 Welcome back to our meds smarter lecture series where we're taking a smarter approach to preparing future physician Before we get started if you'll take just a quick minute and click that like button and also Subscribe and turn the bell on so that you'll be notified when we post new videos Let's continue on in our series covering gram positive bacteria and today We're going to discuss nocardia and actinomyces Nocardia and actinomyces are often discussed together because They have some very similar properties and the USMLE likes to quiz you on your knowledge of those properties So we're going to compare and contrast them in a chart here So nocardia is an aerobic bacteria where actinomyces is an anaerobic bacteria Therefore nocardia loves being in the presence of oxygen Whereas actinomyces doesn't like to be in the presence of oxygen it works better it functions better without oxygen The best way to determine which one you're looking for is to do an acid-fast stain With nocardia you will see that it is weakly acid-fast meaning that we will see some red color come out of the bacteria when we stain it with an acid-fast stain and Whereas actinomyces is not acid-fast. It will only remain blue under the microscope The location where we find nocardia is going to be found in the soil There's a lot of oxygen in the soil area therefore nocardia thrives in that aerobic location whereas the Actinomyces is normally found as a normal part of the oral Reproductive and the GI flora. There's not a lot of oxygen that area So it thrives a lot better in that anaerobic environment So what do we see the infections of these particular bacteria cause? Well nocardia causes pulmonary infections Most specifically in patients who are immunocompromised It can mimic certain things like TB but if you do a PPD the Purified protein derivative that PPD test will be negative some other things that it can do is it can be seen in Cutaneous infections after patients who are immunocompetent undergo some sort of trauma So any type of traumatic event that can break the skin can inoculate that skin with nocardia and we can have some cutaneous infections there as well Finally nocardia can spread to the CNS So be aware of that when you are looking for symptoms related to nocardia Actinomyces however because we know it's already normally found in the oral Reproductive and GI flora. It's most commonly associated with those areas. So it can cause those oral facial abscesses And those those abscesses will drain through the sinus tracts Also, it's linked to dental caries when you have teeth extracted at the dentist Or other types of maxo facial trauma. So you've got that nocardia bacteria in your mouth You go to the dentist have some sort of a dental procedure done that inoculates that into that location And that's how we can get an actinomyces infection in the maxillor area and And specifically with actinomyces Israeli we get what is known as yellow sulfur granules That's going to be a very strong buzzword. You'll see this often the yellow sulfur granules are Characteristic of Actinomyces Israeli infection you can also see a pelvic inflammatory disease with patients that have IUDs Especially if it's an IUD that's been in longer than the recommended time frames. Finally our treatments Treating nocardia is treated with sulfonamides like Bactrum TMP smx and then Actinomyces is treated with just your plain penicillins a good way you can remember that is by using the abbreviation snap So you use sulfonamides for nocardia and actinomyces uses penicillin What you're seeing here is a side-by-side representation of the two different bacteria nocardia and actinomyces If you remember to the previous slide that we discussed Nocardia is weakly acid fast therefore that means it's going to stain a red color under an acid fast stain So that makes the one on the left Nocardia and then the one on the right is actinomyces and I'll point out those red cells They're stained weakly acid fast versus the non-acid fast actinomyces If you found this material helpful for your studying, please like and consider subscribing to the channel Also share this video so that more people can benefit from it like you have