• Actinomyces israelii
-Gram-positive, non-acid-fast, filamentous organism that usually shows branching and may break up into short bacterial forms
-Anaerobe, part of the normal flora of the human oropharynx and upper intestinal tract
• Chronic, slowly progressive infection that may involve many tissues, resulting in the formation of granulomas and abscesses that drain through sinuses and fistulas
• Lesions resemble those produced by mycobacteria, fungi, and cancer, although the causative organisms are bacteria
• Sinus tracts or fistulas usually become secondarily infected with other bacteria
• Abdominal infection may produce an abdominal mass mimicking a malignant process or may give rise to appendicitis
• Nocardiae are gram-positive, aerobic, branching, filamentous organisms that may be acid-fast
• Nocardia asteroides is the most common isolate
• May present in 2 forms:
1. Localized, chronic granuloma with suppuration, abscess, and sinus tract formation resembling actinomycosis
2. Systemic infection, usually beginning as pneumonitis with suppuration and progressing via the bloodstream to involvement of other organs
• Inflammatory nodular masses, abscesses, and draining sinuses occur most commonly in the head and neck (50%)
• 20% of patients have primary lesions in the chest and an equal proportion in the abdomen, most commonly involving the appendix and cecum
• Pelvic actinomycosis can occur in women with prolonged use of an intrauterine device
• More apt to occur as a complication of immunodeficiency in patients with chronic obstructive pulmonary disease, cancer, HIV-associated disease, or corticosteroid-induced immunosuppression
• Multiple draining sinuses with pus containing "sulfur granules"
• Lesions are often hard and relatively painless and nontender
• Systemic symptoms, including fever, are variably present
• Abdominal actinomycosis may mimic appendicitis
• Thoracic actinomycosis may give rise to cough, pleural pain, fever, and weight loss
• Culture reveals gram-positive branching rods, with sulfur granules
• Organisms may be identified by immunofluoresence
• Complete history and physical exam
• Culture draining sinus tracts
• CT scanning and needle aspiration may be helpful diagnostically
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