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Volume 18 | Issue 3 Article 4

1956 Discussion and Case History: Actinomycosis James S. Brewer Iowa State College

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Recommended Citation Brewer, James S. (1956) "Discussion and Case History: Actinomycosis," Iowa State University Veterinarian: Vol. 18 : Iss. 3 , Article 4. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol18/iss3/4

This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. Disscussion and Case History

ACTINOMYCOSIS

James S. Brewer B.S., V.M.D.

Actinomycosis is a disease entity pop­ been discarded gradually since the iso­ ularly called "lump jaw", "lumpy jaw" lation of Actinomyces bovis from soft tis­ and "big head." It has been reported in sue lesions, such as in the udder of swine. the bovine, equine, porcine, ovine, ca­ Corynebacterium pyogenes and Stap­ prine, canine and feline and generally hylococcus aureus are the most commonly affects one or more of the following struc­ isolated secondary invaders associated tures: maxilla, mandible, submaxillary with actinomycosis. A favorable environ­ lymph nodes, skin (behind the angle of ment for their growth is developed as the the jaw), tongue and udder.l The ox primary invader breaks down tissue in is the animal most often affected the course of its spread. The former is commonly in the area around the angle most often associated with Actinomyces of the jaw, hence the lay term "lump bovis in bone lesions while the latter is jaw." In horses, actinomycosis is quite of­ usually seen in the mammary gland of ten seen in the submaxillary lymph nodes sows. Both are responsible for suppura­ and in the spermatic cord as a sequel to tion.2 post-castration infection, usually result­ ing in a typical scirrhous cord. INFECTION At present the actual process of nat­ ETIOLOGY ural infection is unkown. Actinomyces At least four organisms have been as­ bovis is commonly present on the mu­ sociated with the disease, namely, Actin­ cous membranes of the mouth and omyces bovis, Actinobacillus lignieresi, throat, with no evidence of pathology or Corynebacterium pyogenes, and Microco­ disease. Under what circumstances the organism becomes pathogenic and in­ ccus aureus.2 Henrici believes actinomy­ cetes may (1) have evolved into a high­ vades tissue is not known. It is well es­ er form from bacteria; (2) degenerated tablished that the organism can enter tis­ to a lower form from molds; (3) evolved sue through breaks in the mucous mem­ into molds and bacteria. Formerly it was branes or skin such as caused by awns. thought that Actinomyces bovis invaded Udder infections may be caused by the only bony tissue while Actinobacillus entrance of saliva from sucklings into the Lignieresi was thought to be specific for teat canal, especially in swine. Other soft tissues.~ This artificial division has routes of entrance are by way of carious teeth or between the mucous membrane Dr. Brewer is an instructor in the Department and the tooth at the gum line. Still an­ of Obstetrics and Radiology, Iowa State College. other route of infection is through

Issue 3, 1956 145 wounds and surgical openings such as ings which increase in size. Several small produced by castration, especially in tumor-like masses may eventually coal­ horses. It should be emphasized that di­ esce forming infectious granulomas. They rect infection of healthy animals by act­ may be either soft or hard depending on inomycotic animals has not been re­ whether pus or fibrous granulation tis­ ported.3 sue predominates. On cut section the soft infectious granulomas containing pus PATHOGENESIS pockets exude a rather stiff, homogen­ eous, greyish-white material when pres­ After entrance into the tissues the or­ sure is applied. The hard infectious gran­ ganism causes a local irritation which in­ ulomas when incised reveal a dense, fi­ itiates a low-grade, usually chronic in­ brous, reddish-gray granulation tissue flamation which is granulomatous. There containing sulfur granules in the ground is some gross similarity to tuberculous substance. As a case progresses secondary granulomata.2 Microscopically, typical invaders exert their influence and in­ actinomycotic rosettes are il'regularly dividual pus pockets break down to form shaped and variable in size, but usually fistulous tracts which may break into the large, whereas the rosettes of actinobacil­ oral or pharyngeal cavity or through the lus are more spherical and less variable surface of the skin.G In bone, there is in size. It should be emphasized that the simultaneous decalcification and destruc­ so-called sulfur granules which are tion of lamellae and trabeculae which fre­ thought to be pathognomonic of the dis­ quently results in the formation of bone ease by some, are actually formed by sequestra of various sizes and prolific, ir­ clumps of rosettes. The organisms them­ regular new bone formation due to the in­ selves are grouped as radiating, swollen, flammation of the periosteum. Metastasis club-shaped filaments. Sulfur granules to other parts of the body may occur oc­ seem to be more prevalent where growth casionally. conditions are poor. Under ideal condi­ tions, such as in culture tubes, sulfur SYMPTOMS granules are rarely found. 4 On gross examination of a lesion the exudate will The disease characteristically develops often contain these gritty, yellowish gran­ insidiously with little or no evidence of ules. They are called sulfur granules only its presence in the early stages. As men­ because of their color. Microscopically, tioned above, it follows a chronic course actinomycosis presents two general pic­ with no fever (unless a massive growth tures depending on whether the second­ of secondary invaders occurs). The gen­ ary invaders mentioned above are pres­ eral health of the animal is unaffected un­ ent or not. When no secondary invaders til such time as (1) nerves in the area are present the rosettes are closely sur­ become inflamed and the animal is reluc­ rounded by a layer of large mononuclear tant to eat, or (2) bone and muscle in­ phagocytes or by one or more huge mul­ volvement becomes so severe that the an­ tinuclear foreign-body giant cells. If sec­ imal cannot move the mandible, manip­ ondary invaders are present the rosettes ulate the 'tongue, or swallow or (3) an may be surrounded by a layer of poly­ idiopathic fracture occurs. Then the ef­ morphonuclear leucocytes and cell de­ fects of malnutrition soon become evi­ tritus which together form pus. Outside dent. One of the disappointing aspects of this zone of macrophages or pus is a zone the disease is our inability in the past and of lymphocytes with some macrophages at present to kill the causative organism and the whole granuloma is surrounded after it becomes infective. The chronic by a capsule of fibroblasts. As the organ­ course continues relentlessly and spon­ isms grow, new tissue is invaded with taneous recovery is extremely rare. consequent necrosis, pus formation and DIAGNOSIS fibrotic encapsulation occurring at the same time. Grossly this appears as swell- A gradual onset, with little or no sys-

146 Iowa State College Veterinarian Right mandible of a 4-year-old Guernsey bull taken Jan. 6, 1955. Clinically there were no fis­ tulous tracts. Radiographs revealed rarefying osteitis and osteomyelitis in the region of the 2 and 3 premolar.

Same bull, Jan. 5, 1956 Clinical examination revealed numerous scabs and an increase in th£ size of the swelling. No opening or draining fistula. Radiograph reveals greatly increased area oj destruction of bone tissue.

Issue 3, 1956 147 temic involvement or discomfort during water, per os daily for 10 to 14 days. Gotze the early stages, typical swelling of the advises treating cattle with 3 to 4 Gm. maxilla, mandible, submaxillary lymph potassium iodide and 2 to 3 Gm. sodium nodes, skin, tongue, and udder, followed iodide per 200 pounds body weight dis­ by enlargement of isolated lesions and solved in distilled water in a ratio of coalescing of adjacent lesions, ulceration, 10: 100, administered slowly intravenous­ development of fistulous tracts with exu­ ly every 10 to 12 days. From the stand­ dation of soft greyish-white pus contain­ point of rational therapeutics, penicillin ing yellowish gritty granules would lead is the drug of choice among the antibio­ one to suspect actinomycosis. However, tics, since it is the most effective anti­ before a positive diagnosis can be made biotic known against Actinomyces bovis. the possibility of sarcoma, lymphoma, From a practical standpoint, however, fibroma, botryomycosis, tuberculosis and where one has not made a positive diag­ in horses, glanders and strangles must be nosis and the possibility of actinobacillo­ eliminated. Finally, isolation of the or­ sis exists use of streptomycin is advocated ganism by culturing is the only positive in addition to penicillin, since the latter method of diagnosis. has little effect on Actinobacillus lignier­ esi. X-ray therapy has produced good PROGNOSIS therapeutic results. The treatment is Elimination of the disease is practically based on exposure of the lesion and sur­ impossible but a favorable prognosis can rounding tissue equal in area to that of be given in cases where localized, super­ the lesion to 500 roentgens every 48 hours ficial lesions are discovered and treated for 5 treatments using 250 kilovolts and early. When deeper tissue or bony tissue 15 milliamperes at a target-subject dis­ lesions of long standing are presented for tance of 35 cm. using a MM. aluminum treatment the prognosis must be unfav­ filter and a 0.5 MM.. copper filter. The orable. However, treatment of this type x-radiation destroys a slight amount of case may retard the progress of the dis­ healthy tissue surrounding the lesion ease, and could keep a bull of valuable which in turn causes a local inflammation. blood lines in an artificial breeding sta­ This local inflammation increases fibro­ tion in active service for an extended pe­ blastic activity and a thickened encapsu­ riod of time over and above that of a lating layer of fibroblasts surrounds the similar case which remained untreated. lesion. It should be made clear that x-rays do not kill the organism itself, but mere­ TREATMENT ly aid in speeding up the process of wall­ The only dependable and effective ing the lesion off. In addition, there is treatment leading to a cure of actinomy­ some evidence that the invasive proper­ cosis is complete and total extirpation. ties of the organism itself are reduced. This is not possible in most cases, so During a period of about 3 weeks follow­ other methods must be relied upon. Tinc­ ing treatment there may be an increase ture of iodine in equal parts with Lugol's in the size of the lesion with fonnation solution has been used with some success of abscesses which rupture. This should as a local application and injected into not be viewed with alarm since there is superficial lesions. Potassium iodide and usually a gradual improvement follow­ sodium iodide have been used per os and ing this initial period. Treatment of a re­ intravenously with some success. The currence should be delayed until at least former is of value in combating lesions 6 months after the previous treatment at of the tongue and other soft tissues, but which the same treatment may be re­ it seems to aggravate bony lesions which peated. For some unexplained reason le­ may be present. sions of the maxilla respond more read­ A regimen of treatment for cattle rec­ ily than lesions of the mandible. ommended by Kral consists of 6 to 8 Gm. * Actinomycosis potassium iodide dissolved in 1 pint of (Continued on page 208)

148 Iowa State College Veterinarian * Actinomycosis the lesion. The. swelling protruded ap­ (Continued from page 148) proximately 8 cm. from the normal ven­ iral mandibular border and the soft tis­ Case History sues surrounding the lesion showed evi­ On January 6, 1955 a 4-year-old Guern­ dence of inflammation and early deposi­ sey bull was presented to the clinic and tion of calcium. In view of the above find­ was assigned Case No. 48697. A clinical ings, treatment was not initiated since examination revealed a bull of average there was no hope of improving or stabil­ conformation and flesh with a swelling izing the condition. The owner was ad­ on the right mandible protruding approx­ vised to use the bull as long as he wished imately 4 cm. and about 8 cm. long. and then send it to slaughter, but the There were no fistulous tracts visible but humane thing would be to slaughter him one area about 1 cm. square on the ven­ immediately. He decided to send the bull tral border was soft to the touch. The to slaughter immediately. rest of the lesion was firm and non-mov­ Bibliography able. Temperature, respiration, pulse and rumen movements were within normal 1. Hutyra, Marek, & Manninger. Special Path­ ology and Therapeutics of the Diseases of limits. Radiograph No. 3311 revealed a Domestic Animals. London. Bailliere, Tindall rarefying ostitis and osteomyelitis of the & Cox. 5th English Edition, 1949. right mandible in the vicinity of the sec­ 2. Runnels, R. A. Animal Pathology. Ames, Iowa. Iowa State College Press. 5th Edition, ond premolar tooth extending posteriorly 1954. under the third premolar tooth and the 3. KeIser and Schoening. Manual of Veteri­ first molar tooth. On the basis of the cli­ nary Bacteriology. Baltimore. Williams & nical and radiographic findings a diag­ Wilkins. 5th Edition, 1948. 4. Karsner. Human Pathology. Philadelphia. nosis of mandibular actinomycosis dextra J. P. Lippincott. 7th Edition, 1949. and alveolar periostistis was made. Since 5. Kral and Novak. Veterinary Dermatology. it was believed on the basis of the radio­ Philadelphia. J. P. Lippincott. 1953. graphic findings, that the mandibular ca­ nal had not yet been invaded x-ray ther­ .:. Questi()nnaire (Continued from page 136) apy was advised. On January 8 1955 the bull was restrained in the stocks by a stu­ e. Other 8 CIto dent. As described above, 500 roentgens f. Never vaccinate for both was administered to the affected area. simultaneously 12';:. This treatment was repeated every 48 25. Instruments Most Commonly Used hours, using a different student to re­ for Opening Teats strain the bull each time, until a total of a. Lichtys or Yankee 33';; five treatments were administered. The b. Stools 12~;;} bull was discharged on Janury 17, 1955. c. Teat slitter 41 ;.~ On January 5, 1956 the bull was again d. Other 15'.0 presented at the clinic. At this time the 26. Treatment of Scirrhous Cord bull was in extremely poor flesh and had (Swine) refused to eat for 48 hours and had much 4,d difficulty drinking. However, it made a. No treatment 10 78?( frequent attempts to eat and did manage b. Surgical removal 44';; to swallow a small amount of grain. The c. Antibiotic swelling on the right mandible had al­ d. Other 61j: most doubled in size and numerous scabs 27. Calf Castration were noted on the skin over the swelling. a. Emasculator

No open or draining fistulous tracts were o percent 6'1.! ' observed. Radiograph No. 3874 revealed 1 to 10 percent 14% a greatly increased area of destruction of 11 to 50 percent 35'/: bone tissue with much irregular, unor­ 51 to 75 percent 5r,,{ ganized new bone formation throughout 76 to 100 percent 43'/r

208 Iowa State College Veterinarian