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ACTINOMYCOSIS

ACTINOMYCOSIS. Dr.T.V.Rao MD. What is Actinomyctes.

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ACTINOMYCOSIS

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  1. ACTINOMYCOSIS Dr.T.V.Rao MD Dr.T.V.Rao MD

  2. What is Actinomyctes • Gram-positive, pleomorphic non–spore-forming, non–acid-fast anaerobic or Microaerophilic bacilli of the genus Actinomyctes and the order Actinomycetales cause actinomycosis. Actinomyces are very closely related to Nocardia species; both were once considered to be fungal organisms. Dr.T.V.Rao MD

  3. Anaerobic non - sporulating gram-positive rods consist of two groups based on guanosine (G) plus cytosine (C) DNA content: Low mole percent (30-53%) and high mole percent (49-68%) Actinomyctes species member of the high G+C group Taxonomy of the Anaerobic Actinomyctes

  4. Several species can cause actinomycosis and can be polymicrobial infection • Actinomyces is a gram positive, non-spore-forming anaerobic or microaerophilic bacterial rod . Actinomyces israelii causes most Actinomyces infections in humans, although other forms such as Actinomyces Odontolyticus, Actinomyces Viscosus, Actinomyces Meyeri, Actinomyces Gerencseriae, and Propionibacterium Propionicum have also been reported. Actinomyces infections are commonly polymicrobial . Dr.T.V.Rao MD

  5. Actinomycosis • Actinomycosis is an infectious bacterial disease caused by Actinomyces species such as Actinomyces israelii or A. gerencseriae. It can also be caused by Propionibacterium propionicus Dr.T.V.Rao MD

  6. ACTINOMYCES 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

  7. Actinomycosis • A. israelii – the commonest • A .meyeri • A.naeslundii • A.odontolyticus • A. viscosus

  8. Actinomyces is a normal flora • Actinomyces species that cause human disease are not found in nature but are normal flora of the oropharynx, GI tract, and female genital tract. This is not an exogenous infection; therefore, no person-to-person spread of the pathogen occurs Dr.T.V.Rao MD

  9. 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 ACTINOMYCOSIS

  10. Culturing of Actinomyces • Actinomyces species grow well in enriched media with brain-heart infusion and may be aided in growth by an atmosphere of 6-10% ambient carbon dioxide. They grow best at 37°C. Colonies can appear at 3-7 days, but, to ensure that no growth is missed, observe cultures for 21 days. Dr.T.V.Rao MD

  11. pathophysiology • In general, Actinomyces species, being members of the normal flora, are agents of low pathogenicity and require disruption of the mucosal barrier to cause disease. Oral and cervicofacial diseases are commonly associated with dental procedures, trauma, oral surgery, or dental sepsis. Pulmonary infections usually arise after aspiration of oropharyngeal or GI secretions. GI infection frequently follows loss of mucosal integrity, such as with surgery, appendicitis, diverticulitis, trauma, or foreign bodies. Dr.T.V.Rao MD

  12. Typical appearance of histopathological examination with special stains Dr.T.V.Rao MD

  13. People at risk with actinomycosis • Having a dental disease or recent dental surgery (for jaw abscess) • Aspiration (liquids or solids are sucked into lungs) (for lung abscess) • Having bowel surgery (for abdominal abscess) • Swallowing fragments of chicken or other bones (for abdominal abscess) • For women: having an intrauterine contraceptive device (IUD) in place for many years (for abscess affecting the reproductive organs) Dr.T.V.Rao MD

  14. Cervicofacial Actinomycosis • This is the most common and recognized presentation of the disease. • Actinomyces species are commonly present in high concentrations in tonsillar crypts and gingivodental crevices. Many patients have a history of poor dentition, oral surgery or dental procedures, or trauma to the oral cavity. • Chronic tonsillitis, mastoiditis, and otitis are also important risk factors for actinomycosis. Dr.T.V.Rao MD

  15. Infection Cervicofacial region • Periostitis or osteomyelitis can develop if the infection extends to facial and maxillary bones. The mandible appears to be one of the most common osteomyelitis sites. Dr.T.V.Rao MD

  16. Intestinal actinomycosis • The infection usually develops after GI mucosal integrity is broken from surgical procedures or trauma, although, on many occasions, the inciting conditions may not be apparent. Dr.T.V.Rao MD

  17. Abdominal actinomycosis • Appendicitis with perforation is the most common predisposing event, and, as a result, right-sided abdominal infection is far more common than left-sided abdominal infection. The inciting event can precede the diagnosis by months to years. Dr.T.V.Rao MD

  18. CNS disease • Clinical features are indistinguishable from those of other infections of the CNS. • The findings in those patients without meningeal involvement are typically those of a space-occupying lesion with focal neurologic defects and increased intracranial pressure. • Patients with chronic meningitis have an indolent picture that is no different from other chronic meningitides with headaches, low toxicity, and subtle neurologic findings dominating the picture. Dr.T.V.Rao MD

  19. Thoracic actinomycosis • Thoracic actinomycosis involves the lungs and mediastinum . The disease begins with fever, cough, and sputum production.. Multiple sinuses may extend through the chest wall, to the heart, or into the abdominal cavity. Ribs may be involved. Occasionally, Cervicofacial and thoracic disease may result in nervous system complications - most commonly brain abscesses or meningitis. Dr.T.V.Rao MD

  20. Pelvic actinomycosis • This condition is extremely rare in the pediatric population and is almost exclusively is observed in patients who present with prolonged use of intrauterine contraception devices, usually for longer than 2 years. • Pelvic actinomycosis may develop from extension of intestinal infection, commonly from indolent Ileocecal disease. • Patients present with an indolent history of vaginal discharge, abdominal or pelvic pain, menorrhagia, fever, weight loss, and prolonged use of an intrauterine contraceptive device. Dr.T.V.Rao MD

  21. Diagnosis: . • Gram stain. • Culture. (poor growth in culture only in less than 50% of cases.) Sulphur granules (yellowish myecelial masses) • Specimens – open biopsy, aspiration material • The discharge should mix with sterile saline in a universal bottle and allow to stand, particles will separate out. • Place between 2 slides • Crush and gram stain • Observe for Gram positive branching filaments Dr.T.V.Rao MD

  22. Examination of discharges will help in diagnosis • Examination of drained fluid under a microscope shows "sulphur granules" in the fluid. They are yellowish granules made of clumped organisms Dr.T.V.Rao MD

  23. Diagnosis of Actinomyces israelii is difficult • Culture requires 5–7 days but may take 2–4 weeks. “Sulphur granules” are actually yellow colored aggregates of microorganisms; they do not contain sulphur and are therefore a misnomer. These are usually isolated from purulent material and can be visible macroscopically as well as microscopically. Not all Actinomyces species form sulphur granules. Dr.T.V.Rao MD

  24. diagnosis • In the earlier stage, this bacterial infection is difficult to diagnose because it can be can be confused with other conditions. Often, a correct diagnosis is made after taking and examining a sample (biopsy). • It is more easily diagnosed in its later stages, after its hallmark sinus tracts have appeared in the surface of the skin. • Culture of the tissue or fluid shows Actinomyces species. • Examination of drained fluid under a microscope shows "sulfur granules" in the fluid. They are yellowish granules made of clumped organisms. • Examination under a microscope shows the Actinomyces species of bacteria. Dr.T.V.Rao MD

  25. Treatment of actinomycosis • Treatment classically begins with IV penicillin for 2–6 weeks, followed by oral therapy with penicillin or amoxicillin for 6–12 months. For penicillin allergic patients, tetracycline, erythromycin, minocycline and clindamycin have been administered. Imipenem and ceftriaxone have been described as successful in reports. Dr.T.V.Rao MD

  26. Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World • Email • doctortvrao@gmail.com Dr.T.V.Rao MD

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