Infected total knee arthroplasty due to Actinomyces naeslundii.
A case of a total knee arthroplasty infection with Actinomyces naeslundii is described. The difficulties of therapeutic decision-making are emphasized.
Actinomyces↗
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Actinomyces associated with persistent vaginal granulation tissue.
BACKGROUND: We report a case of symptomatic actinomycosis associated with vaginal suture erosion and granulation tissue refractory to conservative management, in an outpatient setting. CASE: Three months after total vaginal hysterectomy and uterosacral ligament vaginal vault suspension, a woman complained of painless, intermittent vaginal discharge and spotting. Despite cauterization of granulation tissue, vaginal spotting persisted for another month. On re-examination, braided polyester suture that was found underlying the granulation tissue was removed. Recurrent symptoms, together with a biopsy revealing actinomycetes, prompted a trial of oral penicillin VK. With persistent symptoms and discomfort during attempts in the outpatient clinic, the woman eventually required suture removal in the operating room. Her symptoms subsequently resolved without recurrence, and no further antibiotic treatment was required. CONCLUSIONS: Actinomyces may be associated with persistent granulation tissue and vault suspension suture material. In rare circumstances, when tissue debridement and suture removal in the clinic is unsatisfactory, surgical intervention in the operating room may be necessary. Ten days of antibiotic therapy alone did not eradicate the granulation tissue, and symptoms resolved only after complete removal of the underlying permanent suture.
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Production and characterization of species-specific monoclonal antibodies against Actinomyces naeslundii and Lactobacillus casei.
Dental caries is a disease induced by a few cariogenic bacterial species. Quantitative detection of these cariogenic bacteria could provide useful information for caries risk assessment. In this study, we developed highly species-specific monoclonal antibodies (MAbs) against the type strains of Actinomyces naeslundii ATCC 12104 and Lactobacillus casei ATCC 11578. Assayed with immunoprecipitation and immunofluorescent microscopy, these antibodies showed high sensitivities and specificities in detecting A. naeslundii and L. casei in saliva. Examining 100 saliva samples using these MAb-based techniques, we found that the number of A. naeslundii in saliva ranges from 0.5 x 10(4) to 4.8 x 10(5) and that the number of L. casei in saliva ranges from 1 x 10(4) to 1.2 x 10(6). With fluorescent imaging techniques and confocal laser scanning microscopy (CLSM), these antibodies were used to visualize A. naeslundii and L. casei within dental plaques derived from stimulated whole human saliva in vitro. The study demonstrated that these MAbs were also able to effectively detect A. naeslundii and L. casei in plaque.
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Pyogenic liver abscess involving Actinomyces: case report and review.
We report a case of isolated hepatic actinomycosis and review 35 previously reported cases. Three-fourths of the reported patients were male, and more than one-half were between 30 and 50 years of age. Although some patients had oral disease or intraabdominal infections, the majority of cases were cryptogenic. Common presenting symptoms included fever, abdominal pain, and anorexia with weight loss. Findings on physical examination included pyrexia, abdominal tenderness, and hepatomegaly. Leukocytosis with a left shift, anemia, an elevated serum erythrocyte sedimentation rate, and an elevated level of alkaline phosphatase were almost universally present. Diagnosis was frequently made at the time of exploratory laparotomy, but percutaneous diagnostic procedures obviated the need for surgery in many recent cases. Microbiological diagnosis involved visualization of branching gram-positive Actinomyces organisms or recovery of organisms in anaerobic culture. Treatment most commonly consisted of prolonged administration of penicillin or tetracycline and was associated with an excellent outcome in the majority of cases.
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Sclerosing osteomyelitis and Actinomyces naeslundii infection of surrounding tissues.
We present the case of a young man with chronic Actinomyces naeslundii infection in the lower leg who underwent a below-the-knee amputation after unsuccessful attempts at diagnosing and eradicating the infection. Actinomycetic organisms from environmental sources can engender a dense fibrotic tissue response without fistulae. Such a response led to a painful, sclerosing, nonsuppurative infection of the bone and surrounding tissues in our patient. This clinical picture, at least the bony and periosteal reaction, was compatible with Garrè's osteomyelitis.
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Disseminated Actinomyces meyeri infection resembling lung cancer with brain metastases.
Thoracic actinomycosis can resemble bronchogenic carcinoma in its clinical presentation and radiographic appearance. We report a case of pulmonary actinomycosis caused by Actinomyces meyeri in which hematogenous dissemination caused multiple brain abscesses resembling metastatic lung cancer. The correct diagnosis was made by thin-needle aspiration of a pleura-based lung mass. The pathogen isolated was further identified with the use of 16S rDNA sequencing. Antibiotic therapy resulted in rapid improvement of the lung lesion; however, the brain lesions required surgical drainage. Antibiotics were continued for more than a year before magnetic resonance images showed complete resolution of the cerebral abscesses.
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Course of infection and case outcome in individuals diagnosed with microbial colonies morphologically consistent with Actinomyces species.
Actinomycosis is considered to be a rare disease in the oral region. A retrospective study of files of the University of Nebraska Medical Center College of Dentistry, Department of Pathology, revealed 30 cases in which Actinomyces species were detected from the years 1982 to 2001 (28,490 specimens). Biopsy submission forms and patient records were reviewed in each of these cases with particular attention to clinical impression, subsequent treatment, and case outcome. Classic treatment for actinomycosis involves the excision of the affected area as well as long-term antibiotics. Our study indicates that antibiotics may not be necessary in treatment of the localized dental presentation of actinomycosis.
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A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man.
Actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.
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Expression of trypsin-like activity by the genera Corynebacterium and Actinomyces in canine periodontitis.
Trypsin-like activity (TLA), clinical parameters and TLA-positive bacteria were examined in periodontitis and healthy sites in dogs. TLA was markedly higher in periodontitis than at healthy sites. There was good correlation between TLA positivity and severity of periodontal disease. The proportions of TLA-positive bacteria to total isolates in periodontitis and healthy sites were 21.1% and 2.1%, respectively. Among TLA-positive bacteria in periodontitis sites, 4.4% showed strong TLA activity, 35.3% showed moderate and 60.3% showed weak activity. In the healthy sites, all the TLA-positive bacteria showed weak activity. In all, 90% of the total number of TLA-positive bacteria were identified as belonging to the family Actinomycetaceae; 40% of bacteria belonging to the family Actinomycetaceae were identified as genus Corynebacterium with moderate trypsin-like activity and the remaining 60% were identified as genus Actinomyces with weak activity. Obligately anaerobic bacteria accounted for only 5.9% of the total population of TLA-positive bacteria; they were gram-negative coccobacilli, gram-positive rods and gram-positive cocci. These observations suggested that bacteria in the family Actinomycetaceae may play an important role in periodontitis and that measurement of TLA is a clinically reliable marker for the diagnosis of periodontitis in dogs.
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Kinetics of adherence of Actinomyces viscosus to saliva-coated silica and hydroxyapatite beads.
Adherence of 14C-labelled strains of Actinomyces viscosus to uncoated and saliva-coated silica and hydroxyapatite beads had both loose and firm components, probably reflecting different subpopulations of bacteria within a single culture. Adherence was characterized by the proportion of bacteria available for each type of adherence and a constant (Kb) for each combination of bacterial strain and bead surface. Loose adherence, which was greater with silica than with hydroxyapatite beads, always involved many more bacteria than firm adherence. Firm adherence was greater with A. viscosus WVU627 than A. viscosus TF11. The association rate constants (Ka) for loose and firm adherence were similar, indicating simultaneous processes, but the dissociation rate constant (Kd) was lower for loose adherence than for firm adherence. Removal of loosely adhering bacteria by washing may only reflect their distance from the bead surface. Silica beads were convenient for studying bacterial adherence and formed an acceptable coating of salivary glycoprotein.
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A possible mechanism for the cellular coaggregation between Actinomyces viscosus ATCC 19246 and Streptococcus sanguis ATCC 10557.
The cells of Actinomyces viscosus ATCC 19246 (Av19246) and Streptococcus sanguis ATCC 10557 (Ss10557) coaggregated immediately after mixing in 40 mM-Tris/HCl buffer. Optimal conditions were pH 7.5 in the presence of Ca2+ at 0.1 mM or higher. Na2 EDTA and its analogues, Na2MgEDTA and Na2MnEDTA at 7.5 mM inhibited the coaggregation. Trypsin and heat treatment impaired the reactive site on Av19246 cells, but not on Ss10557 cells. The coaggregates, once formed, dissociated gradually during extended incubation at 37 degrees C; this was prevented by addition of sufficient Ca2+. The disaggregation appears to be a spontaneous denaturation of the proteinaceous reactive site on Av19246 cell surface. Thus, the coaggregation involves the interaction of a lectin-like substance on the surface of Av19246 with a carbohydrate site on Ss10557. Native Ss10557 cell walls possessed reactivity with Av19246 cells but 5% (w/v) TCA-extracted cell wall residues did not. A carbohydrate moiety extracted from Ss10557 exhibited a high potency in blocking coaggregation, and coaggregates were dissociated upon addition of the carbohydrate. Lactose, galactose and N-acetyl-D-galactosamine (the latter two are major constituents of the antigen extract) also significantly inhibited the coaggregation, but the other antigen components, glucose and rhamnose, did not. Relative inhibitory activity, expressed as molar potency, of carbohydrate antigen, lactose, galactose and N-acetyl-D-galactosamine respectively, was approximately 26 X 10(3):16:4:1. Ss10557 cells and cell walls reacted only with a Ricinus communis (castor bean) agglutinin-120 but not with Glycine max (soybean) agglutinin, Arachis hypogaea (peanut) agglutinin or Phaseolus vulgaris agglutinin (phytohaemagglutinin).(ABSTRACT TRUNCATED AT 250 WORDS)
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Langmuir and scatchard parameters do not describe the binding of Actinomyces viscosus to saliva-treated hydroxyapatite.
The binding of Actinomyces viscosus T14V to saliva-treated spheroidal hydroxyapatite (SHA) beads was studied. The association constant (K) and the total number of binding sites (N) obtained from the Langmuir plots were in good agreement with those reported by other workers (approx. 3 X 10(-8) and 3 X 10(8), respectively). The values for N obtained from Scatchard plots differed from those obtained from Langmuir plots by factors of 10(6) or more. These results suggest that either these equations are inappropriate to describe binding or certain assumptions regarding this system are not being met. The use of these models requires, among other constraints, that the process be reversible and that measurements be taken at equilibrium. A method was developed which allowed a close examination of the equilibrium dynamics without perturbation of the system. The results suggest that the adsorption process is only poorly reversible. Adsorption to SHA was not at equilibrium after 1.5 h. Even when bacteria were allowed to adsorb for longer periods, and the system appeared to approach equilibrium, the increased time of adherence did not significantly alter the derived K or N values. Our results suggest that the use of Scatchard and Langmuir plots is inappropriate to describe binding of A. viscosus to SHA.
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Surface localization of sialic acid on Actinomyces viscosus.
This study reports the presence of sialic acid in Actinomyces viscosus strains T14V and T14AV. Mild acid hydrolysis of whole organisms released a compound which reacted positively in the periodate-thiobarbituric acid, direct Ehrlich's and resorcinol assays, and which co-chromatographed on paper with authentic N-acetylneuraminic acid. Strain T14V contained 10-fold greater concentrations of sialic acid than did strain T14AV. Sialic acid content was dependent upon the stage of growth of the culture, reaching a maximum in early stationary phase. Epifluorescence microscopy of fluorescein isothiocyanate (FITC)-conjugated Limulus polyphemus agglutinin (LPA), a lectin specific for sialic acid, revealed a uniform distribution of bound lectin on the surfaces of strains T14V and T14AV. Additional evidence for surface localization was obtained by demonstration of whole-cell agglutination of both strains with LPA. All LPA interactions with A. viscosus were inhibited by the presence of 0.1 M-N-acetylneuraminic acid. Neuraminidases from Clostridium perfringens, Arthrobacter ureafaciens and Vibrio cholerae did not release detectable amounts of sialic acid, but the extracellular enzyme from A. viscosus cleaved amounts equivalent to those obtained by acid hydrolysis. Other laboratory strains (W1053, M100, W859, 5-5S, RC45, ATCC 19246, and 'binder') as well as recent clinical isolates of A. viscosus were agglutinated by LPA and released sialic acid upon mild acid hydrolysis. Surface-available sialic acid has been implicated in the inhibition of alternative complement pathway activation and subsequent opsonophagocytosis. Thus the occurrence of surface sialic acid in A. viscosus may represent a mechanism of pathogenesis for this oral bacterium.
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Immunochemical and functional studies of Actinomyces viscosus T14V type 1 fimbriae with monoclonal and polyclonal antibodies directed against the fimbrial subunit.
Each of five monoclonal antibodies (mAbs) prepared against the type 1 fimbriae of Actinomyces viscosus T14V reacted with a 54 kDa cloned protein previously identified as a fimbrial subunit. This purified protein completely inhibited the reaction of a specific anti-type-1-fimbria rabbit antibody with A. viscosus whole cells. Maximum values for the number of antibody molecules bound per bacterial cell ranged from 7 x 10(3) to 1.2 x 10(4) for the different 125I-labelled mAbs and was approximately 7 x 10(4) for 125I-labelled rabbit IgG or Fab against either type 1 fimbriae or the 54 kDa cloned protein. Although the different mAbs, either individually or as a mixture, failed to inhibit the type-1-fimbria-mediated adherence of A. viscosus T14V to saliva-treated hydroxyapatite, each rabbit antibody gave 50% inhibition of adherence when approximately 5 x 10(4) molecules of IgG were bound per cell. However, binding of each corresponding rabbit Fab had no significant effect on bacterial attachment unless much higher concentrations were used. These findings suggest that antibodies directed solely against the 54 kDa fimbrial subunit do not react with the putative receptor binding sites of A. viscosus T14V type 1 fimbriae. Instead, inhibition of attachment by the polyclonal antibodies may depend on an indirect effect of antibody binding that prevents the fimbria-receptor interaction.
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Comparison of immunofluorescence and culture for the detection of Actinomyces israelii in wearers of intra-uterine contraceptive devices.
A direct immunofluorescence (IF) method was compared with traditional culture methods for the detection of Actinomyces israelii in endocervical and intra-uterine-device (IUD) smears from 124 IUD wearers. Of 11 specimens that gave positive results by IF, only one was positive by culture. Of the 10 patients with positive IF specimens, three (30%) had signs and symptoms suggestive of pelvic infection and no other pathogen was detected. Direct IF of cervical smears offers a simple, relatively cheap method to screen IUD wearers for A. israelii. Clinical management of such cases is discussed.
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Induction of inflammatory cytokines by a soluble moiety prepared from an enzyme lysate of Actinomyces viscosus cell walls.
A carbohydrate-rich and immunobiologically active component, M1Av, was prepared from an M-1 endo-N-acetylmuramidase digest of cell walls of Actinomyces viscosus ATCC 19246 by CM Sephadex C-25 and Sephadex G-100 chromatography. M1Av stimulated thioglycolate-induced peritoneal macrophages from C3H/HeN and C3H/HeJ mice to release cell-free tumour necrosis factor (TNF) and interleukin (IL)-6, and a cell-associated thymocyte activating factor, probably IL-1. An intravenous (i.v.) injection of M1Av induced increased levels of TNF and IL-6 in the serum of C3H/HeN mice that had been primed with 100 micrograms of muramyldipeptide (MDP) i.v. However, M1Av did not induce TNF release in C3H/HeJ mice similarly primed with MDP. Simultaneous administration of M1Av (100 micrograms, i.v.) and galactosamine (18 mg, intraperitoneally) killed C3H/HeN, but not C3H/HeJ mice. M1Av was shown to be practically free of endotoxin by the Limulus test. These findings indicate that the solubilised A. viscosus cell-wall carbohydrate moiety induced inflammatory cytokines both in vitro and in vivo.
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Pilonidal sinus of the glans penis associated with actinomyces case reports and review of literature.
Pilonidal sinus is a well-recognized condition that occurs most commonly in the sacrococcygeal area of younger men. It is hypothesized to be an acquired chronic inflammation condition due mainly to hair trapped beneath the surface. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, fistulae, and rarely, squamous cell carcinoma. A pilonidal sinus of the penis is a rare entity. The association of a penile pilonidal cyst and Actinomyces is even more uncommon with only three cases reported previously. Two cases of pilonidal sinus are reported in this paper. One of the cases was associated with actinomycosis. Pilonidal sinus of the penis should be considered in the clinical and pathological differential diagnosis and has to be distinguished from balanoposthitis, epidermal cyst, and carcinoma. The knowledge about possible association with actinomycosis is important to ensure early treatment.
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Isolation of Corynebacterium pilosum and Actinomyces pyogenes from cystitis and vulvovaginitis infection in a 2-month-old female calf.
Cystitis and vulvovaginitits, due to Corynebacterium pilosum and Actinomyces pyogenes infection in a 2-month-old female calf, is described. The prominent clinical signs were urinary incontinence, adherence of triple phosphate crystals to the vulvar hair and ulceration on the vulva, the ventral side of the tail skin and the perineum. Only a mild inflammation of the bladder mucosa and submucosa was seen on histological examination.
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