Actinomycetes

MUHAMMAD ASIF
M.Sc., MPhil (Microbiology)
PhD Scholar (Microbiology)

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 Lecture Objectives

At the end of the lecture students will be able to:

• Understand the general characteristics of Actinomycetes.

• Comparison of the medically important Actinomycetes species.

• Describe the characteristics, mode of transmission, pathogenesis,

clinical symptoms, and laboratory identification of Actinomycetes
israelii and Nocardia asteroids.

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Introduction
Actinomycetes are a family of bacteria
that form long, branching filaments
that resemble the hyphae of fungi.

They are gram-positive, but some of

them are also weakly acid-fast rods,
such as Nocardia asteroides.

There are two medically important

organisms, Actinomyces israelii and
Nocardia asteroides.

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Important species

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ACTINOMYCES ISRAELII
Disease:
• A. israelii causes actinomycosis.
Important Properties & Pathogenesis:

• A. israelii is an anaerobe that forms part of the

normal flora of the oral cavity.

• After local trauma such as a broken jaw or dental

extraction, may invade tissues, forming filaments
surrounded by areas of inflammation.

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• Hard, yellow granules

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(sulfur granules)
composed of a mass of
filaments are formed in
pus.

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 Clinical findings

• Actinomycosis appears as a
hard, non-tender swelling that
develops slowly and eventually
drains pus through sinus tracts.

• In about 50% of cases, the

initial lesion occurs on the face,
head, and neck, while the rest
occurs on the chest or
abdomen.

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• Pelvic actinomycosis can occur
in women who have retained an
intrauterine device for a long
period of time.

• A. israelii and Arachnia species

are the most common causes of
actinomycosis in humans.

• The disease is not

communicable.

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Laboratory diagnosis

Microscopy:

• Microscopic examination of clinical specimens

is crucial in the initial assessment.

• Sample types include pus, tissue biopsy, or

aspirates from the affected area.

• The presence of sulfur granules is indicative of

gram-positive branching rods.

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• Sulfur granules are yellow aggregates
of bacteria that are often found in the
pus of actinomycosis infections.

• To confirm the presence of

Actinomyces israelii, sulfur granules
can be crushed and stained with
Gram stain.

• This will reveal the characteristic

branching filaments of the bacteria.
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Culturing
• Actinomyces are strict anaerobes, meaning they require an
oxygen-free environment to grow.

• Specimens should be processed using anaerobic conditions

at 35-37°C for up to 14 days.

• For culture, washed and crushed granules are inoculated

on blood agar or brain–heart infusion agar and into
enriched thioglycolate broth and incubated anaerobically at
37°C.

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• Thioglycollate broth: The
growth of A. israelii looks
like fluffy balls at the
bottom of the tube after 7
days of anaerobic
incubation.

• Blood agar: A. israelii

produces a large, white,
smooth resembling molar
tooth after 10 days of
anaerobic incubation.
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NOCARDIA ASTEROIDES

Disease:

• N. asteroides causes nocardiosis.

Important Properties & Pathogenesis:

• Nocardia species are aerobes and are found in

the environment, particularly in the soil.

• In immunocompromised individuals, they can

produce lung infection and may disseminate.
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 • In tissues, Nocardia species are thin,
branching filaments that are gram-
positive on Gram stain.

• Many isolates of N. asteroides are

weakly acid-fast; i.e., the staining
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process uses a weaker solution of 1%
Sulfuric acid than that used in the stain
for mycobacteria.

• If regular-strength acid is used, they

are not acid-fast.

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Clinical findings

• The most common symptoms of N. asteroides

are pneumonia, a lung abscess with cavity
formation, nodules on the lungs, or empyema.

• The organism can spread from the lung to

various organs, including the brain, where it
can cause brain abscesses.

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• Disease occurs most often in
immunocompromised individuals,

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especially those with reduced cell-
mediated immunity.

• Nocardia brasiliensis, a different

species of Nocardia, causes

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mycetoma foot, usually in tropical
regions.

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Laboratory diagnosis

Microscopy:

• Acid-Fast Staining: Microscopic examination

of clinical samples, such as sputum, pus, or
tissue, can be performed using acid-fast
staining. This technique reveals the
characteristic morphology of Nocardia.

• Characteristic Structures: Branching rods or

filaments that are gram-positive or weakly
acid-fast.
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Culturing
• Nocardia asteroides can be cultured on various types
of media, such as:

• Blood Agar: Cultures on blood agar may show

chalky, dry, and wrinkled colonies.

• Sabouraud Dextrose Agar: Often used for

fungal cultures, this medium can also support
Nocardia growth.

• Lowenstein-Jensen Medium: Specifically used

for the culture of mycobacteria but can also be
used for Nocardia.
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• Morphology: Colonies of Nocardia asteroides on these media can
vary in appearance.

• They are usually white to cream-colored and may have a powdery or

chalky texture.

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 THANK YOU
Muhammadasif.4596@duhs.edu.pk

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