Micro Helminths, Protozoa, & Fungi

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Helminth types & diagnostic feature

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Roundworms - Nematodes

Flat worms - Platyhelminthes

High eosinophil during worm infections.

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Intestinal nematodes

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- All mature into adults in human GI tract while larval forms may distribute throughout body.

Three are ingested as eggs: Ascarius Lubricoids
Enterobius vermicularis (pinworm)
Trichuris trichura (Whipworm)

Two penetrate via skin
Necator Americanus (HookWorm)
Strongyloides stercoralis

One is ingested from pork muscle
Trichinella spiralis

Besides Trichuris trichura(Whipworm) & Enterobius vermicularis(Pinworm), all others invade blood & raise eosinophils

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The three Helminths that migrate to lungs at some point, coughed up & swallowed.

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Ascaris Lumbricoids, Necator Americanus, Strongyloids stercoralis

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Ascaris Lumbricoids life cycle, symptoms & diagnosis

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Ascaris lubricoids - Occurs in tropics & southern US after ingestion of eggs from food. Larvae hatch in intestines, migrate through blood to lungs, grow in alveoli, coughed up & swallowed to mature back in intestines. Produce 200 eggs a day into feces.

- Can develop abdominal cramping, malnutrition, invasion into lungs cause cough, high eosinophil

- Diagnose via finding eggs in feces.

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Necator Americanus life cycle, symptoms, & diagnosis

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Necator Americanus (Hookworm) - Filariform Larvae lives in soil & eats bacteria. Penetrates skin between toes. Travel directly to lungs, grow, coughed up & swallowed. Back in GI, attach by mouths & suck blood.

- Can develop diarrhea, abdominal pain & weight loss. Sucking blood could cause iron deficiency anemia. Intense itching & rash at site of penetration, growth in lung can cause cough, eosinophilia.

- Diagnose via eggs in feces

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Strongyloides Stercoralis

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Strongyloides stercoralis - Larvae live in soil, penetrate skin & travel to lungs, coughed up & swallowed. Eggs don't pass in stool. 3 things:
a) Autoinfection - larvae penetrate intestine to continue cycle
b) Direct cycle - larvae pass in feces to soil to infect next person
c) Indirect cycle - larvae are passed in feces mature & mate & produce eggs & larave in soil to reinfect

- Vomiting, bloating, diarrhea, anemia, weight loss. Pruritic rash, lung symptoms. Immunosuppressants can cause severe autoinfection or many organs.

- Diagnose via larvae in feces or enterotest: swallow nylon string & pull out to find larvae.

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Trichinella spiralis transmission, life cycle, symptoms, diagnosis

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- Infection due to ingestion of encysted larvae of trichinella spiralis in raw pork.

- Following mating, males are passed in feces while females penetrate intestines to produce larvae that travel in blood to organs & muscle where they encyst.

- Most are asymptomatic, but some have abdominal pain, diarrhea, & fever. 1 wk after invasion, larvae move to muscle to produce fevers & myalgias. May invade heart & brain to cause death.

Diagnose via eosinophils, muslce biopsy

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Trichuris triciura transmission, life cycle, diagnosis

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aka Whipworm.

- Transmission via ingestion of egg contaminated food

- Hatch in GI, colonize ascending colon & cecum, & produce thousands of eggs per day for a yr, which pass in feces. Eggs need moist soil to hatch, so no autoinfection.

Diagnose via eggs in feces, look like footballs with bumps on ends. *No eosinophilia b/c worm does not enter blood

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Enterobius Vermicularis transmission, life cycle, diagnosis

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aka Pinworm

- Ingestion

- Mature in ascending colon & cecum. Female migrates to perianal area at night to lay eggs which are infections 4-6hrs later. Severe perianal itching at night. Reinfection to self and others via scratching.

- Diagnose via scotch tape test.

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Blood & Tissue nematodes transmission, life cycle, symptom causes, drug targets & organisms

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- Spread via arthropod rather than fecal contamination.

- Called filariae, & adult filariae live in lymphatics & give birth to microfilariae which migrate to blood. Microfilariae picked up by arthropids which transmit to other human.

- Diseased caused by allergic reaction to microfilariae & dead adult worms in lymph

- Filarial parasites need Wolbachia, a rickettsial like bacteria to reproduce. This is a good drug target.

- Onchocerca volvulus, Wucheria bancrofti & Brugia malayi(Elephatasis), Dracunculus medinensis(Guinea worm)

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Onchocerca Volvulus location, life cycle, symptoms, diagnosis

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- A blood nematode found in Africa & central & south america.

- Transmitted via Black flies. Adults coil up under skin & produce microfilariae which migrate through skin & CT.

- Severe pruritic skin rash thickening called intraepithelia granulomas. Microfilariae may migrate to eye causing river blindness, since black flies breed in rivers & streams.

Diagnose by microfilariae in skin biopsies, or microfilariae in eye

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Wucheria bancrofti & Brugia malayi location, life cycle, symptoms, & diagnosis

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- causes elephantasis

- Wucheria is found in pacific islands & Africa while Brugia is found in malay islands & SE asia.

- Transmission via mosquito bite & infects lymphnodes of genitals & lower extremities. Adults mate & offspring move to blood.

- Frequent infections in endemic areas cause fevers, headaches, fibrous tissue form to clog lymphatics. Resulting in elephantasis.

- Diagnose via drawing blood at night. Nocturnal periodicity.

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Dracunculus medinensis life cycle, symptoms

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aka Guinea worm

- Lives in African & Asian fresh water tiny crustaceans. When person drinks the water, they are infected. Larvae penetrate intestine, male dies but female grows to 100cm. Pokes uterus out of skin & lay eggs when touching water.

- Symptoms include fever, nausea, vomiting, breathlessness during larval release.

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Cutaneous larval migrans

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Creeping eruption of advancing larvae causing raised itchy rash.

Can be due to larvae of dog hookworm, necator americanus, or strongyloides stercoralis.

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Platyhelminthes

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No digestive tract & 2 groups

1) Trematodes (Flukes) - have water snail species as intermediate hosts. Exist & mate in humans, but not in GI.

2) Cestodes (Tapeworms) live and mate in GI. Hermaphrodites.

Trematodes: Shistosoma(Blood Flukes)

Cestodes: (Tapeworms)
Taenia solium (Pork tapeworm)
Taenia saginata (Beef TW)
Diphyllobothrium latum (Fish)
Hymenolepsis nana (Dwarf)
Echinococcus granulosus & Multilocularis(Hydatid disease)

Front 16

Schistosoma life cycle

Back 16

Blood Fluke of Trematodes.

- Found in freshwater, mature in snails & penetrates skin to invade intrahepatic veins where they mate. Migrate to intestine or bladder to be excreted via feces or urine into freshwater stream or lake to continue life cycle.

- Practice molecular mimicry to avoid immune system. So adults can produce eggs in venous system for years.

- Eggs cause systemic illness:
3 major syndromes
1) Dermatitis as it enters swimmer
2) Katayama fever as adults begin laying eggs
3) Chronic fibrosis of organs & vessels inflammation due to deposition of eggs into organs, leading to fibrosis

Diagnose via eggs in stool or urine or serology for antibodies.

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Cestodes characteristics & physical description

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- Hermaphodites that live & reproduce in GI. Takes host nutrients.

- Long & flat, consists of segments called proglottids.

1) Scolex - head with suckers or hooks
2) Immature proglottids
3) Mature proglottids have both male & female sex organs
4) Gravid proglottids have fertilized eggs

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Taenia Solium

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aka Pork tapeworm

- Acquired via ingestion of undercooked pork with larvae. Attaches to intestines via hooks on scolex & grows to 2-8 meters & lay eggs in feces. Pigs eat eggs that develop into larvae & encyst in pig muscle to become CYSTICERCUS.

- Minimal symptoms, diagnose via proglottids in feces

- Cysticercosis is when human ingests eggs rather than larvae & eggs encyst in brain & muscle. Can cause neurocysticercosis causing seizures, hydrocephalus etc. Fluid contents of cyst can cause meningitis, seizures etc.
- Diagnose cysticercosis via CAT scan or biopsy of brain or muscle. Elevated eosinophil

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Taenia saginata

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aka Beef tapeworm

Exact same life as Taenia solium but humans don't develop cysticercosis when ingesting eggs.

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Diphyllobothrium Latum lifecycle, symptoms, diagnosis

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aka fish tapeworm

- Can grow to 45 meters from ingesting raw freshwater fish.

- Eggs in water turn to motile form ingested by crustacean, which is ingested by freshwater fish, which is ingested by human. Lives in Gi & gravid proglottids drop off eggs

- Few abdominal symptoms, but B12 deficiency leading to anemia

- Diagnose via eggs in feces

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Hymenolepsis nana lifecycle, symptoms, diagnosis

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aka Dwarf tapeworm

- Simple life cycle with no intermediate hosts. Ingested by humans & lay eggs.

- Symptoms of abdominal pain, nausea & vomiting

-Diagnose via eggs in feces

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Echinococcus granulosus & Multilocularis life cycle, symptoms & diagnosis

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Causes Hyatid disease

- Perpetuated by dogs & sheep, with humans as dead end. Humans ingest eggs, hatch in intestine, penetrate inestinal wall, disseminate throughout body to liver, lungs, kidney, brain.

- Each larva forms "hyatid cyst" which impinges on organs to cause variety of symptoms. Fluid in cyst is extremely allergenic. Echinococcus busts while Multilocularis spreads laterally & can be mistaken for cancer.

- Diagnose like taenia solium using CAT scan & tissue biopsy.

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Protozoa general characteristics

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Free living eucaryotic cells with organells, nuclei, 2 layers of cytoplasm endoplasm & ectoplasm. Has mouth called cystosome for food ingestion. Can asexually reproduce via division or sexually via fusion. Can secrete protective coat & shrink into cyst during rough times. Regularly it is in motile form called trophozoite.

Can rage from 5micrometers to 2mm.

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Intestinal protozoans

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- Entamoeba histolytica - bloody diarrhea
- Giardia lamblia & Cyclospora cayetanesis cause non bloody diarrhea
- Cryptosporidium & Isospora belli cause severe diarrhea in defective immunity pts like AIDS.

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Entameoba histolytica motility, Transmission, symptoms, diagnosis

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- Moves via pseudopodia.

- Exact method is unknown, but is highest in developing world & immigrants to US. - Can convert to precyst form with 2 nuclei & chromotoid bodies, then mature cyst that's eaten & infects others.

- Most infections are asymptomatic. & mostly homosexual men but 10% will invade intestinal mucosa to cause abdominal pain, & bloody, voluminous diarrhea. Or may penetrate portal circulation to form abscess in liver, then through diaphragm to lung to cause death.

Diagnose via presence of cysts or trophozoites. Trophozoites with RBCs in cytoplasm indicate active disease while no RMC means asymptomatic carriage.

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Giardia lamblia forms, transmission, symptoms, diagnosis

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- Cyst form or trophozoite form that looks like a kite

- Transmission via sewage contamination or rodents & beavers contamination stream. Most are asymptomatic.

- After ingestion, goes form cyst to trophozoite form to adhere to intestinal wall. Prevent fat absorption, resulting in frothy fatty diarrhea that is putrid. No invasion = no blood

Diagnose via examination of stool for cysts or trophozoites

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Cryptosporidium

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- Transmitted via contaminated municipal water & infants in daycare centers. Most are asymptomatic, but ingestion can cause diarrhea & abdominal pain. Self limiting in immunocompetent, however Life threatening diarrhea in immunocompromised.

Front 28

Cyclospora cayetenesis & Isospora belli microscopy, transmission, symptoms

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Both are acid fast staining & transmission via fecal-oral route. Cause severe diarrhea in immunocompromised. Transmission via fecal-oral route.

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Sexually transmitted protozoan transmission, symptoms, & diagnosis

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Trichomonas vaginalis

- STD & lives in female vagina & male urethra. Flagellated like Giardia lamblia & highly motile.

- Females may complain of itching, dysurea, & vaginal secretions. Males are usually asymptomatic.

Diagnose by examination of vaginal discharge.

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Free living meningitis causing amoebas, transmission,

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Naelgeria fowleri, Acanthamoeba, Balamuthia mandrillias

- Live in fresh water & infection occur in summer when people swim in lakes. Many are exposed, few are infected. Infection is usually rapid & fatal

Naelgeria fowleri enters via nasal mucosa into brain & CSF. Cause sudden deadly infection

Acanthamoeba & Balamuthia infects via respiratory or breaks in skin to cause granulomatous encephalitis in immunocompromised.

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Naegleria fowleri symptoms & diagnosis

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- Fever, headache, stiff neck, characteristic of bacterial meningitis. History will reveal swimming a week earlier.

- CSF will have high neutrophil, high protein, low glucose just like bacterial meningitis. However, gram stain & culture will reveal no bacteria.

- 95% mortality within 1 wk.

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Acanthamoeba

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- Responsible for chronic granulomatous brain infection in immunocompromised. May also infect contact lens to cause corneal infection & blindness.

- Headaches, fever, seizure, neurological signs.

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Balamuthia mandrillais

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Much like acanthamoeba but infects both immunocompetent & immunocompromised.

- Can produce granulomatous skin leisions alone or with amebic encephalitis.

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Major Protozoan infections in AIDS PTs

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- Usually harbored without problems, but cause disease when T cells drop below 200

Toxoplasma gondii
Pneumocystis carinii

Front 35

Toxoplasma gondii transmission, disease, Diagnosis

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- Transmission via kitty litter boxes, or ingestion of raw pork. Undergoes sexual division in cat & is excreted as infectious cyst.

1) Most common CNS infection of AIDS pts. With fever, liver & spleen enlargement.Brain infection can cause growing mass with neurological signs. Infections of retina can cause blindness

2) One of the TORCHES that cross PBB. Affects pregnant women previously unexposed. Doesn't occur in previously exposed women. Result in mental retardation, blindness, seizure etc.

Diagnose via CAT scan, or examination of retina

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Pneumocystis Carinii transmission, disease, diagnosis

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- Actually a fungi & lives peacefully in lung. Most common opportunistic infection in AIDS pts.

- Immunocompromised will lead to severe pneumonia called Pneumocystis carinii pneumonia (PCP)

-Presents with short breath, fever, nonproductive cough & death.

Diagnose with X-ray

Front 37

Malaria types, transmission, & lifecycle

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- Caused by 4 different protozoa:
Plasmodium falciparum - most common & deadly 36-48 hrs bursting,
Plasmodium vivax, Plasmodium ovale, - Tertian malaria, bursts every 48 hours
Plasmodium malariae - Quartan malaria bursts every 72hrs

- Transmitted via anopheles mosquito

Pre-erythrocytic stage - Injected as sporozoite to invade liver cell & form trophozoite, which divides asexually & forms thousands of nuclei called shizont. Membrane forms around each nuclei to form merozoites which bursts liver cell. Some merozoites infect other liver cells while some will enter blood to start Exo-erythrocytic cycle

Erythrocytic cycle - Merozoite enters RBC & forms trophozoite shaped like ring. Division results in lysis & fever, chills. Some merozoites form male & female gametocytes which circulate & taken up by mosquito or die. Sexual reproduction by fusion to form oocyst, which divides into many spindle shaped sporozoites which move to mosquito salivary gland & is infected.

Plasmodium vivax & ovale can lay dormant in liver cells. Hence blood screening

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Disease Malaria symptoms & diagnosis

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- Periodic episodes of severe chills & fevers with profuse sweating at 48-72 hr intervals & Last 6 hrs associated with RBC ruptures. Resulting in Anemia & sticky red cells that clog leading to renal failure, lung edema & coma.

Diagnose via blood smears to look for trophozoites & shizonts in RBCs

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Babesiosis

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Much like malaria but transmitted via tick & does not affect liver cells.

- Causes fever & hemolysis with anemia due to RBC invasion

Front 40

Blood-Borne Flagellates organisms, transmission, forms, & general infection characteristics

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Leshimania & Trypanosoma

- Transmitted via blood sucking insect bite.

- Can exist unflagellated as amastigotes or flagellated as promastigotes, epimastigoes, & trypomastigotes

- All cause ulcer at site of insect bite followed by systemic invasion

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Leishmaniasis transmission, location, diseases & diagnosis

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Carried by rodents, dogs & foxes & transmitted via sandfly. Burrows into macrophages & transforms into amastigote.

Found in South & central American, Africa & middle east.

Severity & form depends on host immune response.

Cutaneous Leishmaniasis - Simple: Injected by sandfly & migrate to reticuloendothelial cells. Skin ulcer called oriental sore at bite & heals in a year. Diagnose via skin scrapings from ulcer base.
Diffuse cutaneous Leishimaniasis: Chronic form occurs in pts with deficient immunity. Nodular skin leision arisis with no ulcer, & numerous nodular leisions diffuse across body.

Mucocutaneous Leishmaniasis - Dermal ulcer arisis, but months later, ulcers in mucous membranes of nose & mouth arise. Diagnose via skin scrapings

Visceral Leishmaniasis(Kala-Azar) - Usually affects young malnurished children causing hepatomegaly & massive splenomegaly due to invasion of reticuloendothelial cells. Presents with fever, distension, weight loss etc. Diagnose via liver & spleen biopsy.

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African sleeping disease causes, transmission, symptoms, types & diagnosis

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- caused by Trypanosoma rhodesience & gambiense

- Transmitted via tsetse fly. After bite, the trypomastigote spreads from blood to lymph & CNS.

- Symptoms involve hard painful skin ulcer that heals in 2 wks. Followed by recurrent fever, headache for months. Finally CNS symptoms develop & drowsiness in daytime, behavioral changes, slurred speech, coma & death.

2 Forms - West african sleeping disease caused by gambiense, & East cause by rhodesiense which is much more severe.

Diagnose via visualization of trypomastigotes in blood, lymph, or spinal fluid.

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Chaga's disease causes, locations, transmission, disease, diagnosis

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- Caused by Trypanosoma cruzi, the american trypanosome. Differs greatly from African trypanosomes.

- Found in souther US down to south America.

- Transmitted via Reduviid bug aka kissing bug. Feeds on humans during sleep & defecation releases trypomastigotes. Invasion of local skin, macrophages & loss of flagella to form amastigote.

Acute chaga's disease - Hardened red chagoma develops at skin site entry. Can infect heart tachycardia & brain meningoencephalitis. Occurs for a month & most enter intermediate phase. Some go on to form chronic Chaga's disease

Chronic Chaga's disease - Primarily affects heart & hollow organs like colon & esophagus. Intracellular T.cruzi amastigotes cannot be found & is unclear why these organs develop disease. Causes arrythmia, heartfailure & megadisease of colon & esophagus pain swallowing & constipation.

Diagnose acute via examining blood for motile trypomastigotes

Diagnose chronic via past history

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Acid fast organisms

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Mycobacterium, Nocardia, Cryptosporidium, Isospora Belli

Front 45

The 6 types of Fungi

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Yeast - Unicerlluar growth fungi, reproduces via budding & buds can stay connected forming pseudohyphae. Reproduce slower than bacteria

Hyphae - Threadlike extentions of bacteria in branches that are connected end to end.

Molds - Clumps of intertwined branching hyphae

Spores - Reproducing bodies of molds

Dimorphic fungi - Can grow as either yeast or mold depending on condition, usually yeast at body temp

Saprophytes - Fungi that live in & utilize organic matter like soil & rotten veges as energy

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Fungal virulence factors

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1) Cell membrane - bilayered membrane containing Ergosterol which is essential sterol in fungi. Many antifungals work by disrupting Ergosterol.

2) Cell Wall - Composed mostly of carbohydrate with some protein. Potent antigens to human

3) Capsule - Polysaccharide coating that surrounds cell wall & has antiphagocytic virulence. Visualize with indian ink stain.

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Superficial Fungal Infections symptoms & diagnosis

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Pityriasis Versicolor - aka Tinea Versicolor, caused by Malassezia furfur, is a chronic superficial fungal infection leading to hypopigmented or hyperpigmented skin. Infected skin will not tan.

2) Tinea nigra is caused Exophiala Werneckii, causes brown to black painless patches on palms & soles

Diagnose viascrapings mixed with KOH to reveal hyphae & sphearical yeast.

Front 48

Cutaneous fungal infections of skin, hair & nails virulence, organisms & diseases

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Dermatophytoses - category of cutaneous fungal infections that live in dead, horny layer of skins, hair & nails to secrete keratinase & digest. Common Dermatophytoses are Microsporum, trichophyton, epidermophyton.
1) Tinea corporis(Body) - Ring worm, with expanding red, raised border.
2) Tinea Cruris(Jock itch) - Itchy patches on groin & scrotum
3) Tinea Pedis(Athletes foot) - Begins between toes & cause cracking & peeling of skin
4) Tinea capitis (Scalp) - Primarily occurs in children resulting in scaly red lesions with loss of hair.
5) Tinea Unguium(onychomycosis, Nails) - Causes thickened, discolored, & brittle nails

Diagnose via branched hyphae in KOH solution & examine with Wood's light, certain species of microsporum will fluoresce green.

Candida Albicans - Can cause oral thrush, diaper rash, & Candida Vaginitis.

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Subcutaneous fungal infections transmission, Diseases

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- Gain entry to body following trauma to the skin. May stay local or spread to local nodes. Normally live in soil & have low virulence.

1) Sporothrix Schenckii - Dimorphic fungi commonly found in soil & plants like rose throns. Disease Sporotrichosis is occupational hazard for gardeners. Prick by thorn leaves nodule that necrotizes & ulcerates. Heals but new nodules pop up nearby lymphatic tracts up arm.

2) Phialophora & Cladosporium - Causes Chromoblastomycosis caused by coppor-colored saprophytes found on rotting wood.
- Transmission following puncture wound & small violet warlike lesion develops. Over months to yrs, more arise nearby resembling cauliflower.

Front 50

Systemic fungal infection organisms,

Back 50

Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis, Crytococcus neoformans, Candida albicans, Aspergillus flavis

Front 51

Histoplasma, Blastomyces, Coccidioides forms, location, transmission, disease, treatment

Back 51

Blastomyces dermatidis, Histoplasma capsulatum, coccidioides immitis. All 3 are dimorphic growing in mycelial forms & sending spores to grow as yeasts in humans.

Histoplasma & Blastomyces - Endemic to areas that drain in to Mississippi river while Coccidioides are endemic to Southwest, Arizona area.

All 3 have disease mechanism similar to TB
- Histoplasma capsulatum in bird & bat dropping spores, Blastomyces dermatitidis in soil & rotten wood, Coccidioids immitis in AIDS pts

-Unlike TB, never transmitted person to person
- Has coccidioidin & Histoplasmin like PPD.
-3 clinical presentations
1) Asymptomatic - Majority go unreported
2) Pneumonia - Mild pneumonia with fever, cough, & like TB, granulomas can form with calcification. Small percentage will develop severe pneumonia, weigh loss, fevers, like chronic TB pneumonia.
3) Disseminated - Can cause disseminated disease like meningitis, bone lytic granulomas, skin granulomas, & other organ lesions. Commonly occurs in immunocompromised pt.

- Best diagnosed by obtaining biopsy.
- Acute Histoplasma & Coccidioides don't need treatment while ALL Blastomyces require aggressive treatment

BBLS

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Cryptococcus Neoformans transmission, disease

Back 52

- Causes cryptococcosis which mainly affects AIDS pts.

- Found in pigeon droppings & inhaled.

- Instead of causing pneumonia it causes meningoencephalitis which leads to headache, nausea, confusion, staggering gait, fever & meningitis. Can be fatal. Also pneumonia, skin ulcers & bone lesions like other systemic fungi.

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Candida Albicans disease & diagnosis

Back 53

- Causes candidiasis that causes 3 cutaneous infections in normal hosts as well as additional systemic disease in immunocompromised pts.

Normal:
1) Oral thrush - creamy white exudate with reddish base over mucous membranes of mouth that are hard to scrape off.
2) Vaginitis - "yeast infection" - Develop candida vaginitis more frequently when taking antibiotics, BC pills, during PMS or pregnancy. Vaginal itching & discharge, with cottage cheese affixed to vaginal wall.
3) Diaper rash - warm moist areas like under diapers or between skin folds can become red after candida invasion.

Immunocompromised:
4) Esophagitis - extension of thrush into esophagus causing burning pain with swallowing
5) Disseminated - can invade blood stream & virtually every organ like eyes.

*Candida species is normal but never in blood, diagnose via KOH prep.

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Aspergillus Flavus

Back 54

- Causes Aspergillosis 3 types:
1) Allergic Broncho-Pulmonary Aspergillosis - Inhalation of aspergillus spores can cause this disease resulting in asthma-type reactions.
2) Aspergilloma - People with TB lung cavitations can form aspergillus fungal ball called aspergilloma
3) Invasive aspergillosis - usually occurs in immunocompromised pts characterized by fever, pneumonia & highly fatal.

Front 55

Mycotoxin & example

Back 55

Toxins produced by fungi that cause liver damage & liver cancer. Aspergillus flavis produce Aflatoxin.

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Fungal-like Bacteria

Back 56

Actinomyces & Nocardia, both are gram positive rods

Actinomyces Israelii - Normal flora in mouth & GI, but causes eroding abcesses following trauma to mouth or GI. Cervicofacial actinomycosis, abdominal actinomycosis, thoracic actinomycosus.

- Examination reveals yellow Sulfur Granules * not really composed of sulfur but actinomyces colonies & cellular debris.

Nocardia Asteroides - partially acid fast bacterial & causes same disease process as TB. Also prominent in immunocompromised pts.

* Only Actinomyces have sulfur granules & Only nocardia are acid fast