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Actinomycetes
- 1. Actinomycetes Dr. Kanwal Deep Singh Lyall M.D. Microbiology
- 2. Gen. characteristics • Thin, Gram +ve, non-motile, non-sporing, non- capsulated filaments containing muramic acid. • Break up in to bacillary & coccoid elements • Morphological resemblance to fungi, cellular organization typical of bacteria • Related to Mycobacteria and Corynebacteria • Mostly free living, mainly soil
- 3. Classification Anaerobic • Actinomyces • Arachnia • Bifidobacterium • Rothia Aerobic • Nocardia • Actinomadura • Dermatophilus • Streptomyces
- 4. Actinomyces
- 5. Actinomyces • Discovered by Bollinger – mould like organism in lumpy jaw in cattle • Name coined by Harz • Meaning “ ray like fungus” • Isolated in humans by Wolf & Israel (A. israelii) • A. israelii – humans • A. bovis – cattle • A. naselundii, A. viscosus, A. odontolyticus, A. meyeri
- 6. Contd. • m/c rural areas, agricultural workers , young males • Commensals – mouth, intestine & vagina • Endogenous infection- trauma, foreign bodies, poor dental hygiene • Indurated swellings (connective tissue), supuration and discharge (sulphur granules) • Usually a mixed infection
- 7. Clinical forms • Cervicofacial (60%) – cheeks & sub-maxillary region • Thoracic – lung, pleura, pericardium, chest wall • Abdominal (20%) – caecum, neighboring tissue, abd. Wall, rarely liver via portal vein • Pelvic – assoc. IUCD, draning abscesses – Gingivitis, plaques, mycetoma
- 9. Sulphur granules • Found in exudates • Long, branching, mycelium attached to the sulphur granules • Also obtained by applying gauze pieces on the sinuses • – bacterial colonies • Dense network of Gram +ve filaments, surrounded by a zone of swollen, radiating, club shaped structures (Ag-Ab complex) • Sunray appearance
- 10. Clinical specimen – Pus, tissue, sputum Gross examination of granules – test tube – saline + pus – shake – sediment examined . Granules – white/ yellowish ≈ 1 mm Microscopy – directly under the cover slip (with M. blue – cauliflower like appearance @ 100 x), Crushed b/w slides–Gram’s stain Culture – samples washed – Thioglcosallate liquid medium or BHIA x 35°C anaerobically Liquid - Gen. turbidity – A. bovis, fluffy balls at bottom – A. israelii. Solid – small spidery colonies on 48 – 72 hrs – heaped up, irregular or smooth in about 10 days Species identification – Biochemical Rx, Fluorescence Ab methods, gel diffusion or IF
- 11. Treatment • Prolonged treatment (Months) with Penicillin or Tetracycline • Surgical debridement
- 12. Nocardia
- 13. General Characteristics • Obligate aerobes, Gram +ve , filamentous, rod- shaped, non-sporing, non-motile, catalase positive • N. astroides (A. fast) , N. brasiliensis (A.fast) , N. cavae, N. farcinica, N. nova, N. otitidiscaviarum • Soil, exogenous infection
- 14. Clinical forms • Cutaneous – abscesses, cellulitis or lymphocutaneous , subcut. (actinomycotic mycetoma) • Systemic – usually N. asteroides. m/c pneumonia, lung abscess or mimic Tb – mostly in Immunocompromised • Metastatic – brain, kidney or other organs
- 15. Lab diagnosis & treatment • Direct Microscopy – Gram stain and Mod. ZN stain • Culture – aerobic, readily grow on ordinary media. • Colonies – dry, wrinkled, pigmented (yellow to red) • Biochemical tests
- 16. • Treatment – Resistant to penicillin. – Cotrimoxazole, amikacin, cefotaxime – Surgery
- 17. Actinomycotic Mycetoma • First described from Madura by Gill (1842) • Maduramycosis • Localised, chronic, granulomatous involvement of subcut. and deeper tissue • Foot (Madura foot), hand • Tumor with multiple discharging sinuses • Bacteria and fungi • Color of granules – etiology
- 18. x