ActinomycesActinomyces

Professor Md. Akram HossainProfessor Md. Akram HossainMarch 2012March 2012

11Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

Review QuestionsReview Questions

1.1. WhatWhat isis clinicalclinical significancesignificance ofofActinomycesActinomyces

2.2. SalientSalient bacteriologicalbacteriological propertiesproperties2.2. SalientSalient bacteriologicalbacteriological propertiesproperties3.3. LabLab diagnosisdiagnosis

22Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

IntroductionIntroduction

�� ActinomycesActinomyces fromfrom GreekGreek "actis""actis" ray,ray, beambeam andand "mykes""mykes"mucus,mucus, fungus,fungus, isis aa genusgenus ofof thethe actinobacteriaactinobacteria classclass ofofbacteriabacteria..

�� TheyThey areare allall GramGram--positivepositive andand areare characterizedcharacterized byby�� contiguouscontiguous spread,spread,�� contiguouscontiguous spread,spread,�� suppurativesuppurative andand granulomatousgranulomatous inflammation,inflammation, andand�� formationformation ofof multiplemultiple abscessesabscesses andand�� sinussinus tractstracts thatthat maymay dischargedischarge sulfursulfur granulesgranules

�� ImportantImportant rolerole theythey playplay inin soilsoil ecologyecology.. TheyThey produceproduce aanumbernumber ofof enzymesenzymes thatthat helphelp degradedegrade organicorganic plantplantmaterial,material, ligninlignin andand chitinchitin.. AsAs such,such, theirtheir presencepresence isisimportantimportant inin thethe formationformation ofof compostcompost..

33Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

TaxonomyTaxonomy

BelongsBelongs toto classclass ActinobacteriaActinobacteria.. AtAt leastleasttherethere areare 3636 speciesspecies identifiedidentified.. NormalNormalfloraflora ofof mouthmouth (Gingiva)(Gingiva) andand playplayfloraflora ofof mouthmouth (Gingiva)(Gingiva) andand playplayimportantimportant rolerole inin soilsoil ecologyecology..

Actinomyces israeli Actinomyces israeli is clinically important.is clinically important.

44Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

Morphology & Cultural propertiesMorphology & Cultural properties

�� ActinomycesActinomyces areare anaerobicanaerobic�� Thin,Thin, branchingbranching (filamentous)(filamentous)

GramGram positivepositive bacillusbacillus..�� morphologicallymorphologically ActinomycesActinomyces�� morphologicallymorphologically ActinomycesActinomyces

coloniescolonies formform fungusfungus--likelikebranchedbranched networksnetworks ofofhyphaehyphae

�� Microaerophilic,Microaerophilic, growgrow bestbestanaerobicallyanaerobically.. VERYVERY fastidiousfastidious..

Scanning electron micrograph ofActinomyces israelii.

55Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

Clinical infections by Clinical infections by A.israeliA.israeli

1.1. ActinomycosisActinomycosis-- aa diseasedisease characterizedcharacterized bybythethe formationformation ofof abscessesabscesses inin thethe mouth,mouth,lungs,lungs, oror thethe gastrointestinalgastrointestinal tracttract

2.2. BacterialBacterial endocarditisendocarditis..–– RarelyRarely..2.2. BacterialBacterial endocarditisendocarditis..–– RarelyRarely..

3.3. DentalDental cariescaries

4.4. PeriodontalPeriodontal diseasedisease::

66Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

ActniomycosisActniomycosis

�� MayMay occuroccur asas acuteacute pyogenicpyogenic infectioninfection oror moremorecommonlycommonly asas aa chronicchronic infectioninfection thatthat isis bothbothsuppurativesuppurative andand granulomatousgranulomatous

�� CharacterizedCharacterized byby multiplemultiple abscessesabscesses andandinterconnectinginterconnecting sinussinus tractstracts thatthat containcontain granulesgranules ofofmicrocoloniesmicrocolonies imbeddedimbedded inin tissuetissue elementselements�� MicrocoloniesMicrocolonies areare macroscopicmacroscopic massesmasses ofof filamentousfilamentous�� MicrocoloniesMicrocolonies areare macroscopicmacroscopic massesmasses ofof filamentousfilamentous

bacterialbacterial cellscells thatthat areare "cemented""cemented" togethertogether byby calciumcalciumphosphatephosphate

�� KnownKnown asas sulfursulfur granulesgranules duedue toto theirtheir yellowyellow oror orangeorangeappearanceappearance

�� ChronicChronic suppurationsuppuration resultsresults inin granulomagranuloma formationformationandand aa fibroticfibrotic "walling"walling off"off" ofof thethe lesionlesion

�� UltimatelyUltimately resultingresulting inin bonebone involvementinvolvement

77Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

Types of actinomycosisTypes of actinomycosis

�� FiveFive majormajor clinicalclinical formsforms ofofactinomycosesactinomycoses basedbased onon sitesite ofof infectioninfection::1.1. CervicofacialCervicofacial actinomycosisactinomycosis (most(most commoncommon form)form)

2.2. ThoracicThoracic actinomycosisactinomycosis2.2. ThoracicThoracic actinomycosisactinomycosis

3.3. AbdominalAbdominal actinomycosisactinomycosis

4.4. PelvicPelvic actinomycosisactinomycosis

5.5. CerebralCerebral actinomycosisactinomycosis

88Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

Lab diagnosisLab diagnosis

�� LabLab diagnosisdiagnosis isis mademade bybyGramGram stainingstaining andandhistopathologyhistopathology butbut notnot bybycultureculture..

99Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

�� DifficultDifficult toto cultureculture andand identifyidentify becausebecause thethenumbersnumbers ofof organismsorganisms areare limitedlimited inin affectedaffectedtissuestissues andand areare sequesteredsequestered inin sulfursulfur granulesgranules

�� FastidiousFastidious andand slowslow growthgrowth (up(up toto twotwo�� FastidiousFastidious andand slowslow growthgrowth (up(up toto twotwoweeksweeks oror moremore..

�� ColoniesColonies havehave "molar"molar tooth"tooth" appearanceappearanceonon agaragar

1010Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces

Antimicrobial sensitivityAntimicrobial sensitivity

�� 11stst choicechoice--

�� Penicillin or amoxicillin for six to twelve monthsPenicillin or amoxicillin for six to twelve months

�� 22ndnd choicechoice

�� Doxicycline Doxicycline

�� Surgery if the disease is extensive.Surgery if the disease is extensive.

1111Prof. Md. Akram Hossain, Prof. Md. Akram Hossain, ActinomycesActinomyces