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1. ACTINOMYCETALES By Dr. P.S.Reddy MD For e-learning

2. Fungus – like bacteria. This family includes : Actinomyces, Bifidobacterium Rothia, Arachnia. Nocardia, Actinomadura, Streptomyces.

5. IN THE HOST Sulphur granules in the pus. Granules: Small specks to 5mm. White / Yellowish. Gram staining. Central filamentous mycelium. Club shaped, Gram negative structures GROWTH CHARACTERS

6. CULTURE Liquid medium: As “fluffy balls” RCM. Thioglycollate broth 1% glucose broth. Solid medium : Blood Agar. BHI. Raised, nodular, Cream colored Spidery colonies resembles molar teeth.

8. PREDISPOSING FACTORS Periodontal disease, Trauma, Poor oral hygiene Jaw fractures, Maxillo facial surgeries, Periapical odontitis. Tooth decay

11. Gingival actinomycosis Mycetoma of foot

12. Thoracic actinomycosis: Sinuses on chest wall, Eroded ribs and spine. Abdominal actinomycosis: Ileocaecal region. Appendix, Colonic diverticula.

13. X-ray findings of Thoracic Actinomycosis

15. Laboratory diagnosis: 1. Pus 2. Sputum (not reliable) Specimen + saline ; and allowed to settle. Separate the ”sulphur granules” Do staining & culture. 3. Needle aspiration: From sinuses 4. Open biopsy: For HPE by H & E staining.

17. PREVENTION GENERAL CARE OF THE MOUTH. Brush the teeth at least twice a day. Care of surface grooves, spaces between teeth. Dentist consultancy every six months. MOUTH CARE IN OLDER ADULTS. Bridges and dentures must be kept clean and should be relined. MOUTH CARE IN CHILDREN. Don’t allow the child to fall asleep with a milk.

18. Fluoride application Slows the destruction of enamel and helps to repair minor tooth decay damage by demineralization. Sealants A thin plastic coating that is painted over the grooves to prevent entrapment of food particles. Diet Sugar and Starch. "swish and swallow" after meal.

20. MORPHOLOGY

22. Pathogenesis of Nocardia Soil saprophyte Exogenous infection “ Nocardiosis”

23. PATHOGENESIS: 1.Cutaneous Form: Local abscess, cellulitis. Lympho cutaneous lesions. 2.Subcutaneous Form: Fungating tumor like masses. Sinus formation. Mycetoma. 3.Nocardiosis with liver transplantation 4.Ocular nocardiosis followed by trauma.

24. 5.Systemic Nocardiosis: Pulmonary form. I nhalation. Immunocompromised : Corticosteroids Post Transplantation Immunosuppressive therapy. Aleolarproteinosis. H I V infection. Multiple confluent abscesses. Empyema Heals with little /no fibrosis Haematogenous spread Brain lesion.

27. Nocardia asteroids colony in tissues. Brown – Benn stain

29. Extrinsic Allergic alveolitis: Hypersensitive pneumonitis Occupational disease. Synonyms: Farmers lung. Mushroom worker’s lung. Bagassosis. Caused by: Faenia rectivirgula Thermophilic actinomyces spp. Inhalation of mouldy vegetable matter.