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Dr.T.V.Rao MD
DR.T.V.RAO MD
WHAT IS ACTINOMYCTES
Gram-positive, pleomorphic nonsporeforming, nonacid-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
Actinomyces is a gram positive, non-sporeforming 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 .
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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
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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
ACTINOMYCOSIS
A. israelii the commonest A .meyeri A.naeslundii A.odontolyticus A. viscosus
DR.T.V.RAO MD
ACTINOMYCOSIS
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
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 37C. Colonies can appear at 3-7 days, but, to ensure that no growth is missed, observe cultures for 21 days.
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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.
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CERVICOFACIAL ACTINOMYCOSIS
This is the most common and recognized presentation of the disease. Actinomyces species are commonly present in high concentrations in tonsillar
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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.
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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.
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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.
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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.
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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.
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DIAGNOSIS:
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Gram stain.
Culture. (poor growth in culture only in less than 50% of cases.) Sulphur granules (yellowish myecelial masses)
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
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Examination of drained fluid under a microscope shows "sulphur granules" in the fluid. They are yellowish granules made of clumped organisms
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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
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species of bacteria.
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TREATMENT OF ACTINOMYCOSIS
Treatment classically begins with IV penicillin for 26 weeks, followed by oral therapy with penicillin or amoxicillin for 612 months. For penicillin allergic patients, tetracycline, erythromycin, minocycline and clindamycin have been administered. Imipenem and ceftriaxone have been described as successful in reports .
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