ACTINOMYCETACEAE

Actinomyces
Nocardia
and Streptomyces

Objectives
To be familiar with
The clinical infections associated with
Actinomycetes, Nocardia spp. and
Streptomyces
The microscopic morphology and colonial
morphology of Nocardia and Actinomycetes
Antimicrobial therapy

ACTINOMYCES ISRAELII
A. viscosus
Normal floraand
of mouth
& GIT

Opportunistic pathogen

MORPHOLOGY & GROWTH

Elongated branching Gram-positive bacilli
Anaerobic or microaerophilic
Temperature range 35-37oC
Slow growth on blood agar in 4-7 days
DISEASE

Actinomycosis

ACTINOMYCOSIS
Source of infection

Endogenous

Pathogenesis

After local trauma, organisms invade tissues

organisms multiply Form hard yellow granules
(called sulfur granules) which are bacterial
filaments solidified with tissue exudates
These granules drain outside through sinuses

Sites of actinomyces infections

ACTINOMYCOSIS
Clinical Features and Diseases
A chronic infection
Cervicofacial Actinomycosis
The most common form
Develops due to poor dental hygiene &
tooth extraction
other dental procedures

Appear as hard tender swelling )Lumpy

jaw) that drains pus through sinus
tracts

Multiple sinuses, scarring on neck & sub

maxillary area

Thoracic Actinomycosis
the lung
result of aspiration of actinomyces from the mouth
Sinuses
often appear on the chest wall
and the ribs and spine may be eroded
Primary end bronchial Actinomycosis is an
uncommon complication of an inhaled foreign body
Abdominal Actinomycosis
Abdominal cases commence in the appendix or,
less frequently, in colonic diverticulae
Pelvic actinomycosis

occurs occasionally in women fitted with plastic intra-uterine

contraceptive devices

Other form of infections

Nervous system
Musculoskeletal

Are uncommon

ACTINOMYCOSIS
LAB DIGNOSIS

Sulfur granules in pus specimen

Direct Gram-smear

Finely branching filamentous bacilli

Culture on

Blood agar anaerobically for 4-7 days

Molar tooth appearance

Histopathology

Treatment

Surgical drainage
Penicillin for 4-6 weeks

1.
2.
3.

Nocardia spp.
(Nocard)

Strict aerobes.
Infections caused by Nocardia Spp. can occur in
Immuno-compromised and immuno-competent
individuals.
N. asteriodes, N.brasiliensis are the major causes of
these infections
Nocardia spp. can cause three types of skin
infections in immuno-competent individuals
Mycetoma (chronic, localized, painless, subcutaneous
infection)
Skin abscesses or cellulitis
Lymphocutaneous infections
In Immuno-compromised individuals Nocardia Spp.
Can cause invasive pulmonary infections and
disseminated infections (brain abscess )

Pathogenicity

Release of cord factor, which prevents

nocardia from being phagocytosed by
macrophages.
Catalase production, which inactivates
oxygen metabolites which would normally
be toxic to bacteria

NOCARDIA ASTEROIDES
(80%)

Gram-positive thin branching filaments

Weakly acid fast with 1% HCl modified Af
Aerobic
Found in environment particularly in soil
Disease : Nocardiosis
Source of Infection : Soil (exogenous)
Nocardia asteriods ( Gram Stain

Nocardia asteriods ( modified A F

NOCARDIOSIS : CLINICAL FEATURES

N. asteriodes
Pulmonary Nocardiosis
Due to inhalation of organism
Red nodules on a patient with
disseminated nocardiosis
Pneumonia-like abscesses
Usually in immunocompromised patients
N.brasiliensis
Skin & Subcutaneous Tissue Infection
Usually after trauma like thorne prick
May present as sinus tract like actinomycosis
Ulcer on the arm of a patient with primary
cutaneous nocardiosis

NOCARDIOSIS
LAB DIAGNOSIS
Specimen : Sputum or pus
Staining with :
Gram-stain or Modified Acid-Fast
Culture on:
Blood agar
LJ agar

Growth is visible after incubation for between 2 days and 1 month;

selective growth is favoured by incubation at 45C. Colonies are
cream, orange or pink coloured; their surfaces may develop a dry,
chalky appearance, and they adhere firmly to the medium

TREATMENT
Surgical drainage
Trimethoprim-sulphamethoxazole