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22. Actinomycetes

By Frederick Ortiz,2014-09-10 12:50
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22. Actinomycetes22.

ACTINOMYCETES: INTRODUCTION

    Actinomycetes are true bacteria (related to corynebacteria and mycobacteria), but they form long, branching filaments that resemble the hyphae of fungi.

    They are gram-positive, but some (such as Nocardia asteroides) are also weakly

    acid-fast.

    There are two medically important organisms:

    ; Actinomyces israelii

    ; N. asteroides.

    Color Plate 12

    Nocardia asteroidesGram stain. Arrow points to area of filaments of gram-positive rods. Provider: Professor Shirley Lowe, University of California, San Francisco School of Medicine. With permission.

Table 221. Actinomycetes.

Species Disease Habitat Growth Diagnosis Treatment

    in Media

    A. israelii Actinomycosis Oral cavity Strictly Gram-Penicillin G

    (abscess with anaerobic positive

    draining branching

    sinuses) filaments;

    "sulfur

    granules"

    in pus;

    culture

    (anaerobic)

    N. Nocardiosis Environment Aerobic Gram-Sulfonamides

    asteroides (abscesses in positive

    brain and branching

    kidneys in filaments;

    immunodeficient often acid-

    patients, fast;

    pneumonia) culture

    (aerobic)

    ACTINOMYCES ISRAELII

    Disease

    Actinomyces israelii causes actinomycosis.

    Important Properties & Pathogenesis

    A. israelii is an anaerobe that forms part of the normal flora of the oral

    cavity. After local trauma such as a broken jaw or dental extraction, it may invade tissues, forming filaments surrounded by areas of inflammation. Hard, yellow granules (sulfur granules) composed of a mass of filaments are formed in pus.

    Clinical Findings

    Actinomycosis appears as a hard, nontender swelling that develops slowly and eventually drains pus through sinus tracts. In about 50% of cases, the initial lesion involves the face and neck; in the rest, the chest or abdomen is the site.

    Pelvic actinomycosis can occur in women who have retained an intrauterine device for a long period of time. A. israelii and Arachnia species are the most

    common causes of actinomycosis in humans. The disease is not communicable.

Laboratory Diagnosis

    Diagnosis in the laboratory is made by (1) seeing gram-positive branching rods, especially in the presence of sulfur granules and (2) seeing growth when pus or tissue specimens are cultured under anaerobic conditions. Organisms can be identified by immunofluorescence. There are no serologic tests.

Treatment & Prevention

    Treatment consists of prolonged administration of penicillin G, coupled with surgical drainage. There is no significant resistance to penicillin G. No vaccine or prophylactic drug is available.

NOCARDIA ASTEROIDES

    Disease

    Nocardia asteroides causes nocardiosis.

    Important Properties & Pathogenesis

    Nocardia species are aerobes and are found in the environment, particularly in the soil. In immunocompromised individuals, they can produce lung infection and may disseminate. In tissues, Nocardia species are thin, branching filaments that are gram-positive on Gram stain. Many isolates of N. asteroides are weakly

    acid-fast; i.e., the staining process uses a weaker solution of hydrochloric acid than that used in the stain for mycobacteria. If the regular-strength acid is used, they are not acid-fast.

Clinical Findings

    N. asteroides and Nocardia brasiliensis are the most common causes of human

    nocardiosis. The disease begins as a pulmonary infection and may progress to form abscesses and sinus tracts. Unlike A. israelii, sulfur granules are not formed.

    In immunocompromised persons, the organism may spread to the brain, skin, or kidneys. The disease is not communicable.

Laboratory Diagnosis

    Diagnosis in the laboratory involves

    (1) Seeing branching rods or filaments that are gram-positive or weakly acid-fast (2) Seeing aerobic growth on bacteriologic media in a few days. Treatment & Prevention

    ; Treatment is with trimethoprim-sulfamethoxazole.

    ; Surgical drainage may also be needed.

; Occasional drug resistance occurs.

; No vaccine or prophylactic drug is available.

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