microbiology presentation over Actinomycosis ideal for bds and mbbs students

1. ACTINOMYCOSIS
Guided by;-
DR.DIWAN MAHMOOD KHAN SIR,
AND,
DR.POORVA VERMA MAAM
PRESENTED BY;-
ROHIT KUMAR
ROLL NO – 55
BDS 2ND
YEAR

2. CONTENTS
⦿ Introduction
⦿ Morphology
⦿ Pathogenesis and Immunity
⦿ Clinical Syndromes(ACTINOMYCOSIS)
⦿ TYPES OF ACTINOMYCOSIS
⦿ Epidemiology
⦿ Laboratory Diagnosis
⦿ Treatment
⦿ Prevention and Control

3. INTRODUCTION
⦿ Actinomycosis is caused by Actinomyces.
⦿ Which are considered to be a transitional forms between
bacteria and fungi.
⦿ Actinomyces israeli is the most common Actinomyces
causing human infection.
⦿ In human, Actinomyces species uasually cause diseases
like;-
-Cervicofacial actinomycosis
-Thoracic actinomycosis,
-and, Actinomycosis of the abdomen and pelvis.

4. MORPHOLOGY
Actinomyces show the following
features:-
■ Actinomyces organisms are
Gram-positive, nonmotile,
nonsporing,and non–acid-fast
bacilli.
■ They measure 0.5–1 mm in diameter.
■ They often grow in filaments that
separate into bacillary and coccoid
filaments.

5. PATHOGENESIS & IMMUNITY
⦿ Actinomyces species are present as normal flora of the oral
cavity and also in the lower gastrointestinal tract and
female genital tract of human hosts.
⦿ Establishment of human infection by Actinomyces always
requires the presence of companion bacteria.
⦿ These companion bacteria help in initiation of infection by
producing a toxin or enzyme or by inhibiting host immunity.
⦿ Infection by Actinomyces typically spreads contiguously
and invades surrounding tissues and organs.

6. • Finally, the infection results in
the production of draining sinus
tracts, which contain lot of
damaged tissue.
• And the Bacteria from this site
may disseminate through blood
circulation to distant organs.
Continues…

7. CLINICAL SYNDROME
(ACTINOMYCOSIS)
- Actinomyces causes
actinomycosis.
❑ ACTINOMYCOSIS-
- Actinomycosis is a subacute
and chronic bacterial infection
characterized by contiguous
spread and suppurative and
granulomatous inflammation. Figure - Actinomycosis, sites
and routes of infection

8. -Actinomycosis may manifest as (a)cervicofacial
actinomycosis, (b) thoracic actinomycosis, and (c)
actinomycosis of the abdomen and pelvis.
- The condition is associated with the formation of
multiple abscesses and development of sinus
tracts discharging white to yellowish granules,
known as sulphur granules.

9. TYPES OF ACTINOMYCOSIS
⦿ CERVICOFACIAL
ACTINOMYCOSIS-
- It is the most common
manifestation in humans
comprising about two-thirds of
reported cases.
- The infection occurs in the
cervicofacial region, which
typically occurs following oral
surgery in patients with poor
oral hygiene. Fig- cervicofacial actinomycosis

10. -Initially, the condition manifests as a swelling of the
soft tissue of the perimandibular area.
-during the course of the infection, the disease
spreads and leads to formation of fistulas.
-These fistulas or sinus tracts discharge purulent
material containing yellow granules, known as sulfur
granules.
- If left untreated, this condition may spread to the
blood and eventually to the brain and to the orbit.

11. Fig- cervicofacial actinomycosis in tooth

12. •THORACIC ACTINOMYCOSIS-
-This condition is responsible for
15-20% of cases of actinomycosis.
-It is caused by aspiration of
oropharyngeal secretions
containing Actinomyces and
occasionally during perforation of
the esophagus.
-The condition commonly presents
as apulmonary infiltrate or mass
involving the lung.
fig- thoracic actinomycosis

13. -The condition, if left untreated, can spread outwardly
through the pleura, pericardium, and chest wall,
ultimately leading to the formation of multiple sinuses
that discharge sulfur granules.

14. •ACTINOMYCOSIS OF THE ABDOMEN
AND PELVIS-
-This condition accounts nearly
10-20% of reported cases.
- The ileocecal region is the
most common site involved in
the condition.
-The condition typically presents
as a slowly growing tumor.
fig- pelvic actinomycosis

15. -The infection subsequently spreads and involves
abdominal organs including
the abdominal wall, leading to the formation of
draining sinuses.
- Actinomycosis of pelvis is commonly associated
with prolonged (for many years) use of
intrauterine contraceptive devices. The infection
spreads directly from uterus to pelvis.

16. EPIDERMIOLOGY
⦿ Actinomycosis is distributed worldwide. The condition is
more common in rural areas and in farm workers.
⦿ The condition is seen more commonly in individuals with
poor dental hygiene and in the people with low
socioeconomic conditions.
⦿ Men are affected more commonly than women (male to
female ratio is 4:3) with the exception of pelvic
actinomycosis.
⦿ Majority of the cases are reported in young and
middle-aged patients.

17. LABORATORY DIAGONOSIS
⦿ Laboratory diagnosis is made by direct detection of
Actinomyces in specimens by microscopy and by
isolation of organism by culture.
◗ Specimens-
- The specimens include sputum, bronchial secretions and
discharges,and infected tissues.
- All these specimens may contain large number of
sulfur granules.
- The sulfur granules are also present on the dressings
removed from a draining sinus tract.

18. ◗ Microscopy-
-Sulfur granules are white to yellow and vary in size
from minute specs to large granules.
-These granules are separated from pus and other
specimens and are collected directly from draining
sinuses.
- These are crushed between two slides and are stained
by Gram or Ziehl–Neelsen staining method, using 1%
sulfuric acid for decolorization.

19. -The stained smears on
microscopic examination
show Gram-positive hyphal
fragments surrounded by
peripheral zone of swollen,
radiating, club-shaped
structures presenting a
sunray appearance.
-These club-shaped
structures are Gram
positive, acid fast, and are
believed to be antigen
complexes.

20. Figure - Actinomycosis. Microscopic appearance of sulphur granule
lying inside an abscess. The margin of the colony shows hyaline
filaments highlighted by Masson’s trichrome stain (right photomicrograph).

21. DIAGONOSTIC TECHNIQUES
⦿ Molecular Diagnosis DNA
probes and PCR (polymerase
chain reaction) have been
evaluated and used with high
sensitivity and specificity for
accurate identification of
Actinomyces species in clinical
specimens.

22. ◗ CULTURE-
-Sulfur granules or pus-containing
Actinomyces are immediately
cultured under anaerobic conditions at
35-37°C for up to 14 days.
-The specimens are inoculated on blood
agar, BHI agar, and into thioglycollate
broth and incubated anaerobically at 37°
C.
-A.israeli produces(1-5mm) large,
white,smooth,entire lobulated colonies
resembling molartooth after 10 days of
anaerobic incubation.
Fig- Molar tooth-shaped
colonies of
Actinomyces israelii on
blood agar.

23. TREATMENT
⦿ High-dose penicillins or tetracyclines
given over a prolonged period are the
mainstay of therapy for actinomycosis.
⦿ Metronidazole, cotrimoxazole, and
sulfamethoxazole, and
penicillinase-resistant penicillins, such as
methicillin, oxacillin, and cloxacillin do
not have activity against Actinomyces
species.
⦿ Surgical therapy is included for more
extensive and complicated cases of
actinomycosis.

24. PREVENTION & CONTROL
⦿ Good dental hygiene
and oral hygiene are
important in
prevention of the
disease.

25. * Source of information-
- Textbook of microbiology by- subhash
Chandra parija and cp baveja
- Images courtesy- google and different
books