ACTINOMYCETACEAE

Objectives
At the end of the lecture the students should
be able to:
 Describe the general characteristics of the
organisms
 Understand and recall their pathogenesis
 Enumerate the infections they cause
 Describe the laboratory diagnosis
 List the treatment options
 Genera
 Comprises 3 potentially pathogenic
genera:
Actinomyces
Nocardia
Streptomyces
 Actinomyces israelii

Pathogenesis and clinical disease

Actinomycosis
 Endogenous infection
 Causes abscesses in the jaw, thorax,
abdomen and cutaneous
 Injury to the oral mucosa, e.g. tooth abscess
or extraction, penetrates deep tissue –
abscess formation
 Clinical presentations
 Cervicofacial actinomycosis

 Thoracic actinomycosis

 Abdominal actinomycosis

 Cutaneous actinomycosis
 Diagnosis
 Macroscopic examination
– typical yellow granules (“Sulfur granules”)

 Culture – anaerobically at 37oC for 48h –2

wks

 Gram-positive branching bacilli

 Treatment
Rx:
 Debridement and drainage

 Large doses of penicillin G (20 million

unit/day) or ampicillin

2 – 3 months
 NOCARDIA
 Branched, strictly aerobic, Gram positive
 Environmental saprophytes - soil
 Usually weakly acid-fast
 Infection in immunosuppressed persons

Important species:
– Nocardia asteroides and N. brasiliensis

 Clinical disease:
– Pulmonary nocardiosis
– Cutaneous nocardiosis
 Pulmonary nocardiosis
 Multiple abscesses in the lung; necrotic and
confluent - Atypical pneumonia
 Spread by blood stream to other organs, e.g.
brain abscess.
 N. asteroides in the usual causative agent
 Most common presentation
 Cutaneous nocardiosis
 Mycetoma: - Subcutaneous draining abscess
 Contains white granules
 N. brasiliensis is the frequent cause
 Madura foot:
 Chronic granulomatous infection - foot - bones
and soft tissue.
 Occurs amongst those who walk bare footed.
Sudan, N. Africa and West Coast of India.
 Caused by Actinomadura (Nocardia) madurae.
 Also caused by other Actinomyces and fungi.
 Diagnosis
 Sputum
 Culture on blood agar
 Colonies cream, orange, pink or whitish
dry chalky and adhere firmly to the
medium.
 Gram stain – pleomorphic Gram-positive
 ZN stain - weakly acid-fast branching
filamentous organisms from the sputum,
pus or biopsy tissue
 Treatment

 Surgical drainage of abscesses

 Sulfadrugs e.g. Trimethoprim-

sulfamethoxazole (“Septrin”), amikacin,
imipenem
 Case presentation -1
A 18-year slightly malnourished boy came to the hospital
Casualty with the C/O discharging swelling in the right check
and neck of about 2 months duration. PMH: he has extracted
a tooth about 2 weeks prior to onset of symptoms.

 What is your provisional diagnosis?

 Name 3 other forms of this infection
 Which organism is the infecting agent?
 How would you investigate a case like this?
 What is the treatment option?
 Case presentation -2
A 46-year man who had undergone renal transplantation
about 6 years ago presented with multiple abscesses in the
forearm and chest. A Gram-stain of the pus aspirated from
the lesions revealed Gram-positive beaded and some
branching bacilli which also could be seen with ZN staining.

 What is the likely diagnosis?

 Which organism is responsible for this infection?
 Why did this man develop this type of infection?
 What is the source of the infection?
 What are the treatment options?