Vet Pathol 37:650–652 (2000)

Pyogranulomatous Meningoencephalitis Due to Actinomyces sp. in a Dog

S. S. COUTO, P. J. DICKINSON, S. JANG, AND L. MUNSON

Abstract. Actinomyces sp. are commensal, filamentous, gram-positive, acid-fast–negative bacteria that can
cause pyogranulomatous inflammation in animals and humans. Central nervous system (CNS) disease is a rare
presentation of actinomycosis and is usually due to extension from infected wounds or seeding from distant
sites. A dog with progressive, poorly localized neurologic signs had primary CNS actinomycosis without history
or evidence of previous trauma or other organ involvement. Histologically, there was a severe pyogranulomatous
meningoencephalitis with intralesional filamentous bacteria that were also visible on cytology of the cerebral
spinal fluid (CSF) postmortem. Actinomyces sp. was cultured postmortem from the CSF, confirming the diag-
nosis. This case demonstrates that Actinomyces sp. can be a causative agent of primary CNS disease in dogs.

Key words: Actinomyces sp.; cytology; dogs; hydrocephalus; meningoencephalitis; pyogranulomatous.

Actinomyces sp. are gram-positive, acid-fast–negative fil-
amentous bacteria that cause pyogranulomatous infections in
dogs, cats, cattle, goats, swine, horses, foxes and human be-
ings.5 These anaerobic or microaerophilic commensal organ-
isms are found in the oral cavity of animals and humans.3
Cutaneous actinomycosis is the most common manifestation
in dogs, especially in large breed male dogs, and Actino-
myces viscosus is the most frequent isolate.3–5 These infec-
tions are usually secondary to perforating injuries caused by
bite wounds or foreign bodies. In the most common forms
of clinical disease in the dog, the cervicofacial, abdominal,
and thoracic regions are involved.4,7 In humans, central ner-
vous system (CNS) infection with Actinomyces is rare and
usually results from extension of an adjacent focus or from
hematogenous seeding from a distant site.7 Risk factors in-
clude dental caries or infections, recent tooth extraction,
head trauma, gastrointestinal tract surgery, chronic otitis,
mastoiditis or sinusitis, chronic osteomyelitis, tetralogy of
Fallot, and Actinomyces infection of an intrauterine device.7
A cerebral abscess is the most common manifestation of
human CNS actinomycosis. Other infrequent presentations
are meningitis or meningoencephalitis, actinomycomas, sub-
dural empyema, and epidural abscesses.7 There are two un-
confirmed reports of Actinomyces causing CNS disease in
animals: spinal meningitis in an Arctic fox and encephalitis
associated with hydrocephalus in a dog.1,6 In both cases, the
diagnosis of actinomycosis was assumed based on morpho-
logic characteristics and staining properties of the bacteria
on histologic examination. Culture of Actinomyces from the
CNS and a definitive diagnosis has not been previously re-
ported in domestic animals.
A 1-year-old intact female German Shepherd Dog was
presented to the Veterinary Medical Teaching Hospital of the
University of California–Davis for apparent cervical pain of
2 months duration. All vaccinations were current, travel his-
tory was restricted to northern California and Idaho, and the
animal had been exposed to ticks periodically. No history of
trauma was noted. On physical and neurologic examination,
the dog was quiet and alert and had pain on movement or
palpation of the head and neck. Results from complete blood
count (CBC), serum chemistry analysis, urinalysis, thoracic
radiographs, abdominal ultrasound examination, joint fluid
analysis from several joints, and complete spinal radiographs
650
were within normal limits. Cisternal cerebrospinal fluid
(CSF) analysis revealed neutrophilic pleocytosis with in-
creased protein (Table 1). Neutrophils were nondegenerate,
and no organisms were seen on direct smears. Aerobic and
fungal CSF culture were negative for pathogens. Serologic
analyses for common infectious agents such as Cryptococcus
sp., Toxoplasma sp., Aspergillus sp., Neospora sp., Cocci-
dioidomyces sp., Ehrlichia canis, E. platys, E. equi, and
Rickettsia rickettsii were negative.
A provisional diagnosis of pathogen-free inflammatory
CNS disease was made, and symptomatic treatment was ini-
tiated with prednisone (1 mg/kg orally twice daily). The an-
imal showed marked clinical improvement over the next 10
days but was presented again after 2 weeks with recurrence
of the initial clinical signs. A CBC revealed leukocytosis
(32,900 cells/ml, normal 5 6,000–17,000 cells/ml) with neu-
trophilia (23,359 cells/ml, normal 5 3,000–11,500 cells/ml)
and monocytosis (1,654 cells/ml, normal 5 150–1,350 cells/
ml). A CSF analysis revealed increases in total nucleated
cells and protein (Table 1). Myelography was normal. Aer-
obic and fungal cultures of the CSF were negative, and an-
aerobic culture revealed very small numbers of Fusobacte-
rium nucleatum after 8 days of growth. Treatment with en-
rofloxacin (4.5 mg/kg orally twice daily), metronidazole (8
mg/kg orally three times daily), and prednisone (0.5 mg/kg
orally twice daily) was initiated. Intracranial magnetic res-
onance imaging was declined by the owner. After 1 month
of moderate improvement, the animal acutely decompensat-
ed, was presented obtunded with ataxia, vocalization, and
loss of vision following generalized seizures, and subse-
quently died after a cardiac arrest.
On necropsy, the superficial blood vessels of the cerebral
cortex were hyperemic, and the cerebellum was mildly
coned, protruding slightly through the foramen magnum.
There was approximately 1 ml of purulent material in the
subdural space, mainly located over the brain stem. The lep-
tomeninges overlying the midbrain, pons, and medulla, and
the dura mater lining the corresponding ventral portions of
the calvarium were thickened, hyperemic, roughened, and
opaque. Sagittal sections of the brain showed symmetrically
dilated lateral ventricles, consistent with moderate hydro-
cephalus. The superficial blood vessels of the spinal cord
were diffusely engorged. The head, including oral cavity and
Vet Pathol 37:6, 2000 Brief Communications and Case Reports
Table 1. Cerebrospinal fluid (CSF) analysis of a dog
with CNS actinomycosis at presentation (sample 1) and 2
weeks after corticosteroid treatment (sample 2). Total nucle-
ated cell counts and protein levels increased following symp-
tomatic treatment.
Cisternal CSF
Normal
Parameter Sample 1 Sample 2 values
Total red blood cells (cells/ml) 9 1 0
Total nucleated cells (cells/ml) 189 3,810 0–2
Neutrophils (%) 71 80 Rare
Small mononuclear cells (%) 23 0
Large mononuclear cells (%) 6 20
Protein (mg/dl) 51 150 ,25
Gross appearance Clear Cloudy Clear
teeth, ear canals, tympanic bullae, nasal choanae, and nasal
sinuses, was examined, and no evidence of inflammation or
trauma was found in any of these locations. The dog also
had multiple dark red, 0.5-cm-diameter, consolidated pul-
monary nodules located in the periphery of the right and left
cranial lung lobes.
Cytology smears of the CSF obtained from the subdural
space and stained with Diff Quik (Baxter Scientific Products,
Mc Gaw, IL) showed abundant neutrophils and a few ag-
gregates of degenerated neutrophils (Fig. 1). These aggre-
gates were characterized by radiating gram-positive, acid-
fast–negative filamentous organisms surrounded by a corona
of elongated club-shaped neutrophils. Culture of the CSF
was performed in 5% sheep blood agar with 5% carbon di-
oxide at 37C, and a pure culture of Actinomyces sp. was
obtained.
Histologically, there was severe suppurative and granu-
lomatous meningoencephalitis and ventriculitis that involved
the brain stem and the subependymal white and gray matter
along the lateral third and fourth ventricles (Fig. 2). Rare
radiating bacterial colonies surrounded by neutrophils and a
Splendore-Hoeppli reaction were found within the meninges
of the caudal brain stem (Fig. 3). The pulmonary nodules
were areas of bronchopneumonia, characterized by hemor-
rhage, and neutrophilic infiltrates surrounding small airways.
There also was a single small granuloma within the pul-
monary parenchyma, characterized by an accumulation of
epithelioid macrophages surrounded by a rim of lympho-
cytes. No organisms were seen within this granuloma with
Giemsa, Brown and Brenn, or acid-fast (Fites Faraco) stains.
Actinomycosis of the CNS in animals has not been pre-
viously confirmed by culture of the organism. In the previ-
ously reported cases of meningitis in a fox and a dog, the
diagnosis was assumed based on the histologic appearance
of the filamentous organisms. Furthermore, both animals had
facial or head bite wounds that probably were the source of
infection. The present case is unusual in the absence of pre-
vious history of trauma or other sites of infection. The mul-
tifocal bronchopneumonia affected mainly cranioventral por-
tions of the lungs and was interpreted to be due to aspiration,
secondary to seizures. These lesions were acute and not con-
651
Fig. 1. Cerebral spinal fluid: dog. Central radiating ag-
gregate of Actinomyces sp. surrounded by a corona of neu-
trophils. Diff Quik. Bar 5 15 mm.
sidered to be associated with the actinomycosis. The single
small pulmonary granuloma was a resolving lesion that was
considered unrelated because of its chronicity and the ab-
sence of microorganisms.
This case is also unusual because of the disparity of bac-
terial culture results ante- and postmortem. Fusobacterium
nucleatum was not considered a contaminant and was pos-
sibly a causative agent of a mixed anaerobic meningitis and
ventriculitis, resulting in the clinical signs observed. Differ-
ent antibiotic therapies are used to treat these two anaerobic
organisms; Fusobacterium can be treated with metronida-
zole, whereas penicillin derivatives are recommended for the
treatment of Actinomyces infections. In this case, the anti-
biotic therapy with metraonidazole could have suppressed
the growth of Fusobacterium, facilitating the overgrowth of
Actinomyces, which had not been detected in antemortem
cultures.
Because there was no history of trauma, a migrating fox-
tail (seed of Hordeum murinum or wild barley) was consid-
ered a potential source of infection. Migrating foxtails are a
common cause of granulomas and abcesses due to anaerobic
or mixed bacterial and fungal infections in the western Unit-
ed States. Actinomyces hordeovulneris sp. nov. has been iso-
lated from infections caused by migrating plant awns in Cal-
ifornia.2 However, the present isolate of Actinomyces did not
have the culture characteristics of this species.
Hydrocephalus was common to both this case and the pre-
viously reported canine case and is likely secondary to
blockage of the mesencephalic aqueduct by the florid pyo-
granulomatous ventriculitis. Therefore, some of the chronic,
progressive, poorly localized neurologic signs may be
caused by secondary hydrocephalus in dogs with CNS ac-
tinomycosis.
Actinomyces sp. should be considered as a potential cause
of pyogranulomatous meningoencephalitis in dogs even in
652 Brief Communications and Case Reports
Fig. 2. Brain and meninges; dog. Severe pyogranulomatous meningitis with a bacterial colony (arrow). HE. Bar 5 700 mm.
the absence of a positive antemortem CSF bacterial culture.
Postmortem cytology of the purulent CSF was preferable to
histology in identifying the causative organisms.
Fig. 3. Meninges; dog. Higher magnification of Fig. 2,
with radiating aggregate of Actinomyces sp. and Splendore-
Hoeppli reaction. HE. Bar 5 70 mm.
Vet Pathol 37:6, 2000
Acknowledgements
We thank Dr. R. J. Higgins for valuable assistance with
photomicroscopy.
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Request reprints from Dr. S. S. Couto, Anatomic Pathology
Service, Veterinary Medical Teaching Hospital, 1 Garrod
Drive, Davis, CA 95616 (USA).