1. Actinomycosis

2. Definition:
Is a chronic infection, commonly involves head and Neck region.
Produces open Sinuses and abscess formation.

3. A.Israeli,A.bovis,A.viscosus,A.naeslun-dii, A.odontolyticus.
Causes and risk factors.
. Five types have been described;
A.Israeli,A.bovis,A.viscosus,A.naeslun-dii, A.odontolyticus.
Normally non pathogenic in the nose and throat.
It causes infection when introduced into the facial tissues by trauma, dental procedures etc.
May cause hard abscess and nodule formation; the lumpy jaw.
Except for bovis all are normal flora of the oral cavity.

4. Incidence:
Slight male preponderance.(1.5-1 to 3:1)
Usually 4th to 6th decade.
Can be divided into three distinct forms;
Cervicofacial(50%),pulmonothoracic(30%) and abdominopelvic forms(20%).

5. Characteristics:
They are gram+ve rods.
Anaerobes
Branching and filamentous in morphology.

6. can also sometime cause pulmonary Actinomycosis.
Poor hygiene, dental abscess, alcohol abuse may result in pulmonary actinomycosis.
Causes lung cavities ,nodules and pleural effusions.

7. The Cervicofacial type;
Fever
Hard tender lumps with or without open sinuses mostly in and around the mandibular region
Sulfur granules in the abscess. (sulfur granules can be seen in nocardia infections but those are acid fast)
Wt. loss
Rarely with cervical lymphadenopathy. .

9. Actinomycosis(lumpy Jaw)

10. Pulmonothoracic type:
Poor hygiene, dental abscess, alcohol abuse may result in pulmonary actinomycosis.
Causes lung cavities ,nodules and pleural effusions.

12. Diagnosis:
Clinical findings.
Gram stain.
Culture. (poor growth in culture only in less than 50% of cases.) Sulphur granules (yellowish myecelial masses)
Specimens – open biopsy, aspiration material
The discharge should mix with sterile saline in a universal bottle and allow to stand, particles will separate out.

13. Causes granulomatous inflammation, like chronic abscess of the neck, appendix
Yellow granules in the discharge

16. Place between 2 slides
Crush and gram stain
Gram positive branching filaments

17. Sulfur granules (Hand E)

18. Gram stain showing gram +ve rods

20. Complications:
Osteomyelitis(although not common).
Otitis media.
Meningitis.
Lung infections.
Laryngeal infections(rare0