 )}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  an antibiotic prophylaxis for patients undergoing colonoscopy is }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid8085593 
therefore }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 not recommended}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . Although individual cases of infection }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 after colonoscopy have been reported, in most cases it is not possible to detect the definite causal link with an endoscopic procedure}{
\fs20\lang1033\langfe1025\langnp1033\insrsid15093176\charrsid5914940 , }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 especially in a case of slowly progressive, chronic infection such as abdominal actinomycosis}{
\fs20\lang1033\langfe1025\langnp1033\insrsid15093176\charrsid5914940 . H}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 owever, preceding colonoscopy }{\fs20\lang1033\langfe1025\langnp1033\insrsid4991343\charrsid5914940 
was the only identified }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 event that could lead to a disruption of anatomic barriers}{\fs20\lang1033\langfe1025\langnp1033\insrsid4991343\charrsid5914940  in our patient}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 . The possible contribution of the mucosal inflammation}{\fs20\lang1033\langfe1025\langnp1033\insrsid4991343\charrsid5914940 ,}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid4991343\charrsid5914940 caused by a}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid8085593 n}{
\fs20\lang1033\langfe1025\langnp1033\insrsid4991343\charrsid5914940  ulcerative colitis, }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 to the pathogenesis of the disease in our patient remains unclear. 
\par We believe that polymicrobial sepsis in our patient reflected the polymicrobial nature of the abdominal actinomycotic infection, where }{\i\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 P. aeruginosa}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  has aggravated the pathogenicity of the actinomyces. The \'93companion microbes\'94
 could be important for the initiation of the infection, and their coaggregation for the avoidance of phagocytosis and killing, but their possible role in the increase of pathogenicity and invasiveness of actinomyces needs to be further investigated. }{
\fs20\lang1033\langfe1025\langnp1033\insrsid7174646\charrsid5914940 However, t}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 he antibiotic treatment of \'93companion microbes\'94
 as copathogens has been recommended, but the optimal duration of their treatment was not established. Although the clinical experience of treating actinomycosis with ceftriaxone is very limited, we exposed our patients to a high-dose ceftriaxone therapy 
}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid8085593 that}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  has led to a prompt clinical improvement and complete cure of abdominal actinomycotic lesion. 
\par }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Ceftriaxone-induced pseudocholelithiasis/biliary sludge is a rare}{\fs20\lang1033\langfe1025\langnp1033\insrsid9856467\charrsid5914940 ,}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  }{\fs20\lang1033\langfe1025\langnp1033\insrsid9856467\charrsid5914940 and mostly clinically asymptomatic }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
complication in adult patients. Approximately 40% of ceftriaxone is excreted into the bile, }{\fs20\lang1033\langfe1025\langnp1033\insrsid12846590\charrsid5914940 where it}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
 can precipitate with the ionized calcium, resulting in a }{\fs20\lang1033\langfe1025\langnp1033\insrsid12846590\charrsid5914940 formation }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 of a calcium-ceftriaxone complex }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 [}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 4}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ]}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 .}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  The high daily dosages (over 2 g }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid10181199 per }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 day) and the long-term duration of the therapy}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
 have already been recognized as the main risk factors in the development of }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ceftriaxone-associated biliary sludge }{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 [}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 5}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 ]}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 .
\par }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 The longest }{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid10181199 persist}{\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid10181199 e}{
\fs20\cf6\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid10181199 nce}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
 of ceftriaxone-induced cholelithiasis, lasting up to 60 days after therapy, has been described in children; in most cases it was resolved within 2-3 weeks [}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 5}{
\fs20\lang1033\langfe1025\langnp1033\insrsid8141581\charrsid5914940 -}{\fs20\lang1033\langfe1025\langnp1033\insrsid11680733\charrsid5914940 7}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
]. We can assume that not only the development }{\fs20\lang1033\langfe1025\langnp1033\insrsid3736678\charrsid5914940 but also the persistence }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 of a ceftriaxone-induced
 cholelithiasis positively correlated with the total received dose of the drug. 
\par }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 We can conclude by stating that with the assistance of their copathogens, actinomyces can be involved in an abrupt onset of septic disease}{
\fs20\lang1033\langfe1025\langnp1033\insrsid2949550\charrsid5914940 , and that }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 colonoscopy can also be considered a facilitating factor for the development of abdominal actinomycosis. 
}{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Because of its clinical efficacy, ceftriaxone could be used for the treatment of actinomycosis; however, the optimal daily dose and duration of the therapy have yet to be determ
ined. And lastl}{\fs20\lang1033\langfe1025\langnp1033\insrsid615414\charrsid5914940 y, the awareness of clinicians }{\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
of the possibility that ceftriaxone-induced pseudocholelithiasis can persist for as much as five months after discontinuation of the ceftriaxone therapy, could prevent unnecessary surgical interventions. 
\par }\pard \ql \li0\ri0\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14509721 {\b\fs20\lang1033\langfe1025\langnp1033\insrsid14509721\charrsid5914940 Conflict of interest
\par }\pard \ql \li0\ri252\sl360\slmult1\widctlpar\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin252\lin0\itap0\pararsid14509721 {\fs20\lang1050\langfe1050\langnp1050\langfenp1050\insrsid14509721\charrsid5914940 
The authors declare that there is no conflict of interest}{\fs20\lang1033\langfe1025\langnp1033\insrsid14509721\charrsid5914940 .
\par }\pard \ql \li0\ri0\sl360\slmult1\pagebb\widctlpar\hyphpar0\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid10686197 {\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 L}{
\b\fs20\lang1033\langfe1025\langnp1033\insrsid14431105\charrsid5914940 iterature}{\b\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
\par {\listtext\pard\plain\fs20\lang1033\langfe1025\langnp1033\langfenp1025\insrsid13513218\charrsid5914940 \hich\af0\dbch\af0\loch\f0 1.\tab}}\pard \ql \fi-360\li720\ri0\sl360\slmult1\widctlpar
\jclisttab\tx720\tx1434\hyphpar0\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\itap0\pararsid10686197 {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
Russo TA. Agents of Actinomycosis. In: Mandell GL, Bennett JE, Dolin R. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 6}{\fs20\lang1033\langfe1025\super\langnp1033\insrsid13513218\charrsid5914940 th}{
\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  ed. Philadelphia: Elsevier Churchill Livingstone; 2005, p. 2927.
\par {\listtext\pard\plain\fs20\lang1033\langfe1025\langnp1033\langfenp1025\insrsid13513218\charrsid5914940 \hich\af0\dbch\af0\loch\f0 2.\tab}
Whitlock EP,Lins JS,Liles E, et al. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Int Med 2008;149:638-58.
\par {\listtext\pard\plain\fs20\lang1033\langfe1025\langnp1033\langfenp1025\insrsid13513218\charrsid5914940 \hich\af0\dbch\af0\loch\f0 3.\tab}Nelson D
B.Infectious disease complications of GI endoscopy: part II, exogenous infections. Gastrointest Endosc 2003;57:695-711.
\par {\listtext\pard\plain\fs20\lang1033\langfe1025\langnp1033\langfenp1025\insrsid13513218\charrsid5914940 \hich\af0\dbch\af0\loch\f0 4.\tab}}{\field\fldedit{\*\fldinst {\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
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\cs17\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940  J Korean Surg Soc }{\cs18\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 2011;}{\cs19\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 81}{
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\'f0lu M, Tuncbilek N, G\'fczel A, Karasaliho\'f0lu S. Ceftriaxone-associated biliary pseudolithiasis in children. J Clin Ultrasound 2006;34:217-22.}{\cs21\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 
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Bor O, Dinleyici EC, Kebapci M, Aydogdu SD. Ceftriaxone-associated billiary sludge and pseudocholelithiasis during childhood: a prospective study. Pediatr Int 2004;46:322-4.
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\fs20\lang1033\langfe1025\langnp1033\insrsid13513218\charrsid5914940 Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children. J Clin Ultrasound 2000;28:166-8.
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