ACTINOMYCETES: Introduction Actinomycetes are Gram-positive, catalase-positive, nonmotile baci They are considered to be transitional forms between bacteria and fungi. Like bacteria they possess cell wall, contain-ing muramie aci ‘They also possess prokaryotic nuclei and are susceptible o antibiotics. P ied hyphae similar to the hyphal form i But like fungi, they form delicate filaments call fungi. These hyphal forms are seen in bacteria isolated by culture and are also clinical specimens. ‘The actinomycetes include a wide range of bacteria, which are found in soil vegetables. They are also found in humans and animals. Z The actinomycetes include anaero-bie or facultative snocoblai genus Actinomyces.ms caused by actinomycetes are summarized in Table 46-1 Hunan infections caused by Actinomycetes Cena acnomess, hc atromcess, an acinomcosscfte abdomen and pis, mary cares rca brochpnoay tin, ad sonny cel enc moray infec oporiicifins (vauaticenopns, pons pans udeeg | ilps, and po ramatc sin nin) Opporaiiicins | s Opportuisicinfcions Whipp’ csase x Ente demas Opporursicifcnscthte asd acti rural edhhalt, CNS shu intr Actinomyces Actinomyces israeli is the most common Actinomyces causinghuman infection Other species are Actinomyces _gerencsonei, Actinomyces _turicensis, Actinomyces radingae, Actinomyces europaeus, Actinomyces naeslundii, Actinomyces ‘odontolyticus, Actinomyces viscosus, Actinomyces meyer, and Propionibacterium propionicum. Properties of the Bacteria » Morphology Actinomyces show the following features: Actinomyces organisms are Gram-positive, nonmotile, non-sporing, and non-acid-fast bacilli, ‘They measure 0.5-1 mm in diameter. They often grow in filaments that separate into bacillary and coccoid filaments. » Culture > Actinomyces organisms are facultative anaerobes. , > ‘They growbetter under anaerobic or microaerophilic conditions at an optimum. temperature of 35-37°C. > Presence of 5-10% CO2facilitates the growth, Actinomyces species grow slowly; they need a longer incubation period of 3-4 days. > israeli may require even 7-14 days for growth.1. Brain heart infusion agar: > Brain hear , ae infusion (BHI) agaror heart infusion agar supplemented with 5% defibrinated P, oF horse blood is the enriched medium used frequently for Actinomyces > On these media, i 7 with media, in anaerobic to microaerophilc conditions, the bacteria form colonies characteristic molar-ooth appearance. 2. Liquid media; Heart infusi y cart infusion blood and thioglycollateblood supplemented with 0.1-0.2% sterile rabbit serum are the ae examples of liquid media used for culture of Actinomycesspecies. Pathogenesis and Immu Bere eet rected are present as normal flora ofthe oral cavityand also in the lower gastrointestinal tract and female genital tract of human hosts. copatho-gens that enhance the virulenes bacteria include Bifidobacterium corrodens, Haemophilus anaerobiestreptococci. ‘* These companion bacteria are believed to act as ‘of Actinomyces. These com-panion dentium, Actinobacillusactinomycetemcomitans, Eikenella aphrophi-lus Bacteroides, Fusobacterium, staphylococci, and «Once the infection i established by Actinomyces, the immune system of the infected the form of a suppurative human host stimulates an intense inflammatory response granulo-matous and fibrotic reaction. Infection by Actinomyces typically spreads contiguously and invades surrounding tissues and organs. Finally, the infection results in the production of drain-ing sinus tracts, which contain lot of damaged tissue. Bacteria from this site may disseminate through blood circulation to distant organs. ‘Actinomycosis is a subacute and chronic bacterial infection characterized by contiguous spread and suppurative and gran-ulomatous inflammation. “The condition is associated with the formation of multiple abscesses and development of sinus tracts discharging white to yellowish granules, known as sul-phur granules. Actinomycosis may manifest as (a) cervicofacial actinomycosis, (6) thoracic actinomycosis, and (6) actinomycosis of the abdomen and pelvis.,aboratory Diagnosis sboratory diagnosis jg Snesis is made by g ire and by isolation of organism by Ei detection of Actinomyces in specimens by microscopy » Specimens The specimens : All dead —* Sputum, bronchial secretions and dis-charges, and infected tissues. Tesi raul ares tb number of slur gales Teron! tis essential if. v 8lSo present on the dressings removed from a Citing ie Preferably Under a, a these specimens immediately to the laboratory for p 2, inaerobic conditions. > Microscopy e Sulfur granules are white to yellow and vary in size from minute specs to large ore Fain’s a¥© separated from pus and other specimens and are collected directly m draining sinuses, ie 7. ctushied between two slides and are stained by Gram or Ziehl-Neelsen staining Method, using 1% sulfuric acid for decol-orizaton, > The Stained smears on microscopic examination show Gram-positive hyphal Sregmeate Sivounded by peripheral zone of swollen, radiating, club-shaped structures presenting a Sun-ray appearance, > These club-shaped structures are Gram positive, acid fast, and are believed to be antigen complexes. » Culture ® ‘Sulfur granules or pus-containing Actinomyces are immediately cultured under anaerobic conditions at 35-37°C for up to 14 days. > The specimens are inoculated on blood agar, BHI agar, incubated anaerobically at 37°C. ® israeli produces large (0-5 mm in diameter), white, smooth, entire or lobulated colonies resembling molar tooth after 10 days of anaerobic incubation, and into thioglycollate broth and » Identification of bacteria ® Actinomycetes colonies are identified by microscopy, fluorescent antibody test, and gel immu-nodiffusion test, > The latter two tests are very useful to differenti Species and filamentous anaerobes that produce si biochem-ical reactions, direct iate A. israeli from other actinomycotic imilar type of granules in the tissues,