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Pediatric Actinomycosis Workup

  • Author: Jorge M Quinonez, MD; Chief Editor: Russell W Steele, MD  more...
Updated: Jan 12, 2016

Laboratory Studies

Microbiologic identifications of the organisms that cause actinomycosis are uncommon. Diagnosis usually relies on the clinical picture and the presence of sulfur granules either observed macroscopically or microscopically. No serologic test or skin test for actinomycosis is available. Actinomyces is usually part of the normal flora; its presence on sputum samples, bronchial washings, or cervicovaginal secretions is not enough to make the diagnosis. Polymerase chain reaction has been used for diagnosis in some research laboratories.

  • Gram stain
    • Gram stain is more sensitive than culture.
    • Actinomyces are identified as gram-positive rods that are non–acid fast in diphtheroidal arrangement.
  • Hematoxylin-eosin stain of sulfur granules - Basophilic masses with a radiating border of eosinophilic terminal clubs
  • Culture
    • Tissue, pus, or sulfur granules are ideal.
    • Use anaerobic transport media.
    • No prior use of antibiotics is imperative.
    • Brain and heart infusion blood agar is cultured anaerobically or enriched with carbon dioxide.
    • Growth is in 5-7 days and may take 2-4 weeks.
  • Other useful stains
    • Grocott-Gomori methenamine-silver nitrate stain
    • P-aminosalicylic acid
    • Goodpasture stain
    • Brown-Brenn stain

Imaging Studies

See the list below:

  • CT scanning of the involved area is useful in differentiating between an inflammatory mass and a tumor.[11]
  • Abdominal and pelvic ultrasonographic studies have been used for diagnosing masses that may be due to actinomycosis.
  • Chest radiography in thoracic actinomycosis may provide some idea of the degree of pulmonary and pleural involvement; however, diagnosing the disease on the basis of radiographic findings alone is impossible.


See the list below:

  • Fine-needle aspiration, biopsy, CT scanning, or ultrasound-guided aspirations and biopsies can be successfully used to retrieve clinical materials for diagnosis.

Histologic Findings

See the list below:

  • Histologic diagnosis is difficult because many specimens contain only a few sulfur granules.
  • The use of a specific monoclonal antibody conjugated with fluorescein is a useful alternative that allows rapid identification by direct staining of clinical materials even after they have been fixed in formalin.
Contributor Information and Disclosures

Jorge M Quinonez, MD Senior Vice President and Chief Medical Officer, Family Health Centers of Southwest Florida, Inc

Jorge M Quinonez, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America

Disclosure: Received consulting fee from Glaxo Smith Kline for speaking and teaching.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

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