Actinomyces & Nocardia

Front 1

What are the major differences in staining and culture aspects of actinomyces & Nocardia?

Back 1

Nocardia is acid fast, beaded appearance, strict aerobe, environment source. Infects immunocopromised

Actinomyces - acute branching angles, anaerobic, commensal flora source

Front 2

What are the similarities between Nocardia & Actinomyces?

Back 2

Both - Gram +, filamentous rods, slow growing, require trauma, produce sulfur granules

Front 3

What is the most common source for the infectious agent in nocardiosis?

Back 3

Environmental trauma.

Often rose bush thorn, cactus thorn.

Front 4

What is the most common source for the infectious agent in actinomyces?

Back 4

Own Oral, GI, GU flora in addition to trauma

Front 5

How would actinomyces present?

Back 5

Slow progressive indurated mass that burrows after some type of trauma. Pus (PMN) & sulfur granules form abcess. Sinus tracts and possibly hematogenous spread may result.

Could present in endometrium assoc. w/ intrauterine device

Front 6

How would Actinomyces be diagnosed?

Back 6

1y clinical dx
Demonstrate sulfur granules
Few actinomyces are present & difficult to isolate
Positive culture

Front 7

How would actinomyces be treated?

Back 7

Surgical D&D is important in addition to Penicillin G (4-6wks)

Front 8

What is the pathogenesis of Nocardia?

Back 8

Microbe enters lung/wound -> phagocytosed -> mycolic cell wall allows intracellular proliferation -> Caseous granuloma forms -> microbes are walled off

Infections typically occur i immunocompromised

Front 9

What is the immunity response for Nocardia?

Back 9

PMN are the main response. This does not kill but only impedes growth. Doctor tx is required.

CMI response is critical as activated macrophages will kill pathogen

Front 10

How would nocardia brasiliensis infections manifest?

Back 10

Fever, lymphadentits in regional lymph node

This is skin type infection often post trauma with penetrating environmental sources. Superficial pustule at site of trauma that can develop draining sinus tracts with sulfur granules

Front 11

How is Nocardia diagnosed?

Back 11

Based on the bacteriology of Nocardia:

Gram (+) beaded filamentous branching bacillus
** Weakly Acid fast **
Strict aerobe

Front 12

How is nocardia treated?

Back 12

Surgical D&D is important
TMP-SMX (6-12mo)

Front 13

What is the bacteriology of Actinomyces?

Back 13

Actinomyces - gram positive, acute branching angles, anaerobic, commensal flora source, produces yellow sulfur granules

SLow growing 4-10d

Front 14

What is a common cause of oral actinomyces infection? What is a unique feature?

Back 14

Tooth extraction and infection from normal oral flora

The abscess will form draining sinuses

Front 15

How would nocardia asteroides infections manifest?

Back 15

Cough, dyspnea

This is the inhaled form that causes pneumonia lesions with necrotizing abcessess with cavitations. PMN will impede but kill Nocardia

The lung form can disseminate from the lungs through blood to brain & CNS

Front 16

Describe the Nocardia sputum sample, what pecies would be suspected?

Back 16

Nocardiain sputum. A. Note the filamentous bacteria forming tree-like branches among the neutrophils. The beaded appearance of the rods is typical.


Lung - think asteroides (asteroids = air)
Skin - brasillienses (brazil show skin)

Front 17

Describe the Nocardia sputum sample, what pecies would be suspected?

Back 17

Nocardiain sputum. B. The same sputum stain (AS ABOVE) with the modified (weaker) acid-fast method. Note the red filaments with the same branching pattern as in A

Lung - think asteroides (asteroids = air)
Skin - brasillienses (brazil show skin)

Front 18

What is the bacteriology of nocardia?

Back 18

Gram (+) beaded filamentous branching bacillus
** Weakly Acid fast **
Strict aerobe

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Gram stain of nocardia

Front 19

What are cavitations?

Back 19

The formations of cavities within the body.

Front 20

What are sulfur granules? Who produces them?

Back 20

These are yellow granules often found in the pus that are composed of

Front 21

Who gets these?

Back 21

immune compromised

Front 22

What and how are the routes of entry for Nocardia and Actinomyces

Back 22

Front 23

Summary of Nocardia and Actinomyces

Back 23