Chapter 158 - Actinomycosis, nocardiosis, Actinomycetoma

Question 1

Actinomyces is ___ and part of our nirmal (3)

Answer 1

Anaerobic
Respiratory
Intestinal
Genitourinary

Question 2

Clumping of filamentous bacteria seen in infected living tissue often characteristic but not specific

Answer 2

Sulfur granule/grain

Question 3

Most common causative agent of actinomycosis

Answer 3

A. Israelii

Question 4

Actinomycosis is commonly seen in ___, ages ___ except for GU actinomycosis

Answer 4

Males, 20-60 years old

Question 5

Actinomycosis should be suspected when dealing with 1 out of 3 features:

Answer 5

1. Mass like inflammatory infiltrate of skin and subQ
2. Sinus formation with drainage
3. Relapsing or refractory clinica course after short therapy with antibiotics

Question 6

Arrange from most frequent to less frequent:
Cervicofacial
Thoracic
abdominal

Answer 6

Cervicofacial 55%
Abdominal 20%
Thoracic 15-20%

Question 7

MC sites of cervicofacial actinomycosis (3)

Answer 7

1. Jaw angle, high cervical area (60%)
2. Cheek (16%)
3. Chin (13%)
   Rare: TMJ, retromandibular

Question 8

Bone involvement is ___% in cervicofacial actinomycosis

Answer 8

10

Question 9

Up to 26% will have chest wall involvement in thoracic actinomycosis termed as

Answer 9

Empyema necessitans

Question 10

In 65% of abdominal actinomycosis, there is precipitating (2)

Answer 10

Appendicitis

Diverticulitis

Question 11

IUd use longer than ___ years is considered a risk factor for Gu actinomycosis

Answer 11

2

Question 12

Grains are commonly seen in this particular form of actinomycosis

Answer 12

Punch/Fist actinomycosis

Question 13

In thoracic disease __ seems to predominate

Answer 13

A. Graevenitzii

Question 14

True granuloma formation is common in actinomycosis.

True or False

Answer 14

False, rare

Question 15

Best material for culture (3)

Answer 15

Purulent drainage
Tissue
Microscopic granules
nOT swav

Question 16

Culture media of actinomycosis

Answer 16

Thioglycolate w/ 0.5 sterile rabbit serum at 35 C for 14 days

Question 17

Stains for actinomycosis (4)

Answer 17

Brown Brenn
Gram
Giemsa
Gomori

Question 18

Rim of eosinophilic material surrounding granules in tissue

Answer 18

Splendore Hoepplie phenomenon

Question 19

Nocardia cannot be stained with Fite

True or False

Answer 19

False, actinomyces

Question 20

Eumycetoma granules stain positive with (2)

Answer 20

PAS

Gomori

Question 21

Treatment for actinomyces

Answer 21

PenG 18-24 M units IV for
30 days if cervicofacial
3 mos for pelvic or thoracic

Question 22

Risk factors for relapse or death (3)

Answer 22

Duration longer than 2 months
Lack of antibiotic therapy or surgery
Needle aspiration rather than open drainage or excision

Question 23

In nocardia, ___ infection is seen in immunocompetent and __ in immunocompromised.

Answer 23

Cutaneous

Pulmonary

Question 24

Primary skin disease is most commonly caused by ___; hematogenous dissemination by ____

Answer 24

N. Brasiliensis

N. Asteroides

Question 25

Nocardiosis occurs most commonly in __, presenting as __ most commonly

Answer 25

Males; pulmonary disease >> skin

Question 26

MC form of cutaneous Nocardia infections

Answer 26

Sporotrichoid or lymphocutaneous forma

Question 27

Cellulitis form most commonly affects ___ while sporotrichoid form affects ___

Answer 27

LE | UE

Question 28

__ forms are able to survive inside macrophages due ti inhibition of phagosome lysosome in vitro

Answer 28

L

Question 29

Presence of (2) in Nocardia relates to virulence

Answer 29

Superoxide dismutase | Complex cell wall glycolipid

Question 30

Nocardia sps with high degree of resistance to 3rd gen cephalosporins

Answer 30

N. Farcinica

Question 31

High degree of dissemination amongst Nocardia sp

Answer 31

N. Pseudobrasiliensis

Question 32

Definitive diagnosis of Nocardia

Answer 32

Isolation of sp. in culture

Question 33

Pretreatment of Nocardia specimens with low pH ___ for 4 mins is required

Answer 33

KCl-HCl

Question 34

Matching type 1. N. Asteroides 2. N. Brasiliensis 3. N. Otitidiscavarum A. Salmon pink to orange B. Orange C. Pale

Answer 34

A B C

Question 35

Gold standard for ID of Nocardia sp

Answer 35

RNA sequencing on 16S rRNA

Question 36

Cornerstone of Tx for Nocardia except N. Otitidiscavarum

Answer 36

TMP SMX | (5-10mkday + 25-50mkday) BID-QID

Question 37

In America, MC etiology of actinomycetoma is

Answer 37

Nocardia brasiliensis

Question 38

Mycetoma triad (3)

Answer 38

Painless subQ mass Sinus formation Seropurulent discharge with grains

Question 39

Actinomycetoma mainly affects ___age ranging from ___ mc involving

Answer 39

M, 21-40 years old, LE

Question 40

Actinomycetoma caused by N. Brasiliensis is a very inflammatory process characterized by tumor like soft tissue swelling, deformity, and discharging sinus tracts with communicating channels that exudate pus (97%)

Answer 40

Tumefaction

Question 41

MC etiology of women with plantar involvement

Answer 41

A. Madurae

Question 42

Actiomycetoma without sinus tracts

Answer 42

Cryptic mycetoma

Question 43

Actinomycetoma characterized by Single or multiple small lesions observed mainly in children

Answer 43

Minimycetoma

Question 44

Risk factor for actinomycetoma

Answer 44

Walking barefoot in areas of high prevalence

Question 45

Purple granules with a cartographic shape and eosinophilic fringe are seen in

Answer 45

Actinomyces madurae