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THE ACTINOMYCETES, Vol. I 



field and Bayne-Jones (1915); actinomycosis 

 of the esophagus by Langer, of tonsils l)y 

 Davis (1914), of the oral ca\'ity by Naeslund 

 (1925), and Sullivan and Goldsworthy 

 (1940), cervicofacial by Glahn (1954), of the 

 nervous system by Jacobson and Cloward, 

 and of the heart by Cornell and Shookhoff 

 (1944). Pulmonary actinomycosis has re- 

 ceived much attention (Warthin and Olney, 

 1904; Sartory and Sartory, 1925; Penta, 

 1941; Lynch and Holt, 1945; Poppe, 1946; 

 Vawter, 1946; Garrod, 1952). The earlier 

 literature on \'arious forms of actinomycosis 

 is found in the work of Schlegel (1928). 



Erikson suggested that the anaerobic or- 

 ganisms should be divided into the human 

 and the bovine types. Lentze also concluded 

 that actinomycosis in man and in animals 

 represents two different types of anaei'obic 

 gram-positive organisms. Those involved 

 are: (a) one (R-type) capable of growing on 

 the surface of the medium, forming leathery 

 irregular colonies and producing a sediment 

 in liquid media; (b) another (S-type) pro- 

 ducing smooth, easily broken colonies on 

 solid media and causing turbidity in anaero- 

 bic liquid media. The first represents the 

 classical type of Wolff-Israel and the other 

 resembles corynebacteria. According to 

 Wright, however, no significant differences 

 exist between human and bo\'ine strains. 



Gradually, an extensive amount of litera- 

 ture has accumulated on the etiology of in- 

 fections caused by actinomycetes. Naeslund 

 grouped these infections under the anaerobic 

 and aerobic types. The first, or A form, can 

 be readily isolated from the mouth; it is a 

 typical A. bovis and can bring about the 

 true actinomycotic infection. The second, or 

 15 form, is a j)atliogenic aerobe, considered 

 to he less important than the anaerobe; it is 

 commonly found in nature, usually produc- 

 ing reddish or yellowish colonies, is acid- 

 fast, and usually forms spores; it comprises 

 the forms now included under Nocardia. 



Rosebury isolated foui' strains of .4. hovis 



from cervicofacial actinomycosis, and 11 

 from gingival scrapings taken under oral 

 pathological conditions in the absence of 

 actinomycosis. Optimum conditions for 

 growth of these organisms were proA'ided by 

 anaerobiosis in the presence of 5 per cent 

 carbon dioxide. Considerable variation was 

 observed in oxygen tolerance among the dif- 

 ferent strains at different times. Pure cul- 

 tures were maintained by cultivation under 

 anaerobic conditions. Cope summarized the 

 data of 1330 cases of actinomycosis: of these, 

 56.8 per cent affected the cervicofacial re- 

 gion, 22.3 the abdomen, 14.9 the thorax, and 

 5.9 per cent other sites. 



The clinical features of actinomycosis were 

 described by Conant and Rosebury as fol- 

 lows : 



"Actinomycosis is a subacute or chronic, gen- 

 erally progressive disease of man, cattle, swine, 

 horses and other animals, characterized by the 

 development of indurated granulating swellings 

 chiefly in connective tissue, by suppuration 

 usually of limited extent, and by the presence in 

 the pvis or lesions of Actinomyces bovis, demon- 

 strable microscopicall}- or culturally. In man the 

 lesions are found chiefly in the cervicofacial con- 

 nective tissues and in the thoracic or abdominal 

 viscera, and develop over periods ranging from a 

 few weeks to a year or more. The lesions spread 

 widely by contiguity, sometimes pointing toward 

 the skin and forming fistulae that tend to heal and 

 reform elsewhere; rarely pointing toward mucous 

 or serous membranes. The organism may be dis- 

 seminated through the blood, or, in the lungs, 

 through the bronchi. The lymphatic system is only 

 rarel}- involved. Bone maj' be eroded in the path 

 of the lesion, but is seldom affected interstitially 

 except in the jaws." 



Different forms of actinomycosis are fur- 

 ther differentiated by Conant and Rosebury : 



"Cervicofacial actinomycosis accounts for 

 more than half of all cases in man. It apparently 

 originates from the mouth, but affects the soft 

 tissues and skin of face and neck, and the tongue, 

 and secondarily, the maxillary bones. The salivary 

 glands, larynx, thyroid, and lacrymal glands, the 

 orbit and even the brain may more rarely be in- 

 volved. The comnioiicst lesions appear on the 



