Download - ACTINOMYCES
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ACTINOMYCES
ACTINOMYCES SPP. ARE POTENTIALLY PATHOGENIC COMMENSALS OF MOUTH IN HUMANS & ANIMALS. MAJOR COMPONENT OF DENTAL PLAQUE AT PROXIMAL SITES OF TEETH.
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THESE ARE GRAM POSITIVE PLEOMORPHIC BACTERIA, WHICH MAY SHOW BRANCHED FILAMENTS.
THEY ARE FACULTATIVE ANAEROBES.
MEDIA USED ARE - BRAIN HEART INFUSION
AGAR / BROTH, THIOGLYCOLLATE BROTH WITH 0.1-0.2% RABBIT SERUM.
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PATHOGENIC SPECIES ARE – A. israelii, A. naeslundii, A. meyeri, A. odontolyticus, A. viscosus. ALL THE SPECIES ARE
COMMENSALS IN MOUTH, THEREFORE , ENDOGENOUS CAUSE OF DISEASE.
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PATHOGENESIS-
ACTINOMYCOSIS IS A CHRONIC SUPPURATIVE DISEASE , CHARACTERIZED BY PERIPHERAL SPREAD TO CONTIGUOUS TISSUES,
RARE HAEMATOGENOUS SPREAD.
IT FORMS SINUS TRACTS , WHICH DRAINS THE LESIONS.
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THE PUS CONTAINS COLONIES OF THE ORGANISM, WHICH ARE CALLED AS SULPHUR GRANULES.
THERE ARE THREE IMPORTANT SITES OF PRIMARY INFECTION IN ACTINOMYCOSIS.
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1. CERVICOFACIAL- PRIMARY LESION IS USUALLY IN
THE MANDIBLE OR MAXILLA.
IT OCCURS BY DIRECT EXTENSION FROM A PERIODONTAL ABSCESS, NEGLECTED CARIOUS OR BROKEN TEETH, DENTAL EXTRACTION OR ACCIDENTAL FRACTURE OF JAW.
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2. THORACIC-
IT OCCURS IN LUNGS AS A RESULT OF ASPIRATION OF HYPHAL FRAGMENTS OF ACTINOMYCES FROM TOOTH SURFACES OR DENTAL CARIES .
THE LESION IN THE LUNG MAY INVOLVE PLEURA AND PERICARDIUM.
IT SPREADS OUTWARDS THROUGH THE CHEST WALL PRODUCING MULTIPLE DRAINING SINUSES.
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3. ABDOMINAL –
MOST OFTEN SEEN IN THE APPENDIX.
LABORATORY DIAGNOSIS- SPECIMENS: PUS, SINUS DISCHERGE, BRONCHIAL
SECRETIONS, SPUTUM OR INFECTED TISSUES ARE COLLECTED ASEPTICALLY.
THESE SPECIMENS CONTAIN SULPHUR GRANULES.
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1. MICROSCOPY – PUS IS MIXED WITH STERILE
WATER. SULPHUR GRANULES SETTLE TO BOTTOM.
GRANULES ARE CRUSHED BETWEEN TWO SLIDES & STAINED WITH GRAM AND ZEIHL-NEELSEN STAIN USING 1% SULPHURIC ACID FOR DECOLOURISATION.
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GRANULES ARE SEEN TO CONSIST OF GRAM POSITIVE HYPHAL FRAGMENTS 0.5- 1 µm IN DIAMETER SURROUNDED BY A PERIPHERAL ZONE OF SWOLLEN RADIATING CLUB-SHAPED STRUCTURES PRESENTING A SUN RAY APPEARANCE.
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CLUBS ARE GRAM NEGATIVE & ARE OF HOST ORIGIN.
SULPHUR GRANULES & MYCELIA IN TISSUE SECTIONS CAN BE IDENTIFIED BY DIRECT FLUORESCENCE MICROSCOPY.
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2. CULTURE- SULPHUR GRANULES ARE
WASHED THOROUGHLY IN STERILE NORMAL SALINE .
THEY ARE CRUSHED IN A DROP OF SALINE WITH A GLASS ROD.
THEN THEY ARE INOCULATED ON BRAIN HEART INFUSION AGAR,
BLOOD AGAR & IN THIOGLYCOLLATE BROTH.
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THEY ARE INCUBATED BOTH AEROBICALLY & ANAEROBICALLY IN
5-10 % CO2 AT 35-37°C FOR UPTO 14 DAYS.
THE COLONIES ARE 0.5-2mm IN DIAMETER, WHITE TO GREY-WHITE, SMOOTH, ENTIRE OR LOBULATED RESEMBLING MOLAR TEETH.
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GROWTH IS FURTHER CONFIRMED BY DIRECT FLUORESCENCE MICROSCOPY AND BIOCHEMICAL TESTS.
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3. BIOPSY IN HAEMATOXYLIN AND EOSIN
STAINED SECTIONS, THE SULPHUR GRANULES ARE DEEPLY STAINED WITH HAEMATOXYLIN EXCEPT AT PERIPHERY WHICH IS STAINED BY EOSIN.
THE TISSUE REACTION IS A CHRONIC SUPPURATIVE, FIBROSING, INFLAMMATORY PROCESS.
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TREATMENT-
SURGICAL REMOVAL OF AFFECTED TISSUE .
LARGE DOSES OF PENICILLIN UPTO
6 WEEKS. TETRACYCLINE MAY ALSO BE
USED.