ACTINOMYCETACEAE

 Actinomyces
 Nocardia
 and Streptomyces
 Objectives

To be familiar with
 The clinical infections associated with
Actinomycetes, Nocardia spp. and
Streptomyces
 The microscopic morphology and colonial
morphology of Nocardia and Actinomycetes
 Antimicrobial therapy
 ACTINOMYCES ISRAELII
 Normal floraand A. viscosus
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
 organisms multiply Form hard yellow granules
(called sulfur granules) which are bacterial
filaments solidified with tissue exudates
 These granules drain outside through sinuses
Sites of actinomyces infections
 ACTINOMYCOSIS
Clinical Features and Diseases
 A chronic infection
Cervicofacial Actinomycosis
 The most common form
 Develops due to poor dental hygiene &
tooth extraction
 other dental procedures
√
Appear as hard tender swelling )Lumpy
jaw) that drains pus through sinus
tracts
√ Multiple sinuses, scarring on neck & sub
maxillary area
 Thoracic Actinomycosis
 the lung
 result of aspiration of actinomyces from the mouth
Sinuses
 often appear on the chest wall
 and the ribs and spine may be eroded
 Primary end bronchial Actinomycosis is an
uncommon complication of an inhaled foreign body
Abdominal Actinomycosis
 Abdominal cases commence in the appendix or,
less frequently, in colonic diverticulae
 Pelvic actinomycosis
 occurs occasionally in women fitted with plastic intra-uterine
contraceptive devices
 Other form of infections
 Nervous system
 Musculoskeletal
 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. (Nocard)
 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
1. Mycetoma (chronic, localized, painless, subcutaneous
infection)
2. Skin abscesses or cellulitis
3. Lymphocutaneous infections
 In Immuno-compromised individuals Nocardia Spp.
Can cause invasive pulmonary infections and
disseminated infections (brain abscess )
 Pathogenicity
Release of cord factor, which prevents
nocardia from being phagocytosed by
macrophages.
 Catalase production, which inactivates
oxygen metabolites which would normally
be toxic to bacteria
 NOCARDIA ASTEROIDES
(80%)
 Gram-positive thin branching filaments
 Weakly acid fast with 1% HCl modified Af
 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
N. asteriodes
Pulmonary Nocardiosis
 Due to inhalation of organism Red nodules on a patient with
 Pneumonia-like abscesses disseminated nocardiosis

 Usually in immunocompromised patients

N.brasiliensis
Skin & Subcutaneous Tissue Infection
 Usually after trauma like thorne prick
 May present as sinus tract like actinomycosis

Ulcer on the arm of a patient with primary

cutaneous nocardiosis
 NOCARDIOSIS
LAB DIAGNOSIS
Specimen : Sputum or pus
Staining with :
 Gram-stain or Modified Acid-Fast
Culture on:
 Blood agar
 LJ agar
 Growth is visible after incubation for between 2 days and 1 month;
selective growth is favoured by incubation at 45°C. Colonies are
cream, orange or pink coloured; their surfaces may develop a dry,
chalky appearance, and they adhere firmly to the medium
TREATMENT
 Surgical drainage
 Trimethoprim-sulphamethoxazole