Actinomycosis & Norcardiosis

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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

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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

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A.israelii, A.naeslundii;

Gram positive; sulfur granule;

Related to decay tooth and peridentitis

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A chronic suppurative and granulomatous disease of the cervico-facial, thoracic or abdominal areas

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Cervicofacial Actinomycosis

NOTE: Sinus tract originating in oral cavity has made it’s way to the surface at

the jawline. 05/03/23 7JAAS

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 hemoptysis05/03/23 8JAAS

Colonized IUD Resulting in Pelvic Actinomycosis

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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

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Sputum Pus Biopsy tissue

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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.

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Streptomyces species?

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Specimen-pus Drug of choice-penicilline

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Subcutaneous infections, pulmonary infections, and brain abscesses

N. asteroides; N. brasiliensis

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Clinical Specimens:Sputum,Pus,Biopsy tissue

Sulfamethoxazole-TrimethoprimSulfamethoxazole-Trimethoprim05/03/23 20JAAS

Endemic in the tropics and subtropicsCaused by,true fungi (eumycetoma) or by filamentous bacteria (actinomycetoma)

Male to female ratio of 2.2:1Actinomycetoma is caused by a group of filamentous bacteria, among which N. brasiliensis and

Streptomycesmadurae are the most common

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Eumycetoma is caused by a group of fungi with

thick, septate hyphae, including Allescheria boydii, Madurella griesia and Madurella Mycetomi

Surgical debridement, followed by prolongedappropriate antibiotic therapy for severalmonths is required for actinomycetoma

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Eumycetoma-thick club shaped structures (<) (H and E, ×1250)

Actinomycetoma-thin filamentous bacteria seen (H and E, ×500)Madura foot-

partially healed ulcer

THANK YOU

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