Clinical Background
Actinomycosis and nocardiosis are often considered when patients develop granulomatous diseases.
Epidemiology
- Incidence
- Actinomycosis - 1-2/300,000
- Nocardiosis - <1/300,000
- Age
- Actinomycosis - peak 40-60 years
- Nocardiosis - all ages
- Sex
- Actinomycosis - M>F
- Nocardiosis - M:F;3:1
- Transmission
- Actinomycosis
- Mucosal barrier disruption with contiguous spread
- Inhalation of aspirated material
- Nocardiosis - inhalation or direct inoculation (eg, penetrating injury)
Organisms
- Actinomyces
- Actinomyces is a facultative anaerobe
- Gram-positive
- Non-spore forming
- Commensal of the human oropharynx gastrointestinal tract and female genitalia
- Disease mainly caused by A. israelii
- Infection may be associated with IUD use
- Most infections are polymicrobial
- Nocardia
- Genus of aerobic actinomycetes
- Aerobic, gram-positive
- Weakly acid-fast
- Soil saprophytes
- Disease mainly caused by N. asteroides complex
Risk Factors
- Actinomycosis
- Alcoholism
- Poor oral hygiene
- Pulmonary form - emphysema, chronic bronchitis, bronchiectasis
- Nocardiosis
- Alcoholism
- Diabetes mellitus
- HIV
- Immunocompromised state - particularly solid organ transplant patients
- Trauma
Clinical Presentation
- Actinomyces
- Most frequent location - oral-cervicofacial
- Soft tissue swelling, abscess or mass lesion
- Most common in premandibular region
- Sinus tracts occur frequently
- Thoracic disease
- Slowly progressive pneumonia
- Abdominal disease
- Appendicitis, perirectal disease, hepatitis, pelvic disease
- Nocardia
- Predominantly causes pneumonia
- Irregular nodular disease
- May progress to cavities
- Disseminated disease commonly occurs
- Cerebral abscesses occur in approximately 30% of patients with pulmonary disease
- Skin and soft tissue infections, lymphadentitis
- Usually resulting from trauma
- Bacteremia
- Peritonitis
- Usually peritoneal dialysis catheter related
See Also
Diagnosis
Diagnosis
- Laboratory testing
- Actinomyces
- Culture from infected site - specimen must be collected and transported under anaerobic conditions
- Occasionally sulphur granules are noted in infected material on histopathology
- Nocardia
- Gram stain and modified acid-fast stain of sputum or infected material
- Culture from infected site
Differential Diagnosis
- Pulmonary manifestations
- Mycobacteria
- Lung abscess
- Lung cancer
- Aspergillus
- Cryptococcus
- Rhodococcusequi (formerly Corynebacteriumeqwi)
- Cervical-facial manifestations
- Neoplasm
- Tonsillitis
- Other odontogenic infections
Tests generally appear in the order most useful for common clinical situations
| Test name: Acid Fast Stain, Partial or Modified (for Nocardia sp.)
|
| ARUP #: 0060325 |
| Methodology: Stain/Microscopic Exam
|
| Use: Presumptive identification of some actinomycetes (Nocardia and Gordonia spp, etc.) |
| Test name: Nocardia Culture (Includes Gram stain 0060101)
|
| ARUP #: 0060093 |
| Methodology: Bacterial Culture
|
| Use: Includes Gram stain
Diagnose nocardia infection |
| Follow-up: Identification determined by 16S rRNA gene sequencing |
| Test name: Anaerobe Culture (Includes Gram Stain 0060101)
|
| ARUP #: 0060143 |
| Methodology: Standard reference procedures for bacterial stain, anaerobic culture and identification
|
| Use: Includes Gram stain
Diagnose actinomycoses infection |
References
General References
Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev.
2006;
19(
2):
259-282.
Conant EF, Wechsler RJ. Actinomycosis and nocardiosis of the lung. J Thorac Imaging.
1992;
7(
4):
75-84.
Warren NG. Actinomycosis, nocardiosis, and actinomycetoma. Dermatol Clin.
1996;
14(
1):
85-95.
Yildiz O, Doganay M. Actinomycoses and Nocardia pulmonary infections. Curr Opin Pulm Med.
2006;
12(
3):
228-234.
Nocardia infections. Am J Transplant.
2004;
4 Suppl 10:
47-50.
References from the ARUP Institute for Clinical and Experimental Pathology Research®
Cloud JL, Conville PS, Croft A, Harmsen D, Witebsky FG, Carroll KC. Evaluation of partial 16S ribosomal DNA sequencing for identification of nocardia species by using the MicroSeq 500 system with an expanded database. J Clin Microbiol.
2004;
42(
2):
578-584.
Dunn JJ, Malan AK, Evans J, Litwin CM. Rapid detection of Mycoplasma pneumoniae IgM antibodies in pediatric patients using ImmunoCard Mycoplasma compared to conventional enzyme immunoassays. Eur J Clin Microbiol Infect Dis.
2004;
23(
5):
412-414.
Medical Reviewers
Carney, Heather, M.D. Assistant Medical Director, Transfusion Services at ARUP Laboratories; Pathology, University of Utah
Petti, Cathy A., M.D. Medical Director, Infectious Diseases at ARUP Laboratories; Assistant Professor, Pathology and Medicine, University of Utah
Comprehensive Review: July 2008
Last Update: July 2008
