Actinomycosis

“ Furthermore, it must be borne in mind that actinomycosis is a local disease, causing great destruction of tissue where the fungus multiplies, but which very rarely becomes generally disseminated over the body from the original disease focus. The fungus is found only in places where the disease process is manifest to the eye or becomes so in a very short time after the lodgment of the fungus. ”

“ They are easily removed by the scissors, after which their roots should be thoroughly cauterized with a pointed stick of lunar caustic or chloride of zinc.
7 ACTINOMYCOSIS OF THE LIPS. In the rich river bottom lands of northern Germany and Russia where actinomyces abound actinomycosis is common in the form of papillæ of greater or lesser size on the lips and nose of horse and ox. The abrasion of these parts by thorns, thistles, stubble, dry fibrous fodders and other irritants, appears to produce a raw surface for the colonization of the germ, which is not slow to avail of the opportunity. ”

“ Beside the entozoa, there are also vegetable parasites. Of these, the most important is the streptothrix actinomyces, the cause of actinomycosis in man and cattle. Israel, in 1877, gave the first accurate account of it in man; and Böllinger, the same year, studied it in cattle. Ponfick, in 1882, recognised the identity of the disease in man and animals. In 1885, Israel published the collected records of 37 cases in man, tabulated according to the site of the primary infection. Boström, about this time, made cultures of the fungus: but all the earlier attempts at inoculation failed ”

“ The fungus of actinomycosis develops equally well in most tissues. It destroys bone by erosion and spares only nerves and tendons. The pus from the affected region contains small yellowish granules ("sulphur grains") of irregular shape, attaining at most 0'75 mm. in diameter. They are soft and consist of an inextricable felted mass of inycelia. The threads are radially arranged at the periphery of the grain, and their free extremity widens into a bulbous, club-like termination (10-20 μ. long by 8-10 μ wide) . ”

“ Intravenous injections of large quantities of normal salt solution are also of considerable value, 4 to 6 quarts per day for an ox and 20 to 40 fluid ounces per day for a sheep.
ACTINOMYCOSIS. Actinomycosis is a disease produced by a fungus belonging to the group of oomycetes (Actinomyces bovis) which develops in the depths of living tissues in man and the ox, producing grave and sometimes incurable lesions, most commonly in and about the jaws. ”

“ Actinomycosis. This disease affects both animals and man. As Professor Crookshank points out, it has long been known in this country,100 but its various manifestations have 317been mistaken for other diseases or have received popular names.
Here we can only mention the most outstanding facts concerning the disease. It is caused by the "ray fungus," or Streptothrix actinomyces, which, growing on certain cereals, often gains entrance to the tissues of man and beast by lacerations of the mucous membrane of the mouth, by wounds, or by decayed teeth. ”

“ It has already been stated that the actinomyces fungus found in human disease is considered by authorities the same as that occurring in bovine affections. It is therefore of interest to conclude this article with a brief discussion of the disease in man and its relation to actinomycosis in cattle. ”

“ Whether an animal affected with actinomycosis should be used for human food after all diseased organs and tissues have been thoroughly removed is a question the answer to which depends on a variety of circumstances. Among these may be mentioned the thoroughness of the meat inspection itself, the extent of the disease, and the general condition of the animal affected. ”

“ MYCETOMA, OR MADURA FOOT.--Mycetoma is a chronic disease due to an organism resembling that of actinomycosis, but not identical with it. It is endemic in certain tropical countries, and is most frequently met with in India. Infection takes place through an abrasion of the skin, and the disease usually occurs on the feet of adult males who work barefooted in the fields. ”

“ Actinomycosis manifests itself in the neck as a diffuse, painless swelling, which slowly infiltrates the superficial structures, becoming brawny at some places, and at others breaking down and forming sinuses from which the ray fungus escapes in the discharge. ”

“ It appears, furthermore, that in certain districts or countries the disease seems by preference to attack certain parts. Thus in England actinomycosis of the tongue is most prevalent. In Denmark the soft parts of the head are most prone to disease, while in Russia the lips are the usual seat. ”

“ Mycetoma, the Madura foot of India, is a disease very similar to actinomycosis, and, like that disease, is produced by a somewhat characteristic streptolhrix. It usually attacks the feet and legs, however, and appears to be the result of infection through injured tissues. ”

“ He showed clearly that the actinomycosis of the tongue, a disease which appears to be quite common in Germany, and is there known as "wooden tongue," could be quickly and permanently cured by the administration of iodid of potassium. Nocard calls attention to the success of Thomassen, of Utrecht, who recommended this treatment so long ago as 1885, and who has since treated more than 80 cases, all of which have been cured. A French veterinarian, Godbille, has used the same remedy in a number of cases of actinomycosis in the tongue, all of which have been cured. ”

“ The last named, seen in inoculated rabbits, have been held to establish a relationship between the microbes of tuberculosis and actinomycosis, as the club-shaped cells do not take the usual Ziehl-Neelsen stain for tubercle bacilli, but the Birsch-Hirshfeld’s actinomyces stain. Apart from the rabbit such variations are not likely to prove sources of fallacy in identification of the microbe.
Morphology. As met with in the tubercle of man or ox the bacillus is a minute rod with rounded ends, 1.5 to 3.5μ long, by 0.2μ in thickness. In the ox it is shorter and thicker on an average than in man. ”

“ That human beings have contracted actinomycosis by coming in contact with diseased cattle is not shown by the cases that have been reported, for the occupations of most of the patients did not bring them into any relation whatever with cattle. While the possibility of such direct transmission is not denied, nevertheless it must be considered as extremely remote. Practically the same position is maintained at present by most authorities as regards the transmission of the disease to man by eating meat. ”

“ When it implicates the intestinal canal and its accessory glands, the lungs, pleura, and bronchial tubes, or the brain, the disease is not amenable to surgical treatment.
_Differential Diagnosis._--The conditions likely to be mistaken for surgical actinomycosis are sarcoma, tubercle, and syphilis. In the early stages the differential diagnosis is exceedingly difficult. In many cases it is only possible when suppuration has occurred and the fungus can be demonstrated. ”

“ Uncomplicated cases do not show fever and the occasional enlargement of lymphatic glands is probably connected with bacterial infections.
There are never visceral metastases in mycetoma as is true of the nearly related actinomycosis.
The process shows no tendency to heal naturally or under treatment but fortunately does not extend, the process being confined to a foot or a hand. The joints are rarely if ever invaded. Unless the sinus-riddled member is amputated the drain on the patient gradually exhausts him and death ensues in ten or fifteen years. ”

“ The prognosis is grave, whatever the clinical form of the disease. Important advances, it is true, have lately been made, and the iodide of potassium treatment is of great value, but too much must not be expected of it, and its benefits have certainly been exaggerated. Clinical experience suffices to prove that only actinomycosis of soft tissues can be cured by drugs, bony lesions being amenable only to medical and surgical treatment combined. Even combined treatment is often unsuccessful. ”

“ Malformations are rare (diverticula, ectopia) . Tuberculosis is usually secondary. Gummata are rare. Actinomycosis is usually secondary to actinomycosis of the neck or lungs. Primary neoplasms are rare. Secondary carcinoma and sarcoma (especially lymphosarcoma) are more frequent. Cysticercus, trichina and echinococcus are rare.
6. Heart. Note more carefully its position, whether displaced to right or left, location of apex, borders, etc. Relative size compared to cadaver’s right fist, which is usually a little smaller than the heart. ”

“ The region of the mouth and jaws is one of the commonest sites of surgical actinomycosis. Infection takes place, as a rule, along the side of a carious tooth, and spreads to the lower jaw. A swelling is slowly and insidiously developed, but when the loose connective tissue of the neck becomes infiltrated, the spread is more rapid. The whole region becomes infiltrated and swollen, and the skin ultimately gives way and free suppuration occurs, resulting in the formation of sinuses. ”

“ Etiology.—The disease is caused by the penetration of certain species of fungi into the tissues of the foot, although rarely the hand or some other part of the body may be affected. These species of fungus develop in granulomatous areas from which sinuses lead to the surface of the foot, in the discharges from which are found small granules resembling those found in the discharges from actinomycosis lesions.
As a rule only one kind of fungus is found in a single case. ”

“ Not content with her vast triumphs in space over the infinitely great, she dives down to the infinitely small, and stores up for us portraits of the disease-bearing generation of Schizomycetes, the stiff-necked bacteria, and the wriggling vibrio, the rolling microccus, and the fungoid actinomycosis—with deadly tresses ”

“ Others have found that cattle grazing upon low pastures along the banks of streams and subject to inundations are more prone to the disease. It has also been observed that feed gathered from such grounds, even after prolonged drying, may give rise to the disease. Actinomycosis is not infrequent in cattle in the Southwest and is generally supposed to be the result of eating the prickly fruit of the cactus plant, causing wounds of the mucous membrane and subsequent infection with the parasite. ”

“ The black sheep of the Stickine and Iskoot regions are so seldom seen by white men, save when a sportsman kills his allotment of three specimens, we really do not know anything about the extent to which actinomycosis prevails in those herds, or how deadly are its effects. One thing seems quite certain, from the appearance of the diseased skulls found by the writer in the taxidermic laboratory of Frederick Sauter, in New York. The enormous swelling of the diseased jaw bones clearly indicates a disease that in some cases affects its victim throughout many months. ”

“ In contemplating the fungus theory of pellagra it is interesting to note that of all the diseases known to be caused by fungi, such as thrush, ringworm, pinta, tinea imbricata, mycetoma, actinomycosis, pneumonicosis, not one in any way resembles pellagra.
Of the more recent etiological theories concerning pellagra the following may be mentioned: Dr. Licorish of Barbados believes that the disease is due to an excessive sugar diet; Auld ascribes it to a magnesium infiltration from the ingestion of maize; Dr. Pixley of South Carolina incriminates rancid fats ”

“ Vegetable parasit.es: ringworm, caused by the Trichophyton tonsurans; favus, caused by the Achorion Schonleinii; tinea versicolor, caused by the Microsporon Furfur; erythrasma, due to the Microsporon minutissimum; actinomycosis, due to the Acti- nomyces or ray fungi; mycetoma or Madura foot, due to Dyscomyces; aspergillosis and pinto, caused by an unknown fungus; streplothrix infections other than from the ray fungus, sporotrichosis; blastomy- cetic dermatitis, due to a fungus of the yeast family. ”

“ There is but little pain, and no glandular involvement or constitutional disturbance. The disease runs a prolonged course, sometimes lasting for twenty or thirty years. Spontaneous cure never takes place, and the risk to life is that of prolonged suppuration.
If the disease is localised, it may be removed by the knife or sharp spoon, and the part afterwards cauterised. As a rule, amputation well above the disease is the best line of treatment. Unlike actinomycosis, this disease does not appear to be benefited by iodides. ”

“ They possess filaments, which may be branched, and almost always have septa and a sheath. Perhaps the most marked difference from the lower bacteria is in their reproduction. In the higher bacteria we have what is in fact a flower—terminal fructification by conidia. In this group of vegetables we have the12 Beggiatoa, Leptothrix, Cladothrix, and, at the top, the Streptothrix. It has been demonstrated that Streptothrix actinomycotica and Streptothrix maduræ are the organismal cause, respectively, of Actinomycosis and Madura-foot, two diseases which have hitherto been obscure. ”

“ Infection is believed to be conveyed by the husks of cereals, especially barley; and the organism has been found adhering to particles of grain embedded in the tissues of animals suffering from the disease. In the human subject there is often a history of exposure to infection from such sources, and the disease is said to be most common during the harvesting months.
Around each colony of actinomyces is a zone of granulation tissue in which suppuration usually occurs, so that the fungus comes to lie in a bath of greenish-yellow pus. ”