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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.