ACTINOMYCETALESBy

Dr. P.S.Reddy MDFor e-learning

Fungus – like bacteria. Fungus – like bacteria.

This family includes : This family includes :

Actinomyces, Actinomyces, Bifidobacterium Bifidobacterium

Rothia, Rothia, Arachnia.Arachnia.

Nocardia, Nocardia, Actinomadura, Actinomadura,

Streptomyces.Streptomyces.

Transitional formsTransitional forms between bacteria & fungi. between bacteria & fungi.

Cell walls with muramic acid. Cell walls with muramic acid.

Prokaryotic nuclei.Prokaryotic nuclei.

Sensitive to AntibioticsSensitive to Antibiotics

Mycelial network with branching Mycelial network with branching filamentsfilaments

Actinomyces:Actinomyces: Ray – like Ray – like appearance.appearance.Soil saprophytes.Soil saprophytes.Commensals in man & animal. Commensals in man & animal.

Morphology:Morphology: Gram positive,Gram positive,Non acid fast. Non acid fast.

AAnaerobe.naerobe. Branching mycelial Branching mycelial

formsforms..

IN THE HOST IN THE HOST Sulphur granulesSulphur granules in the in the pus.pus.

Granules: Small specks to Granules: Small specks to 5mm. 5mm.

White / Yellowish. White / Yellowish.

Gram staining. Gram staining.

Central filamentous Central filamentous mycelium. mycelium.

Club shaped, Gram Club shaped, Gram negativenegative

structuresstructures

GROWTH GROWTH CHARACTERSCHARACTERS

CULTURECULTURE

Liquid medium:Liquid medium: As “fluffy balls”As “fluffy balls”

RCM. RCM.

Thioglycollate brothThioglycollate broth

1% glucose broth.1% glucose broth.

Solid medium :Solid medium : Blood Agar. Blood Agar.

BHI.BHI.

Raised, nodular, Cream colored Raised, nodular, Cream colored Spidery Spidery

colonies resembles molar teeth.colonies resembles molar teeth.

Species causing ActinomycosisSpecies causing ActinomycosisA. israelii, A. israelii, A. meyeri, A. meyeri, A. naeslundii,A. naeslundii,A. odontolyticum A. odontolyticum (Dental plaque).(Dental plaque).

Rural, Young male Rural, Young male

persons. persons.

Agricultural workers. Agricultural workers.

Not communicable.Not communicable.

PREDISPOSING FACTORS

Periodontal disease,

Trauma, Poor oral

hygiene

Jaw fractures,

Maxillo facial surgeries,

Periapical odontitis.

Tooth decay

ActinomycosisActinomycosis

Chronic granulomatous Lesion Chronic granulomatous Lesion

with multiple abscesses, fibrosis with multiple abscesses, fibrosis

and sinuses.and sinuses.

External appearance:

Slowly enlarging hard,red, Slowly enlarging hard,red, painless painless

lump. lump.

No lymphatic involvement. No lymphatic involvement.

Blood spread: liver, brain, bone.Blood spread: liver, brain, bone.

CERVICOFACIAL ACTINOMYCOSIS Odontogenic in origin.Appears as red lump with draining sinuses. A recent history of tooth extraction or signs of tooth decay (dental cavity or dental caries) or poor dental hygiene.

SUPRA GINGIVAL ACTINOMYCOSIS

Poor oral hygiene.

Gingival actinomycosisMycetoma of foot

Thoracic Thoracic actinomycosis:actinomycosis:

Sinuses on Sinuses on chest wall,chest wall,

Eroded ribs and Eroded ribs and spine. spine. Abdominal actinomycosis:Abdominal actinomycosis:

Ileocaecal region. Ileocaecal region.

Appendix,Appendix,

Colonic diverticula. Colonic diverticula.

X-ray findings of Thoracic Actinomycosis

Pelvic actinomycosis :Pelvic actinomycosis :I U C D.I U C D. Punch actinomycosis :Punch actinomycosis :

Punch on adversaries Punch on adversaries teeth.teeth.

Gingivitis.Gingivitis. Periodontitis.Periodontitis. Dental plaque & Dental caries.Dental plaque & Dental caries.

Mycetoma. Mycetoma.

Laboratory diagnosis: Laboratory diagnosis:

1. Pus1. Pus

2. Sputum (not reliable) 2. Sputum (not reliable)

Specimen + saline ; and allowed to Specimen + saline ; and allowed to settle. settle.

Separate the Separate the ”sulphur granules” ”sulphur granules”

Do staining & culture. Do staining & culture.

3. Needle aspiration: From sinuses 3. Needle aspiration: From sinuses

4. Open biopsy: For HPE by H & E 4. Open biopsy: For HPE by H & E staining. staining.

TREATMENT

Penicillin is the drug of choice :2 to 12 months.Surgical therapy is often indicated for curettage of bone, resection of necrotic tissue, excision of sinus tracts.

PREVENTION

GENERAL CARE OF THE MOUTH.

Brush the teeth at least twice a day.

Care of surface grooves, spaces

between teeth.

Dentist consultancy every six

months.

MOUTH CARE IN OLDER ADULTS.

Bridges and dentures must be kept

clean and should be relined.

MOUTH CARE IN CHILDREN.

Don’t allow the child to fall asleep

with a milk.

Fluoride applicationSlows the destruction of enamel and helps to repair minor tooth decay damage by demineralization.

SealantsA thin plastic coating that is painted over the grooves to prevent entrapment of food particles.

DietSugar and Starch."swish and swallow" after meal.

NOCARDIA:NOCARDIA:Nocard. Nocard. Soil saprophytes.Soil saprophytes.Some are pathogenic :Some are pathogenic :

N. asteroides,N. asteroides,

N. brasiliensis, N. brasiliensis, N.madurae (non acid fast) N.madurae (non acid fast)

Morphology:Morphology:Resembles rapidly growing Mycobacteriae.Resembles rapidly growing Mycobacteriae.Branching filamentous (bacillary and coccal Branching filamentous (bacillary and coccal forms). forms). Weakly Acid fastWeakly Acid fast (1% H2 SO4) (1% H2 SO4)Gram positive.Gram positive.

MORPHOLOGYMORPHOLOGY

CULTURE:CULTURE:

Slow growing Slow growing aerobe. aerobe. (1 – 2 wks). (1 – 2 wks).

N A :N A : Dry, granular, wrinkled colonies Dry, granular, wrinkled colonies

with yellow to red pigment. with yellow to red pigment.

““Star shaped colony”Star shaped colony”

B H I :B H I : Trypticase soy agar is Better. Trypticase soy agar is Better.

Sabourad’s Dextrose Agar.Sabourad’s Dextrose Agar.

Pathogenesis of NocardiaPathogenesis of NocardiaSoil saprophyteExogenous infection

“Nocardiosis”

PATHOGENESIS:PATHOGENESIS:

1.Cutaneous Form:1.Cutaneous Form:

Local abscess, cellulitis. Local abscess, cellulitis.

Lympho cutaneous lesions. Lympho cutaneous lesions.

2.Subcutaneous Form:2.Subcutaneous Form:

Fungating tumor like Fungating tumor like masses. masses. Sinus formation. Sinus formation.

Mycetoma. Mycetoma.

3.Nocardiosis with 3.Nocardiosis with liverliver

transplantationtransplantation

4.Ocular nocardiosis4.Ocular nocardiosis

followed by trauma.followed by trauma.

5.Systemic Nocardiosis: 5.Systemic Nocardiosis: Pulmonary Pulmonary form. form.

IInhalation.nhalation.

Immunocompromised : Immunocompromised :

CorticosteroidsCorticosteroids

Post Transplantation Post Transplantation Immunosuppressive Immunosuppressive therapy. therapy.

Aleolarproteinosis.Aleolarproteinosis.

H I V infection. H I V infection.

Multiple confluent abscesses.Multiple confluent abscesses.

EmpyemaEmpyema Heals with little /no fibrosis Heals with little /no fibrosis

Haematogenous spread Brain Haematogenous spread Brain lesion.lesion.

LAB. DIAGNOSIS: LAB. DIAGNOSIS: Sputum, Pus, Biopsy.Sputum, Pus, Biopsy.Microscopy.Microscopy.Culture.Culture.

TREATMENT: TREATMENT: Sulphonamides. Sulphonamides. Amikacin. Amikacin. Surgical drainage.Surgical drainage.

Grams staining

Acid fast staining

Nocardia asteroids colony in Nocardia asteroids colony in tissues.tissues.

Brown – Benn stainBrown – Benn stain

ActinomycesActinomyces Nocardia.Nocardia. Anaerobe.Anaerobe. Strict aerobe. Strict aerobe.

35 - 37°C.35 - 37°C. Wide range of temperature. Wide range of temperature.

Oral commensal.Oral commensal. Saprophyte (soil) Saprophyte (soil)

Non – acid fast.Non – acid fast. Acid fast (weakly)Acid fast (weakly)

Endogenous .Endogenous . Exogenous .Exogenous .

No lymphatic involvement. Lymphatics involved.No lymphatic involvement. Lymphatics involved.

No pigment usually.No pigment usually. Pigment produced. Pigment produced.

Extrinsic Allergic alveolitis: Hypersensitive Extrinsic Allergic alveolitis: Hypersensitive pneumonitispneumonitis

Occupational disease.Occupational disease.

Synonyms:Synonyms: Farmers lung. Farmers lung.

Mushroom worker’s lung.Mushroom worker’s lung.

Bagassosis.Bagassosis.

Caused by:Caused by: Faenia rectivirgula Faenia rectivirgula

Thermophilic actinomyces spp.Thermophilic actinomyces spp.

InhalationInhalation of mouldy vegetable matter. of mouldy vegetable matter.