A brief review on Actinomycosis and Norcardiosis

1. 01/27/16 1JAAS

2. Anaerobic, filamentous, gram positive bacillus
◦ Exhibit true branching
 “Mykes” – Greek for “fungus”
 Thought by early microbiologist to be fungi
because of:
◦ Morphology
◦ Disease they cause
01/27/16 2JAAS

3. Not highly virulent
(Opportunist)
◦ Component of Oral Flora
 Periodontal pockets
 Dental plaque
 Tonsilar crypts
◦ Take advantage of injury to
penetrate mucosal barriers
 Coincident infection
 Trauma
 Surgery
01/27/16 3JAAS

4.  A.israelii,
A.naeslundii;
 Gram positive;
sulfur
granule;
 Related to
decay tooth
and
peridentitis
01/27/16 4JAAS

5. 01/27/16 5JAAS

6.  A chronic suppurative and granulomatous disease
of the cervico-facial, thoracic or abdominal areas
01/27/16 6JAAS

7. Cervicofacial Actinomycosis
NOTE: Sinus tract originating in oral
cavity has made it’s way to the surface at
01/27/16 7JAAS

8.  15% of cases
 Aspiration of organism
from the oropaharynx
 Slowly progressive
process involving lung
and pleura
◦ May be mistaken for
malignancy
 Chest pain, fever, wgt
loss and hemoptysis
01/27/16 8JAAS

9. Colonized IUD Resulting in
Pelvic Actinomycosis
01/27/16 9JAAS

10. Form indurated masses with fibrous walls and
central loculations with pus
◦ Pus contains "Sulfur Granules"
 Gritty, yellow white
 Average diameter - 2mm
 Composed of mineralized “mycelial” mass
Chronic infection
◦ Form burrowing sinus tracts to skin or mucus
membranes
 Discharge purulent material
01/27/16 10JAAS

11. 01/27/16 11JAAS

12.  Sputum
 Pus
 Biopsy tissue
01/27/16 12JAAS

13. Gram Stain and Macroscopic
Colonies of Actinomyces
NOTE: Molar tooth appearance of colonies
on agar can help remind us that the oral
cavity is a common niche for Actinomyces.
01/27/16 13JAAS

14. Streptomyces
species?
01/27/16 14JAAS

15.  Specimen-pus
 Drug of choice-penicilline
01/27/16 15JAAS

16. 01/27/16 16JAAS

17.  Subcutaneous
infections, pulmonary
infections, and brain
abscesses
 N. asteroides; N.
brasiliensis
01/27/16 17JAAS

18. 01/27/16 18JAAS

19. 01/27/16 19JAAS

20.  Clinical Specimens:Sputum,Pus,Biopsy tissue
Sulfamethoxazole-TrimethoprimSulfamethoxazole-Trimethoprim01/27/16 20JAAS

21. Endemic in the tropics and subtropics
Caused by,true fungi (eumycetoma) or by filamentous
bacteria (actinomycetoma)
Male to female ratio of 2.2:1
Actinomycetoma is caused by a group of filamentous
bacteria, among which N. brasiliensis and Streptomyces
madurae are the most common
01/27/16JAAS 21

22. Eumycetoma is caused by a group of fungi with
thick, septate hyphae, including Allescheria
boydii, Madurella griesia and Madurella
Mycetomi
Surgical debridement, followed by prolonged
appropriate antibiotic therapy for several
months is required for actinomycetoma
01/27/16JAAS 22

23. 01/27/16JAAS 23
Eumycetoma-thick club
shaped structures (<) (H
and E, ×1250)
Actinomycetoma-thin
filamentous bacteria seen
(H and E, ×500)Madura foot-
partially healed
ulcer

24. THANK YOU
01/27/16JAAS 24