Actinomycosis/Osteomyelitis Flashcards
Stem:28 year old with crohn's, on steroids, presented by abscess on the face
Actinomycosis/Osteomyelitis
Stem:28 year old with crohn’s, on steroids, presented by abscess on the face
Mention 4 pathological tests to do on this patient?
Aspirate for c&s, FBC,Gram stain, blood culture
Aspirate showed green and grey discharge, what could it be?
Could be Actinomycosis, Staph aureus, Strept. pyogenes, Pseudomonas aeruginosa
Organisms causing actinmycosis?
Actinomyces israelii
What are the characters of actinomyces?
. Gram positive
. Filamentous and branching in shape resembles fungal hyphae
. Anaerobic or micraerophilic
. Slowly growing
. Non motile
. Produces sulfur granules
What causes yellow stains?
Actinomyces are noted for forming characteristic sulfur granules in infected tissue
What are the common sites of actinomyces?
They are normal constituents of the oral flora within gingival crevices and tonsillar crypts and are particularly prevalent in periodontal pockets, dental plaques, and on carious teeth. They might be normal colonizer of the colon and vagina.
What is the treatment of actinomycosis?
The antimicrobial of choice is still penicillin, because Actinomyces species are not known to be resistant to penicillin. Other acceptable alternatives include clindamycin, doxycycline, or erythromycin.
If developped a facial sinus, what would be the treatment?
Surgical debridement +- reconstruction
What else could cause OM of the mandible?
Odontogenic Infection,fractures, H&N radiation, immunodefeciency, Bisphosphonates therapy, DM, FB
What happens if abscess is left untreated?
· Complete resolution
. Healing by connective tissue replacement (scarring, or fibrosis)
. Chronic inflammation
Complications of chronic abscess?
. Fistulation or sinus formation
. Chronic ulcer
· Amylodosis
. Malignant transformation
Why RA patients are at more risk of developing infection?
Individuals must be maintained on anti-TNF therapy to avoid disease flares.This long-term treatment with anti-TNF agents predisposes individuals to infection with opportunistic organisms such as M tuberculosis.
What are biofilms?
A viscous layer of extracellular polysaccharides adheres to host tissues or devices like intravascular catheters and artificial joints. This biofilm enhances bacterial virulence by protecting microbes from immune responses and increasing resistance to antimicrobials.
Types of cells in acute and chronic inflammation?
In acute inflammation: Neutrophils, mononuclear cells
In chronic inflammton: Mononuclear cells(moncytes, macrophages,lymphcyes,, plasma cells) and fibroplasts
How to reduce infection intraoperatively?
Preoperative measures:
. Optimizing underlying medical conditions
. Antibiotic prophylaxis
. Skin preparation
. Hair removal
Intraoperative measures:
· Strict sterile technique:
. Minimizing surgical time and blood loss Minimize theatre traffic
. Use of laminar flow which is a ventilation system designed to provide continuous flow of filtered air over the operating table to decrease SSI
