Presentation of fungus like organism:- ACTINO-MYCOSIS, its types, clinical features and treatment detail....

1. ACTINOMYCOSIS

2. ACTINOMYCOSIS
It is a chronic, suppurative granulomatous
disease caused by a fungus-like organism
Actinomyces Israelii.
 It is an anaerobic gram-positive filamentous
organism.
 It has been established that A Israelii may be
recovered from the oral mucosa, tonsillar crypts,
dental cavities and pharynx of many normal
persons.
 The method of infection is not definitely known.
 Entry into the tissue is resumed to result from
trauma or ulceration or by tooth extraction.

3.  It is not known whether additional factors like
hypersensitivity is necessary for subsequent
evolution.
 The actinomyces grow in the human tissue in
the form of yellow colonies which are easily seen
in the pus as ‘sulphur granules’ by the naked eye.
 When these granules are crushed under a cover
glass and examined unstained, two elements may
be distinguished – branching mycelial elements
and club forms.

4.  The filaments are gram-positive and constitute
greater part of the body, whereas the clubs are
gram-negative pear-shaped bodies which form a
fringe around the periphery of the colony of the
body.
 The filaments are arranged in radiate fashion
from the centre part of the granule.
 The characteristic radial arrangement is
responsible for the familiar term ‘ray fungus’.
The clubs probably represent a means of
defence against the invading organism.

5.  Three clinical forms of actinomycosis are
encountered.
 In more than half the cases the initial lesion
involves the tissues of the face and neck
including the mandible, in the remainder cases
the lungs and the gastrointestinal tract are
involved with equal frequency.
 The basic pathology is a subacute pyogenic
inflammation with considerable induration and
multiple sinus formation.

6. 1. FACIO-CERVICAL ACTINOMYCOSIS
 The lower jaw is more
frequently involved,
which may be
adjacent to a carious
tooth.
 A firm mass slowly
develops.
 It is characteristically
seen over the angle of
the mandible.
 It is frequently
painless.

7. CONTINUE…..
 The connective tissue, the muscle and the bone are
successively destroyed and replaced by granulation
tissue.
 An abundant fibrous tissue reaction may lead to
brawny induration in the affected area.
 Gradually softening occurs at few places with
appearance of abscesses, which ultimately burst to
form multiple sinuses.
 So the overlying skin becomes indurated and bluish
in colour with openings of numerous sinuses.
 The pus is usually thin and contains sulphur granules
which are diagnostic.

8. 2. IN THE ABDOMINAL
In the ABDOMINAL form,
mainly the caecum or
appendix is affected.
 In the submucosa flat
grey nodules appear,
which turn into a large
firm mass, readily
mistaken for
malignancy.
Suppuration within it
forms multiple
abscesses.

9. CONTINUE…..
 Ultimately the abdominal wall is involved with
multiple sinuses discharging thin pus with
sulphur granules.
 The liver is the second organ affected by this
disease.
 It is involved either by direct extension or by
blood borne infection through portal vein.
 The lesion is a honey-comb mass within the
liver which resembles a sponge saturated with
pus.

10. 3. LUNGS
LUNGS are involved by direct
spread from the neck
downwards or from abdomen
upwards.
 Lungs may be affected by
aspiration of the fungus.
 The lung becomes riddled
with abscess cavities
surrounded by abundant
fibrous tissue.
 Gradually the chest wall
may be involved with
multiple sinuses.

11. SPREAD
Actinomycosis is not known to spread.
 Sometimes the lesion may rupture into a vessel
to cause blood borne metastases in distant
organs e.g. the liver, the brain, the heart, kidney,
spleen and ovary.
 Spread by lymphatics is unknown.

12. TREATMENT
 A. Israelii are
sensitive to penicillin,
lincomycin and
tetracycline.
 If penicillin is used a
prolonged intensive
course should be
given 10 mega units
daily in the beginning
reducing to 4 mega
units daily later on.