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Actinomyces & Nocardia 06-07-Med

The document discusses Actinomyces israelii and Nocardia spp., noting that Actinomyces causes actinomycosis typically through dental infections presenting with draining sinuses, while Nocardia causes nocardiosis primarily in immunocompromised individuals through pulmonary or cutaneous infections acquired from the environment. Both can be identified microscopically by their branching filamentous morphology and require culture and staining for diagnosis and treatment with antibiotics such as penicillin for Actinomyces and trimethoprim-sulfamethoxazole for Nocardia.

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414 views11 pages

Actinomyces & Nocardia 06-07-Med

The document discusses Actinomyces israelii and Nocardia spp., noting that Actinomyces causes actinomycosis typically through dental infections presenting with draining sinuses, while Nocardia causes nocardiosis primarily in immunocompromised individuals through pulmonary or cutaneous infections acquired from the environment. Both can be identified microscopically by their branching filamentous morphology and require culture and staining for diagnosis and treatment with antibiotics such as penicillin for Actinomyces and trimethoprim-sulfamethoxazole for Nocardia.

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© Attribution Non-Commercial (BY-NC)
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Actinomyces and Nocardia

Objectives

To be familiar with
• The clinical infections associated with
Actinomycetes
• The clinical infection caused by Nocardia spp.
• The microscopic morphology and colonial
morphology of Nocardia and Actinomycetes
• Antimicrobial therapy
ACTINOMYCES ISRAELII
• Normal flora of mouth & GIT
• Opportunistic pathogen

MORPHOLOGY & GROWTH


• Elongated branching Gram-positive bacilli
•Anaerobic or microaerophilic
•Temperature range 35-37oC
• Slow growth on blood agar in 4-7 days

DISEASE: Actinomycosis
ACTINOMYCOSIS
Source of infection
• Endogenous
Pathogenesis
• After local trauma, organisms invade tissues
• Due to low oxygen tension, organisms multiply
• Form hard yellow granules (called sulfur
granules) which are bacterial filaments
solidified with tissue exudates
• These granules drain outside through sinuses
ACTINOMYCOSIS
Clinical Features
• A chronic infection
Cervicofacial Actinomycosis
• The most common form
• Develops due to poor dental hygiene & tooth
extraction. Appear as hard tender swelling
that drains pus through sinus tracts
• Multiple sinuses, scarring on neck &
submaxillary area
Thoracic & Abdominal Actinomycosis
• Are uncommon
ACTINOMYCOSIS

LAB DIGNOSIS
• Sulfur granules in pus specimen
Direct Gram-smear :
• Finely branching filamentous bacilli
Culture on
• Blood agar anaerobically for 4-7 days
• Molar tooth appearance
Histopathology
Treatment
• Surgical drainage
• Penicillin for 4-6 weeks
Nocardia spp.
• Strict aerobes.
• Infections caused by Nocardia Spp. can occur in
Immuno-compromised and immuno-competent
individuals.
• N. asteriodes, N.brasiliensis are the major causes of
these infections
• Nocardia spp. can cause three types of skin
infections in immuno-competent individuals
5. Mycetoma (chronic, localized, painless, subcutaneous
infection)
6. Skin abscesses or cellulitis
7. Lymphocutaneous infections
• In Immuno-compromised individuals Nocardia Spp.
Can cause invasive pulmonary infections and
disseminated infections (brain abscess )
NOCARDIA ASTEROIDES
(80%)
• Gram-positive thin branching filaments
• Weakly acid fast
• Aerobic
• Found in environment particularly in soil
• Disease : Nocardiosis
• Source of Infection : Soil (exogenous)
Nocardia asteriods ( Gram Stain)

Nocardia asteriods ( modified A F)


NOCARDIOSIS : CLINICAL FEATURES

Pulmonary Nocardiosis
• Due to inhalation of organism
• Pneumonia-like abscesses
• Usually in immunocompromised patients

Skin & Subcutaneous Tissue Infection


• Usually after trauma like thorne prick
• May present as sinus tract like
actinomycosis
NOCARDIOSIS
LAB DIAGNOSIS
Specimen : Sputum or pus
Staining with :
• Gram-stain or Weak Acid-Fast
Culture on:
• Blood agar
• LJ agar

TREATMENT
• Surgical drainage
• Trimethoprim-sulphamethoxazole

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