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ACTINOMYCOSIS
• Actinomycosis is an indolent, slowly progressive infection caused by
anaerobic or microaerophilic bacteria Actinomyces
• Mouth, Colon, Vagina
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Three clinical
the combination of chronicity, progression across tissue
boundaries, and mass-like features (mimicking malignancy, with
which it is often confused); (2) the development of a sinus tract,
which
• may spontaneously resolve and recur; and (3) a refractory or
relapsing
• infection after a short course of therapy, since cure of established
actinomycosis
• requires prolonged treatment.
Actinomycosis is most commonly caused by
• A. israelii,
• A. naeslundii,
• A. odontolyticus,
• A. viscosus,
• A. meyeri,
• A. gerencseriae,
• and Propionibacterium propionicum
• Most often polymicrobial
• anaerobic Gram-positive fungal like bacteria
which is a branching filamentous organism. It is
called as“Ray fungus” because of sun-ray
appearance.
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Actinomycosis occurs throughout life
peak incidence in the middle decades.
Males :Females 3:1
The critical step in the development of
actinomycosis is disruption of themucosal
barrier.
• actinomycosis spreads contiguously in a
slow progressive manner,ignoring tissue
planes.
• Single or multiple indurations.
• Central necrosis consisting of neutrophils and
sulfur granules
• The fibrotic walls of the mass are typically
described as “wooden.”
• Over time, sinus tracts to the skin,adjacent
organs, or bone may develop.
• rarely distant hematogenous seeding may occur.
• these unique features of actinomycosis mimic
malignancy, with which it is often confused.
• Foreign bodies appear to facilitate infection.
CLINICAL MANIFESTATIONS
• Oral-Cervicofacial Disease
• Thoracic Disease
• Abdominal Disease
• Central Nervous System Disease
• Musculoskeletal andSoft Tissue Infection
• Disseminated Disease
No lymph nodal involvement
• Gram’s staining shows Gram-positive
mycelia in centre with Gram-negative
radiating peripheral filaments.
• Actinomycosis must be treated with high
doses of antimicrobials for a prolonged
period.
Therapy needs to be individualized,
18 to 24 million units of penicillin IV daily
for 2 to 6 weeks,followed by oral therapy
with penicillin or amoxicillin for 6 to
12months,
MADURA FOOT (MYCETOMA
PEDIS
• chronic granulomatous condition of the
foot involving subcutaneous and often
deeper tissues causing multiple
discharging sinuses.
• It is common in India and Africa.
• It can be fungal (more common) or
bacterial origin. Bacterial can be
Actinomyces or Nocardia.
• Nocardia madurae (most common)
• Nocardia brasiliensis
• Nocardia asteroides
• Actinomyces israelii
• Organism enters through a prick in the foot usually who
walks barefoot
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Reaches deeper plane in the foot
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Evokes chronic granulomatous infl ammation
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Causes pale, painless, fi rm nodule
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Formation of vesicles
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Burst to form a discharging sinuses
Discharging granules may be Black, Red, Yellow
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Antifungal drugs—amphotericin.
Long-term penicillins.
Dapsone, iodides.
In severe cases amputation may be
required.
• Madura hand