784 Actinomycosis 



the lower animals. The fungi may enter the organism through 

 the mouth and pharynx, through the respiratory tract, through the 

 digestive tract, or through wounds. 



The invasion has been known to take place at the roots of carious 

 teeth, and is more liable to occur in the lower than in the upper jaw. 

 Israel reported a case in which the primary lesion seemed to occur 

 external to the bone of the lower jaw, as a tumor about the size of a 

 cherry, with an external opening. Two cases of the disease observed 

 by Murphy, of Chicago, began with toothache and swelling of the 

 jaw. A few cases of dermal infection are recorded. Elsching* 

 has seen a case in which calcified actinomyces grains were observed 

 in the tear duct. 



In some way, the organisms sometimes enter the lung and cause 

 a suppurative bronchopneumonia with adhesive inflammation of 

 the contiguous pleura. After the formation of thepleuritic'adhesions 

 the disease may penetrate the newly formed tissue, extend to the 

 chest- wall, and ultimately form external sinuses; or, it may penetrate 

 the diaphragm and invade the abdominal organs, causing interesting 

 and characteristic lesions in the liver and other large viscera. 



Lesions. — The lesions of actinomycosis vary under circumstances 

 not well understood. They fall into the groups of granulomas, but 

 how they shall comport themselves has some reference to the tissue 

 in which they occur. A primitive lesion may be described as con- 

 sisting of the ray -fungus at the center and a reaction zone round 

 about it. In close approximation to the fungus it is not uncommon to 

 find a number of foreign-body giant-cells in a zone of lymphocytes, 

 plasma cells, and endothelial cells. Beyond these are endothelial 

 cells and fibroblasts. As the lesions enlarge the cellular collections 

 die at the center while growing at the periphery. 



The disease in the tongue eventuates in dense indurations, at the 

 centers of which dead and calcified actinomyces or small collections 

 of pus or necrotic matter can be found. 



In the maxillary bones, the cell collections result in absorption 

 and redeposition of the bone in a rarefied form, and instead of the 

 induration seen in the tongue, necrosis and suppuration are apt to 

 eventuate in the formation of sinuses through which the pus and acti- 

 nomyces are evacuated. These sinuses commonly become seconda- 

 rily infected by a miscellany of bacteria from the surface and further 

 suppuration, necrosis and destruction quickly follow. It is such 

 secondarily admitted organisms that make the isolation of the 

 actinomyces difficult, and that so commonly lead to the appearance, 

 in the culture, of the aerobic easily cultivated Nocardia, confused 

 by so many investigators with the true cause of the disease. 



As the complicating infection and suppuration leads to the en- 

 larging sinuses and fistulae, the actinomyces are liberated and escape 

 in the pus. They are large enough to be seen by the naked eye 

 .* Centralbl. f. Bakt. u. Parasitenk., xviii, p. 7. 



