Actinomyces

CASE 1

• A 29 year old man has recurrent drainage from a small open sore anterior to his right ear. He has experienced swelling, tenderness, and drainage from the right side of his face and jaw since the extraction of a painful, upper molar 2 months earlier.

• The patient has been covering the draining site with a gauze bandage when it drains and he has noted that the draining pus contains firm flecks of yellow material that resemble “sulphur granules.” However, when one of the granules is stained (blue) and examined microscopically, it is observed to be composed of a mass of branching, slender Gram-positive bacteria, consistent with Actinomyces spp.

Questions:

1. Where did this organism come from? Was the patient colonized with the organism? If yes, where?
2. What was the source of the bacteria that eventually spread through soft tissues and out through intact skin?
3. What special conditions would be required to grow this bacterium in culture of the drainage?
4. Actinomyces spp. are susceptible to which class of antibiotics?
5. How long should this patient be treated with an antibiotic in order to cure this infection?

CASE 2

• A 66 year old woman has chronic pain in the right lower quadrant of her abdomen. Initially, she had low grade fever, but this largely resolved after she was given a course of ciprofloxacin.

• Three weeks after the onset of the pain and the antibiotic treatment, she developed redness and swelling of the abdominal skin over the right lower quadrant. Shortly thereafter, a papule in the center of this swollen area erupted and began draining pus with “sulphur granules”.

• An ultrasound examination of the lower abdomen revealed a 6cm periappendyceal fluid collection.

Questions:

1. What features of Actinomyces infection in this case is reminiscent of Case #1?
2. How should this patient be treated? For how long?