ACTINOMYCES

 ACTINOMYCES SPP. ARE

POTENTIALLY PATHOGENIC COMMENSALS OF MOUTH IN HUMANS & ANIMALS.  MAJOR COMPONENT OF DENTAL PLAQUE AT PROXIMAL SITES OF TEETH.

2% RABBIT SERUM. THESE ARE GRAM POSITIVE PLEOMORPHIC BACTERIA.1-0. . THIOGLYCOLLATE BROTH WITH 0.  MEDIA USED ARE BRAIN HEART INFUSION AGAR / BROTH.  THEY ARE FACULTATIVE ANAEROBES. WHICH MAY SHOW BRANCHED FILAMENTS.

meyeri. odontolyticus. ENDOGENOUS CAUSE OF DISEASE. .  A.  A.  A.PATHOGENIC SPECIES ARE –  A. ALL THE SPECIES ARE COMMENSALS IN MOUTH. viscosus. israelii. naeslundii.  A. THEREFORE .

 IT FORMS SINUS TRACTS . CHARACTERIZED BY PERIPHERAL SPREAD TO CONTIGUOUS TISSUES. WHICH DRAINS THE LESIONS.PATHOGENESIS ACTINOMYCOSIS IS A CHRONIC SUPPURATIVE DISEASE . .  RARE HAEMATOGENOUS SPREAD.

 THERE ARE THREE IMPORTANT SITES OF PRIMARY INFECTION IN ACTINOMYCOSIS. THE PUS CONTAINS COLONIES OF THE ORGANISM. WHICH ARE CALLED AS SULPHUR GRANULES. .

.1.  IT OCCURS BY DIRECT EXTENSION FROM A PERIODONTAL ABSCESS. CERVICOFACIALPRIMARY LESION IS USUALLY IN THE MANDIBLE OR MAXILLA. DENTAL EXTRACTION OR ACCIDENTAL FRACTURE OF JAW. NEGLECTED CARIOUS OR BROKEN TEETH.

THORACIC IT OCCURS IN LUNGS AS A RESULT OF ASPIRATION OF HYPHAL FRAGMENTS OF ACTINOMYCES FROM TOOTH SURFACES OR DENTAL CARIES .2.  THE LESION IN THE LUNG MAY INVOLVE PLEURA AND PERICARDIUM. .  IT SPREADS OUTWARDS THROUGH THE CHEST WALL PRODUCING MULTIPLE DRAINING SINUSES.

BRONCHIAL SECRETIONS. LABORATORY DIAGNOSIS SPECIMENS:  PUS.  THESE SPECIMENS CONTAIN SULPHUR GRANULES. . ABDOMINAL –  MOST OFTEN SEEN IN THE APPENDIX. SPUTUM OR INFECTED TISSUES ARE COLLECTED ASEPTICALLY.3. SINUS DISCHERGE.

1.  GRANULES ARE CRUSHED BETWEEN TWO SLIDES & STAINED WITH GRAM AND ZEIHL-NEELSEN STAIN USING 1% SULPHURIC ACID FOR DECOLOURISATION. MICROSCOPY –  PUS IS MIXED WITH STERILE WATER. SULPHUR GRANULES SETTLE TO BOTTOM. .

1 µm IN DIAMETER SURROUNDED BY A PERIPHERAL ZONE OF SWOLLEN RADIATING CLUB-SHAPED STRUCTURES PRESENTING A SUN RAY APPEARANCE. GRANULES ARE SEEN TO CONSIST OF GRAM POSITIVE HYPHAL FRAGMENTS 0. .5.

 SULPHUR GRANULES & MYCELIA IN TISSUE SECTIONS CAN BE IDENTIFIED BY DIRECT FLUORESCENCE MICROSCOPY. CLUBS ARE GRAM NEGATIVE & ARE OF HOST ORIGIN. .

.2. CULTURE SULPHUR GRANULES ARE WASHED THOROUGHLY IN STERILE NORMAL SALINE .  THEY ARE CRUSHED IN A DROP OF SALINE WITH A GLASS ROD.  THEN THEY ARE INOCULATED ON  BRAIN HEART INFUSION AGAR. BLOOD AGAR & IN THIOGLYCOLLATE BROTH.

ENTIRE OR LOBULATED RESEMBLING MOLAR TEETH.  THE COLONIES ARE 0.5-2mm IN DIAMETER. THEY ARE INCUBATED BOTH AEROBICALLY & ANAEROBICALLY IN 5-10 % CO2 AT 35-37°C FOR UPTO 14 DAYS. . WHITE TO GREY-WHITE. SMOOTH.

 GROWTH IS FURTHER CONFIRMED BY DIRECT FLUORESCENCE MICROSCOPY AND BIOCHEMICAL TESTS. .

FIBROSING. INFLAMMATORY PROCESS.  THE TISSUE REACTION IS A CHRONIC SUPPURATIVE. THE SULPHUR GRANULES ARE DEEPLY STAINED WITH HAEMATOXYLIN EXCEPT AT PERIPHERY WHICH IS STAINED BY EOSIN. BIOPSY  IN HAEMATOXYLIN AND EOSIN STAINED SECTIONS.3. .

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 LARGE DOSES OF PENICILLIN UPTO  6 WEEKS. .TREATMENT SURGICAL REMOVAL OF AFFECTED TISSUE .  TETRACYCLINE MAY ALSO BE USED.

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