C'AISA'I'ION Ol" AN I.MAI, DISIvVSES 



261 



cluu'k or sul)m;i\illar\ skin, ami aic cliaiaclcii/cd 

 by inthiratoil or (>(l(Muatoiis swellings, hluisli or 

 rodtiisli ill color, with a toii(l(Mic\' to t'orni a scries 

 of irrof^ular folds separated l)y furrow s, the healing 

 lesions forming scars as new lcsii)iis dcvcloj). 



"Thoracic aclinoinycosis accounts for al)()Ut 

 fifteen iier c(Mit of liuniaii cases. It is found niainlx 

 in the lunjis. witli llic formation of alisccsses and 

 cavities which are usually small. l']xtonsive lesions 

 may be found in the bronclii, and their rupture 

 may lead to dissemination of the infection by way 

 of the bronchial tree. Actinomycotic pleurisy and 

 empyema have been observed, as has involvement 

 of the heart and pericardium. Thoracic lesions 

 may originate from the mouth or thro.at In* aspira- 

 tion, by extension from the abdomen, or by me- 

 tastasis. 



"Abdominal actinomycosis comprises about 

 twenty per cent of luunan cases. The lesions may 

 be found in any organ but are most common in 

 the region of cecum and the appendix. From here 

 they may extend with su])purating foci and the 

 formation of fibrous adhesions to the abdominal 

 wall, where skin lesions may appear similar to 

 those of cervicofacial actinomycosis. Or the 

 lesion ma_\' remain circumscribed, forming a 

 fibromalike mass. The liver is commonly attacked, 

 and lesions of the genital tract are relatively 

 frequent. The stomach, small intestine and kidney 

 are seldom afTected. Infection is probably derived 

 in most instances directly or indirectly from the 

 intestinal or genital mucous membranes which, 

 however, are not themselves involved. In the skin, 

 actinomycosis, secondary to lesions of underlying 

 tissues or organs, is relativelj^ common, as has 

 been noted; but it is doubtful whether true actino- 

 mycosis is ever primary in the skin." 



Nocardiosis 



Xocard was the first to describe, in 1888, a 

 pathogenic actinomyces of the aerobic type. 

 This organism \vas found to be the cause of 

 "farcin du Boeuf," a disease of cattle in the 

 Guadeloupe Islands. Trevisan named this 

 organism Xocardia, in honor of its discov- 

 erer, the species being A^. farcinica. Soon af- 

 ter^vards, Eppinger described a filamentous 

 organism found in the pus of a cerebral 

 abscess; he designated it as Cladothrix 

 asteroides. This organism was transferred to 

 the genus Nocardia by Blanchard and Xo- 

 card (1896). MacCallum reported in 1902 



that .V. (islcntidcs |)i'(»(liic('s ;i dilTii.^e perito- 

 nitis ill cxpcriiiiciitnl ;iiiiiii;ils. According to 

 H(>iib()\v, Smith, and (ii-inison, about 90 per 

 (•('lit of all clinical cases of actinomycosis arc 

 caused 1)\' .1. lion's; the reiiiaiiiiiig 10 per 

 cent are caused by A', asteroides, uKJst strains 

 of which are partially acid-fast. Benbow ct 

 al. excluded from this classificat ion the myce- 

 tomas which are caused by otluM- species of 

 Nocardia. 



Following these early studies, much work 

 was done on nocardiosis and the organisms 

 in\-olved. It is sufficient to mention that of 

 Nakayama (190()), Evans (1918), Drake 

 and Henrici (1943), Gonzalez-Ochoa (1945), 

 Gonzalez-Ochoa and Hoyos, Binford and 

 Lane (1945), and Kirby and McNaught 

 (1946). 



Pijper and Pullinger (1927) emphasized 

 the affinity for iron among the Nocardia or- 

 ganisms. 



Henrici differentiated between three well- 

 defiiied types of infection caused by actino- 

 mycetes in man and in animals: 1. The 

 limipy jaw type, which is the most common 

 infection and is produced by an organism be- 

 loiiging to A. bovis studied by Israel. 2. The 

 madura foot type, caused by an aerobic form 

 which is usually designated as Nocarrlia 

 madurae, and more recently recognized as 

 Strcptomyces madurae (Mariat, 1958). 3. A 

 rare type of infection caused either by N. 

 asteroides, most frequently in man, or by N. 

 farcinica, which occurs in cattle. Glover et al. 

 (1948) suggested that the term "actinomy- 

 cosis" be restricted to infection due to the 

 microaerophilic A. bovis and that "nocardio- 

 sis" be used for infections caused by the 

 aerobic A^. asteroides and other species of 

 Nocardia. 



As many as 13 species of Nocardia isolated 

 from white, yellow, or red granules found 

 in the pus in cases of mycetoma have been 

 described, but some of these names are now 

 recognized as synon3^ms. Vincent cultivated 

 the organism now known as S.(N.) madurae. 



