ACTINOMYCES

ACTINOMYCES SPP. ARE

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

 THESE ARE GRAM POSITIVE

PLEOMORPHIC BACTERIA, WHICH MAY SHOW BRANCHED FILAMENTS. THEY ARE FACULTATIVE ANAEROBES. MEDIA USED ARE BRAIN HEART INFUSION AGAR / BROTH, THIOGLYCOLLATE BROTH WITH 0.1-0.2% RABBIT SERUM.

PATHOGENIC SPECIES ARE

A. israelii, A. naeslundii, A. meyeri, A. odontolyticus,

A. viscosus.

ALL THE SPECIES ARE COMMENSALS IN MOUTH, THEREFORE , ENDOGENOUS CAUSE OF DISEASE.

PATHOGENESIS ACTINOMYCOSIS IS A CHRONIC

SUPPURATIVE DISEASE , CHARACTERIZED BY PERIPHERAL SPREAD TO CONTIGUOUS TISSUES, RARE HAEMATOGENOUS SPREAD.
IT FORMS SINUS TRACTS , WHICH

DRAINS THE LESIONS.

 THE PUS CONTAINS COLONIES OF THE

ORGANISM, WHICH ARE CALLED AS SULPHUR GRANULES.

THERE ARE THREE IMPORTANT SITES

OF PRIMARY INFECTION IN ACTINOMYCOSIS.

1. CERVICOFACIALPRIMARY LESION IS USUALLY IN THE MANDIBLE OR MAXILLA.

IT OCCURS BY DIRECT EXTENSION

FROM A PERIODONTAL ABSCESS, NEGLECTED CARIOUS OR BROKEN TEETH, DENTAL EXTRACTION OR ACCIDENTAL FRACTURE OF JAW.

2. THORACIC

IT OCCURS IN LUNGS AS A RESULT OF ASPIRATION OF HYPHAL FRAGMENTS OF ACTINOMYCES FROM TOOTH SURFACES OR DENTAL CARIES .

THE LESION IN THE LUNG MAY INVOLVE

PLEURA AND PERICARDIUM.

IT SPREADS OUTWARDS THROUGH THE

CHEST WALL PRODUCING MULTIPLE DRAINING SINUSES.

3. ABDOMINAL
MOST OFTEN SEEN IN THE APPENDIX.

LABORATORY DIAGNOSIS SPECIMENS: PUS, SINUS DISCHERGE, BRONCHIAL SECRETIONS, SPUTUM OR INFECTED TISSUES ARE COLLECTED ASEPTICALLY. THESE SPECIMENS CONTAIN SULPHUR GRANULES.

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

 GRANULES ARE SEEN TO CONSIST OF

GRAM POSITIVE HYPHAL FRAGMENTS 0.5- 1 m IN DIAMETER SURROUNDED BY A PERIPHERAL ZONE OF SWOLLEN RADIATING CLUB-SHAPED STRUCTURES PRESENTING A SUN RAY APPEARANCE.

 CLUBS ARE GRAM NEGATIVE & ARE OF

HOST ORIGIN.
SULPHUR GRANULES & MYCELIA IN

TISSUE SECTIONS CAN BE IDENTIFIED BY DIRECT FLUORESCENCE MICROSCOPY.

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.

 THEY ARE INCUBATED BOTH

AEROBICALLY & ANAEROBICALLY IN 5-10 % CO2 AT 35-37C FOR UPTO 14 DAYS.

THE COLONIES ARE 0.5-2mm IN

DIAMETER, WHITE TO GREY-WHITE, SMOOTH, ENTIRE OR LOBULATED RESEMBLING MOLAR TEETH.

 GROWTH IS FURTHER CONFIRMED BY

DIRECT FLUORESCENCE MICROSCOPY AND BIOCHEMICAL TESTS.

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

SUPPURATIVE, FIBROSING, INFLAMMATORY PROCESS.

TREATMENT SURGICAL REMOVAL OF AFFECTED

TISSUE . LARGE DOSES OF PENICILLIN UPTO 6 WEEKS. TETRACYCLINE MAY ALSO BE USED.