Actinomyces/Nocardia
by Fran Savage, DVM & Marv Nelson
edited by Diana Kubitz

In the Brittany and/or other hunting breeds, aerobic abscesses should be suspected any time there is a FIRM swelling:
1) Sublumbar (just behind the ribcage)
2) Thoracic ( on ribcage)
3) Cervical (on the neck)
4) Submandibular (under Jaw).

Pyothorax should be suspected any time the dog is having trouble breathing and chest radiographs reveal pleural effusions (fluid in the outside of the lungs). The single most important key to accurate diagnosis is proper collection of a sample for culture. THIS SAMPLE SHOULD BE COLLECTED BEFORE ANY ANTIBIOTIC TREATMENT.

Before Treatment: Obtain baseline CBC, UA Chem Profile. Begin IV Fluids—LRS (If warranted)

COLLECTION OF SAMPLE:
1) Aspirate abscess or Chest cavity with syringe and a 20-23 gauge needle.
2) IMMEDIATE injection into vacutainer tube WITHOUT exposing to oxygen (exposure will kill anaerobic bacteria).
3) Send vacutainer to lab qualified to do Aerobic and Anarobic cultures. make notation in the analysis to rule out Actinomyces/ Nocardia.

TREATMENT OF ABCESS:
1)Anesthesia- remember these infected animals are very ill with multiple organ dysfunction.
a) A light induction agent such as Ketamine/valium can be used.
b) Follow with intubation and Forane gas.
    1) Lance abscess- Examine exudate (pus) for foreign body material (grass awn, stubble, foxtail, (spear grass,cheat), etc) and SULPHER granules (whitish -grey flecks in pus), IF sulpher granules are present, IT IS NOT NOCARDIA. (VERY IMPORTANT FINDING)
    2) Remove as much of the thick fibrous capsule and necrotic tissue as possible down to muscle or ribcage. Many of the spores and organisms are in this tissue.
    3(Gram stain any sulpher granules found-- if found gram positive filamentous rods-- THINK Actinomyces until proven otherwise.
    4) Place PENROSE drain to maintain drainage for at least one week or until drainage stops. This also exposes organisms to oxygen.
    5) Flush abscess daily with dilute Betadyne solution.

Begin APPROPRIATE antibiotic therapy for Nocardia/ Actinomyces and other anaerobes. Preferred Treatment is Ampicllin (or Amoxicillin) and Antirobe. For Nocardia- Sulphas are drug of choice. (Diana’s note: It is thought that the organisms may have become “immune” to Ampicillin and Amoxicillin and newer drugs such as Baytrill are now being used in combination with Antirobe. However, it is cautioned that others believe that Baytrill should not be used for more than three weeks because of side effects.)

TREATMENT OF PYOTHORAX
1) Anesthetic induction.
2) Place chest drain- examine drainage for foreign bodies and sulpher granules. Chest Drainage Treatment- (Do twice daily until drainage volume decreases dramatically.) then decrease drainage frequency to once daily.)
    a) Aspirate drainage from chest.
    b) Flush with 100 cc sterile saline.
    c) Drain again.
    d)Instill injectable Cephalosporins mixed with 25 cc sterile saline into chest.
3)Treat with appropriate antibiotic therapy.

IF CULTURES results show ACTINOMYCES or other anaerobes( e.g. BACTEROIDES, FUSOBACTERIUM ) antibiotic therapy SHOULD CONTINUE FOR THREE MONTHS. It is VERY important to rest the dog for three months, keeping STRESS to a minimum. (It should be noted that many people have had their animals relapse if this was not followed.) Good quality vitamin therapy is recommended. Many of these animals are anemic and malnourished because of this disease process. END

Marv’s Comment:
At times folks feel pressured to "Defend A Title” and it is tempting to violate the three months rule to run the Nationals or other championships. With Ty his first "lump” was found at jaw area and Fran treated it May 97. We waited for full treatment and rest and since I thought Ty wasn’t very sick, I delivered Ty to camp in Early Aug.

There was heavy pressure in summer camp 97 and on through fall and into a heavy schedule in spring, and repeated in 98, stress, in summer camp, long trips and many days in the trailer. A “ FREEZE UP” in the hind parts was treated with Rimadyl for "intervertebral disc syndrome" and amoxitabs, was ordered to rest three weeks and ease back into training.

At the Chicken Classic, in Bonesteel, South Dakota, without adequate explanation as to why he got so sick or undue alarm, he couldn't stand to eat and we did the “lumps” all over again this time on left side, sublumbar. The treatment was to install drain and treat with Antirobe /ampycillin, no excision, no tests, just a drain for week. Tests were considered to be a waste of money, as the “treatment would be the same anyway.” Fran’s procedures should have been followed. Pressure to defend Ty’s title caused us to run in the 99 Nat's AAA despite a lump I found at Midwest Trial in early Nov at old Sept drain site. I took him to KState the next morning. One of “best small animal vets” tried to send me home to "Watch It". I refused, saying that he was gonna get real sick without treatment. I didn't have Fran’s paper with me and I was not as familiar with the test as I should have been. They agreed to and did an ultra sound and a radiograph, finding an abscess that the needle aspirate had missed, they apologized. The diagnosis, cytology revealed both cocci and rod shaped bacteria, Aerobic culture and sensitivity, an Aerobic culture submitted, treatment was Enrofloxacin and Clavamox twice daily, with hot packs 2 -3 times daily, recheck NOT needed we rested and treated, Ty was eased back into short roadwork and ran the Nat's to defend the title. I brought Ty home at Christmas. The lump returned early January so back to KState, with more surgery, Baytril, and Clavamox.

Now the Pressure was to run him in the US OPEN. Another lump was found in Nebraska in April, another surgery same site, Baytril and Clavamox and here we are. Maybe we don’t deserve this dog, and acted like idiots in hindsight. Ty will always be on antibiotics at least once daily while campaigning and we will always make room for a break from "The Routine" at regular intervals for a good rest and fun time. I don't like and may not accept Ty’s always being on stakeout chains tied by the neck, I’d like to see the dogs in runs constructed for a modicum of freedom. Hope you gain from our experience. Best of luck this fall. Study this paper and BELIEVE.
Regards
Marv

Diana’s Note: Everyday we all hear of some dog suffering from Actinomyces or Nocardia. Fran believed that most cases were misdiagnosed as Nocardia. She felt that the majority of cases were Actinomyces. At the time of her death she was working hard to save dogs from this dreadful disease and would have written a paper to be presented to her peers. We hope that by sharing this information with you, Fran will continue in her quest to save her Brittany friends.