pathology practical actinomycosis and maduramycosis 22 07-2014
TRANSCRIPT
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Actinomycosis
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• A. Israelii – the commonest• A .Meyeri• A.Naeslundii• A.Odontolyticus• A. Viscosus
Actinomycosis
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ACTINOMYCOSISNot highly virulent (Opportunist)– Component of Oral Flora• Periodontal pockets• Dental plaque• Tonsilar crypts
– Take advantage of injury to penetrate mucosal barriers• Coincident infection• Trauma• Surgery
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PEOPLE AT RISK WITH ACTINOMYCOSIS • Having a dental disease or recent dental surgery (for
jaw abscess)• Aspiration (liquids or solids are sucked into lungs)
(for lung abscess)• Having bowel surgery (for abdominal abscess)• For women: having an intrauterine contraceptive
device (IUD) in place for many years (for abscess affecting the reproductive organs)
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Cervicofacial Actinomycosis • This is the most common and recognized
presentation of the disease.• Actinomyces species are commonly present in
high concentrations in tonsillar crypts and gingivodental crevices.
• Many patients have a history of poor dentition, oral surgery or dental procedures, or trauma to the oral cavity.
• Chronic tonsillitis, mastoiditis, and otitis are also important risk factors for actinomycosis.
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Infection Cervicofacial region
• Periostitis or osteomyelitis can develop if the infection extends to facial and maxillary bones.
• The mandible appears to be one of the most common osteomyelitis sites.
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Abdominal Actinomycosis
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Examination of discharges will help in diagnosis
• Examination of drained fluid under a microscope shows "sulphur granules" in the fluid. They are yellowish granules made of clumped organisms
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Dr.T.V.Rao MD 12
Typical appearance of histopathological examination with special stains
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• The smears revealed radiating filamentous colonies of Actinomyces in a background of neutrophilic exudates;
• PAS stain also showed Actinomyces colonies.
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Mycetoma • Mycetoma is a chronic subcutaneous
infection caused by actinomycetes or fungi. • This infection results in a
granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone.
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Mycetoma • Mycetoma is characterized by the
formation of grains containing aggregates of the causative organisms that may be discharged onto the skin surface through multiple sinuses.
• Mycetoma was first described in the mid 1800s and initially named Madura foot, after the region of Madura in India where the disease was first identified.
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•
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• Slow spreading skin infection • Local swelling • Small hard painless nodules • Ulceration • Pus discharge • Sinuses • Scarred skin & discolouration • Itching • Pain & Burning sensation if superinfected
Clinical features
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• Direct microscopy: • Blood- Leukocytosis & neutrophilia• Culture of exudates • Skin biopsy• Serology.
DIAGNOSIS.
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Excised mycetoma showing a draining sinus(cut open in this preparation) containing black grains.
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H&E stainskin biopsy
H&E stained tissue section showing blacked grained eumycotic mycetoma caused by Madurella mycetomatis.
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• Granulomatous Inflammation With Abscess Formation.
• A Central Zone Exists Where Polymorphonuclear Cells Are Abundant And Granules Or Grains Are Found.
• This Central Zone Is Surrounded By Lymphocytes, Plasma Cells, Histiocytes, And Fibroblasts.
Histopathological Findings
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