Commensal actinomyces in normal tonsil
Presents with asymetrical tonsillar enlargement
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Routine sections of tonsillar tissue.
There are rounded to slightly irregular aggregates of Actinomyces organisms seen in tonsillar crypts. On higher power, thin filamentous organisms can be identified radiating from the edge of the aggregates.
Actinomyces israelii is a normal commensal organism in the oral cavity so in this case the aggregates are non-pathogenic.
Actinomyces are filamentous, gram-positive, anaerobic bacteria. They were in the past mistakenly classified as fungi, probably because of their filamentous morphology, and sometimes more chronic clinical presentation. The most common commensal and pathogenic human species is Actinomyces israelii .
Actinomyces israelii is a commensal organism of the oral cavity so the rounded aggregates of Actinomyces organisms seen above in tonsillar crypts are not pathogenic. The aggregates can also be seen in the setting of clinical infection, particularly in puralent material (pus) draining from abscesses, where they are large enough to be seen macroscopically and are said to resemble 'sulphur granules'.
Clinical infection with Actinomyces is usually treated with surgical drainage and antibiotics (Penicillin).