Clinico-Therapeutic Management of Actinomycosis in a Buffalo.
A Jaffrabadi buffalo was presented with history of gradually increasing swelling on mandibular region. Clinical examination revealed round to circular hard, painless, localized, chronic, progressive, granulomatous swelling that most frequently involves the mandibular region. Smear examination of pus discharges from skin at the region of mandible revealed presence of gram positive, filamentous organism i.e. Actinomyces bovis. On the basis of clinical findings, microbiological examination and X-ray, it was diagnosed as a Actinomycosis. The treatment carried out was surgical debridement and antibacterial therapy, particularly iodides. In the present case, systemic antibiotics along with surgical debridement lead to complete recovery without any complications.
Keywords: Actinomycosis; buffalo; surgical management; therapeutics
Actinomyces and Nocardia species, are believed to be fungi because of their branching filaments and now classified as higher prokaryotic bacteria (Raymond and Foglia, 1998). Actinomyces bovis is the primary etiologic agent of actinomycosis or lumpy jaw in bovines and is an important cause of economic losses occur directly from debilitation of affected animal and indirectly from slaughter of livestock because of its widespread occurrence and poor response to the routine clinical treatment (Blowey and Weaver, 1990). Actinomycosis is a specific disease characterized by classical rarefying mandibular osteomyelitis and commonly known as 'lumpy jaw' and mixed suppurative and granulomatous inflammatory reactions, connective tissue proliferation and presence of sulphur granules. The most common manifestation of this disease is a rarefying osteomyelitis of bones of head, particularly mandible and maxilla, though the rare cases may involve soft tissues, particularly the alimentary tract (Bertone and Rebhum, 1984).
Actinomyces bovis is a symbiotic inhabitant of oral mucosa that gains access through the abrading and penetrating injury to buccal mucosa and dental alveoli. Involvement of adjacent bone frequently results in facial distortion, loose teeth and dyspnea due to swelling in nasal cavity (Thomas, 1998). Predisposition to disease seems to occur through direct extension of infection from the gums, apparently following injury or as a complication of periodontitis (Jubb et al., 1993). The basic lesion in actinomycosis is represented by granulation tissue having small abscesses, sulphur granules and occasionally draining sinus tracts.
History and Diagnosis
A seven year old Jaffrabadi buffalo about 450 kg was presented with history of gradually increasing swelling on mandibular region. Anamnesis revealed that the owner had increased the dry fodder (wheat straw) in diet for last one month and swelling appeared about 15 days ago. Animal had partially lost its appetite and its regurgitation frequency had decreased. Clinical examination revealed round to circular, hard, painless, localized, chronic, progressive, granulomatous swelling with opening or discharge through the skin (Fig. 1).
The oral cavity was examined for presence of any foreign object or dry feed jammed between the teeth and cheeks. The tentative diagnosis of actinomycosis was made on basis of clinical signs and X-ray which was confirmed later by presence of pus having an appearance of 'sulphur granules' in the cavity of the lesion. Smear examination of the discharging pus stained with Gram's stain revealed presence of gram positive, filamentous organisms i.e. Actinomyces bovis.
Treatment and Discussion
Treatment is started with surgical debridement and anti bacterial therapy for actinomycosis. The hard swelling was matured by topical application of Kaolin poultice twice daily for five days. This caused the swelling to break through the skin and discharge at openings. The pus having an appearance of yellowish 'sulphur granules' was removed. The sulphur granules are almost pathognomonic for actinomycosis and mainly composed of bacterial filaments and mineralized calcium phosphate of host origin, the clubs representing encapsulation of the organisms by layers of a calcium phosphate-protein complex (Radostits et al., 2007).
Debridement and curettement of wound was achieved by sharp surgical debridement using scalpel, curette and scissors, followed by mechanical debridement using dry cotton swabs. The cavity was cauterized using KMn[O.sub.4] crystals and wound was closed by horizontal mattress sutures pattern, using 2/0 chromic catgut. The wound was dressed daily with Tincture of iodine until complete healing, followed by removal of stitches on 10th post-operative day. Strepto-penicillin 5g/day intramuscular was given along with Meloxicam (Melonex (a) @ 2 mg/kg b.wt. IM) for five days as a post-operative measure and Potassium iodide, 10 g/day for 7 days, given orally.
Catamnesis revealed that healing was complete in 15 days with no recurrence and untoward consequences when animal was last examined two months after surgery. Similar to the present study, traditional therapy for actinomycosis includes oral or intravenous dosing of iodides and/or antibiotics such as penicillin and streptomycin but with variable results (Brunton et al., 2005; Radostits et al., 2007). Since the iodide dosing is time consuming and antibiotics/antibacterials have poor penetration into the site of infection, proper treatment protocol for actionomycosis is still anticipated. For the proper management of condition, earlier reports suggest that treatment of any kind is more effective when combined with surgical intervention (Mettler et al., 2009).
Although at first instant, the disease can easily confused with abscesses of cheek muscles and throat region and foreign bodies due to similarity in one or more clinical signs. However following tactful anamnesis and through clinical investigation, it can easily be differentiated. As in later, abscesses of cheek muscles and throat region are quite common when spiny grass-awns occur in diet. They are characterized by their movability and localization in soft tissues with thin, fetid or caseous pus depending on duration of abscess and prompt recovery follows opening and drainage as well as in case of foreign bodies or accumulations of dry feed jammed between teeth and cheek commonly cause a clinical picture which resembles that associated with actinomycosis and the inside of mouth should be inspected if enlargement has occurred suddenly (Radostits et al., 2007).
In the present case, the tentative diagnosis was made on basis of clinical signs and was confirmed later on by the X-ray (Fig. 2) and presence of pus like 'sulphur granules' in excised cavity (Blood and Studdert, 1988). These organisms are obligatory parasites of oropharynx in most of the animals and therefore lesions mainly occur in adjacent tissues of cervicofacial region. Mucosal injury is an essential prerequisite for establishment of infection by organisms; however, tissue invasion in actinomycosis is a complex mechanism. The presence of Staphylococcus aureus as an aerobe may build oxygen tension in injured tissue and favours anaerobic conditions for development of actinomycosis (Farooq et al., 2013). Such aerobes have been associated in actinomycosis and often amplify the pathogenic potential of Actinomyces sp. by providing aggressive enzymes such as hyaluronidases and toxins (Nashiruddullah et al., 2004).
A microbiological investigation is very important to identify the nature of bacteria that causes infection in animals. Consequently, microbial analysis will leads to identification of unknown bacteria that are the causative agents of infection. Accordingly treatment was preceded keeping in view the role of proper debridement of excavated cavity in healing. Appropriate debridement sets the stage for conversion of chronic wounds into acute ones, with eventual healing. In the present case, systemic antibiotics along with surgical debridement lead to complete recovery without any complications.
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B.R. Patel (1), J.S. Patel (2) and S.C. Parmar (3)
Department of Teaching Veterinary Clinical Complex College of Veterinary Science and Animal Husbandry Anand Agricultural University (AAU) Anand - 388001 (Gujarat).
(1.) Assistant Professor and Corresponding author.
(2.) Professor and Head, Department of Veterinary Medicine, Veterinary College, JAU, Junagadh.
(3.) Research Associate, Department of Veterinary Gynaecology and Obstetrics
(a) - Brand of Intas Animal Health, Ahmedabad
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|Title Annotation:||Short Communication|
|Author:||Patel, B.R.; Patel, J.S.; Parmar, S.C.|
|Article Type:||Clinical report|
|Date:||Jul 1, 2016|
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