Actinomyces Species

00:01 Actinomyces Species, a bacteria.

00:03 Actinomyces are gram-positive rods that are obligate anaerobes and they have branching filaments.

00:10 They’re very slow growing and they’re not acid fast.

00:14 Importantly and is a distinguishing factor, Actinomyces create macroscopic sulfur granules, meaning, you can see these with the naked eye.

00:23 These appear to be yellow-orange masses of organisms and they resemble little grains of sand.

00:29 This is especially prominent in a surgical specimen or a wound when one opens it up and you can make a diagnosis very much in the operating theater by looking within the depths of the wound.

00:42 It is a very common contaminant and a common flora but there are several types of Actinomyces which are actual pathogens, one of which is Actinomyces Israelii.

00:54 So, as noted before, Actinomyces are normal flora, they colonize pretty much everywhere, upper respiratory tract, the gastrointestinal tract, certainly, the reproductive tract and they only cause disease or infection when there is some sort of breakdown in the mucosal barrier.

01:14 Whether it’s through a trauma, whether it’s through a planned procedure or even bad dentition.

01:22 So, after that breakdown of barrier occurs, then, the infection occurs via an endogenous, you carry it with you mechanism.

01:30 So, the most common type of Actinomyces infection is cervical facial disease.

01:37 This is classically caused by Actinomyces Israelii and it causes as you see in the picture of the patient on the right, tissue swelling along with fibrosis and scarring.

01:49 Many times as the infection progresses slowly and it is unrecognized clinically, it has time to create abscesses and sinus tracks which develop underneath the skin.

02:02 And in the picture, you see the patient has a draining tract, a little pit right to the right side of the earlobe.

02:11 That would be a very typical presentation for a patient with Actinomyces cervical facial disease.

02:17 In addition, they may develop multiple sites of abscesses tracking along the jaw and so, Actinomyces infection has been also called lumpy jaw syndrome.

02:30 We described things really well in microbiology.

02:33 Another type of infection would be a Mycetoma.

02:37 Now, that prefix Myce sounds an awful lot like a fungus and in fact, there are some elements of the Actinomyces growth which resembled that of a fungus, slow growing but not acid fast. T he Mycetomas can occur through inoculation in any sort of the skin which has trauma but they can also occur elsewhere throughout the body as you see there, abdomen, pelvis, thoracic infections.

03:04 So, what are the risk factors? Well, as noted before, poor oral hygiene is probably the very number one source especially if that poor oral hygiene is followed by dental surgery or even oral trauma.

03:18 However, because the organism is normal flora elsewhere, any other penetrating type injury, whether it’s planned through surgery, planned through pelvic surgery, or through trauma can now cause such an infection but so to can placement of indwelling devices and a classic example would be Salpingitis which is related to the placement of intrauterine device.

03:46 Prevention and treatment, surgical debridement is the most important component as it is with any infected wound or skin in soft tissue infection but that should be followed by penicillin as well.

03:59 So, with Actinomyces infections, fortunately, they are relatively rare but when seen, they’re commonly associated with poor oral hygiene, some sort of dental procedure, an then, they present with a draining sinus tract or the lumpy jaw syndrome and when surgically opened, one can see tiny little yellow grains of sulfur are the identifying feature of Actinomyces.