Pathology
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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Actinomycosis
Introduction

Actinomycosis (caused by Actinomyces israelii)

Clinical signs
  • deep, draining abscesses
  • purulent chronic inflammation
  • purulent discharge with tiny granules
Pictures

Dental sinus is often caused by actinomycetic infection: Dental sinus, Macro (3743) Dental sinus, Macro (3744) Dental sinus, Macro (3745)

Histology

Purulent, mixed infiltrate (neutrophils, eosinophils, plasma cells, histiocytes), granulation tissue, pseudoepitheliomatous hyperplasia of the surrounding epidermis. Lobulated colonies of these bacteria (30 – 3000 µm) are typical, but not always present.

Pictures

Actinomycosis: Actinomycosis, HE 5x (482) Actinomycosis, HE 40x (481)

PAS staining: Actinomycosis, PAS 10x (483) Actinomycosis, PAS 40x (484)

Case study
Actinomycosis
MUDr. Hana Jedličková, PhD.
Etiology

Actinomycosis is a chronic, suppurative infection caused by saprophytic gram-positive bacteria actinomycetes (Actinomyces israelii), which can be present in the mouth and gastrointestinal tract in healthy individuals.

Actinomycetes can be detected in smears, histology (Giemsa, Gomori stains) and by cultivation.

Clinical signs

Most common is the cervicofacial involvement. Infection occurs in the sites of trauma (i.e. dental procedures) resulting in abscesses with sinus tracts draining pus. The surrounding skin is inflamed and indurated. Thoracic and abdominal involvement is also possible. In immunocompromised individuals the clinical presentation may vary (disseminated lesions, chronic skin infiltrates, etc.).

History

51-year-old man had a 6-month history of an indurated red plaque with pustules on the dorsal aspect of his right hand. The lesion appeared two weeks after a minor skin injury by a saw in the garden. He was treated with amoxicilin and itraconazole (positive cultivation of trichophyton mentagrophytes) without clinical effect.

The patient had type 2 diabetes mellitus and hypertension; he was working as a plumber.

Clinical signs

An indurated red plaque 7×5 cm with many small pustules and crusts on the dorsal aspect of the hand, on the third finger a healed scar after the trauma.

Pictures

Actinomycosis, hand: Actinomycosis VYRADIT, Clinical picture (6150)

Histology

Pseudoepitheliomatous hyperplasia and suppurative granulomas with positive granules in the Giemsa stain. The granules are basophilic with eosinophilic halo (Splendore-Hoeppli phenomenon).

Pictures

Actinomycosis: Actinomycosis, Giemsa 40x (6102)

Madura foot