Actinomycosis

• A. Israelii – the commonest• A .Meyeri• A.Naeslundii• A.Odontolyticus• A. Viscosus

Actinomycosis

ACTINOMYCOSISNot highly virulent (Opportunist)– Component of Oral Flora• Periodontal pockets• Dental plaque• Tonsilar crypts

– Take advantage of injury to penetrate mucosal barriers• Coincident infection• Trauma• Surgery

PEOPLE AT RISK WITH ACTINOMYCOSIS • Having a dental disease or recent dental surgery (for

jaw abscess)• Aspiration (liquids or solids are sucked into lungs)

(for lung abscess)• Having bowel surgery (for abdominal abscess)• For women: having an intrauterine contraceptive

device (IUD) in place for many years (for abscess affecting the reproductive organs)

Cervicofacial Actinomycosis • This is the most common and recognized

presentation of the disease.• Actinomyces species are commonly present in

high concentrations in tonsillar crypts and gingivodental crevices.

• Many patients have a history of poor dentition, oral surgery or dental procedures, or trauma to the oral cavity.

• Chronic tonsillitis, mastoiditis, and otitis are also important risk factors for actinomycosis.

Infection Cervicofacial region

• Periostitis or osteomyelitis can develop if the infection extends to facial and maxillary bones.

• The mandible appears to be one of the most common osteomyelitis sites.

Abdominal Actinomycosis

Examination of discharges will help in diagnosis

• Examination of drained fluid under a microscope shows "sulphur granules" in the fluid. They are yellowish granules made of clumped organisms

Dr.T.V.Rao MD 12

Typical appearance of histopathological examination with special stains

• The smears revealed radiating filamentous colonies of Actinomyces in a background of neutrophilic exudates;

• PAS stain also showed Actinomyces colonies.

Mycetoma • Mycetoma is a chronic subcutaneous

infection caused by actinomycetes or fungi. • This infection results in a

granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone.

Mycetoma • Mycetoma is characterized by the

formation of grains containing aggregates of the causative organisms that may be discharged onto the skin surface through multiple sinuses.

• Mycetoma was first described in the mid 1800s and initially named Madura foot, after the region of Madura in India where the disease was first identified.

•

• Slow spreading skin infection • Local swelling • Small hard painless nodules • Ulceration • Pus discharge • Sinuses • Scarred skin & discolouration • Itching • Pain & Burning sensation if superinfected

Clinical features

• Direct microscopy: • Blood- Leukocytosis & neutrophilia• Culture of exudates • Skin biopsy• Serology.

DIAGNOSIS.

Excised mycetoma showing a draining sinus(cut open in this preparation) containing black grains.

H&E stainskin biopsy

H&E stained tissue section showing blacked grained eumycotic mycetoma caused by Madurella mycetomatis.

• Granulomatous Inflammation With Abscess Formation.

• A Central Zone Exists Where Polymorphonuclear Cells Are Abundant And Granules Or Grains Are Found.

• This Central Zone Is Surrounded By Lymphocytes, Plasma Cells, Histiocytes, And Fibroblasts.

Histopathological Findings