Actinomyces and Nocardia

Objectives

To be familiar with
• The clinical infections associated with
Actinomycetes
• The clinical infection caused by Nocardia spp.
• The microscopic morphology and colonial
morphology of Nocardia and Actinomycetes
• Antimicrobial therapy
 ACTINOMYCES ISRAELII
• Normal flora 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
• Due to low oxygen tension, organisms multiply
• Form hard yellow granules (called sulfur
granules) which are bacterial filaments
solidified with tissue exudates
• These granules drain outside through sinuses
 ACTINOMYCOSIS
Clinical Features
• A chronic infection
Cervicofacial Actinomycosis
• The most common form
• Develops due to poor dental hygiene & tooth
extraction. Appear as hard tender swelling
that drains pus through sinus tracts
• Multiple sinuses, scarring on neck &
submaxillary area
Thoracic & Abdominal Actinomycosis
• 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
 Nocardia spp.
• 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
5. Mycetoma (chronic, localized, painless, subcutaneous
infection)
6. Skin abscesses or cellulitis
7. Lymphocutaneous infections
• In Immuno-compromised individuals Nocardia Spp.
Can cause invasive pulmonary infections and
disseminated infections (brain abscess )
 NOCARDIA ASTEROIDES
(80%)
• Gram-positive thin branching filaments
• Weakly acid fast
• 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

Pulmonary Nocardiosis
• Due to inhalation of organism
• Pneumonia-like abscesses
• Usually in immunocompromised patients

Skin & Subcutaneous Tissue Infection

• Usually after trauma like thorne prick
• May present as sinus tract like
actinomycosis
 NOCARDIOSIS
LAB DIAGNOSIS
Specimen : Sputum or pus
Staining with :
• Gram-stain or Weak Acid-Fast
Culture on:
• Blood agar
• LJ agar

TREATMENT
• Surgical drainage
• Trimethoprim-sulphamethoxazole