378 ACTINOMYCOSIS 



appearance because of the orientation of the branches and the strong 

 tendency of the hyphae to break apart at the septa. Although most 

 of the growth is at the hyphal tip as in other fungi there is some 

 intercalary elongation of the cells which is responsible for the char- 

 acteristic zigzag appearance. The organism is Gram-positive, but 

 some cells destain except for particles and droplets of Gram-positive 

 material. 



Treatment and Prognosis. Actinomycosis is resistant to treatment, 

 but the prognosis is fairly good in localized lesions of the cervico- 

 facial area (so-called lumpy jaw). Systemic infections involving 

 the abdominal and thoracic organs are usually fatal. X^e usual 

 treatment consists of surgical drainage and administration of iodides 

 and deep x-ray. Thymol has been reported as useful in a few cases. 

 Recent reports indicate that the sulphonamides and penicillin are 

 effective in the treatment of this mycosis. 



Taxonomy. Actinomyces bovis is the correct name for the an- 

 aeroljic organism which causes the common type of actinomycosis 

 in which mycotic granules surrounded by "clubs" are usually present. 

 At the present time it is usually considered that a single species is 

 responsible for human and bovine actinomycosis. The name of the 

 fungus was improperly used by Bostroem for a saprophytic con- 

 taminant, as already pointed out, and some later investigators have 

 accepted Bostroem's usage. Misuse of the name has caused so much 

 confusion that a number of authorities have adopted the designation 

 Cohnistreptothrix Israeli in place of the older name. Reasons for 

 retaining the old name are set forth in a number of papers.^- -** 



It is unprofitable to discuss the taxonomy of Bostroem's organism 

 because it is apparent from the literature that a considerable number 

 of aerobic species of Streptomyces have been identified with it at 

 one time or another. Some of these were in all probability air-borne 

 contaminants which, once deposited in culture collections, were dis- 

 tributed under the erroneous name A. bovis; some may have been 

 introduced into the isolation cultures from contaminated syringe 

 needles, and some may actually have been pathogens of an unusual 

 type. Nocardia asteroides will be discussed below. 



Geographic Distribution. The distribution of the disease is world- 

 wide in temperate and tropical climates. Sanford, whose map indi- 

 cating a concentration of cases in the upper Mississippi Valley is often 

 cited, did not claim that his survey of reported cases gave any indi- 

 cation of the distribution of the disease. His statement that it prob- 

 ably indicated, instead, where the disease had been properly searched 

 for and diagnosed has been generally overlooked. The common con- 



