A recent immigrant from rural Brazil presents with a swollen face and extremely poor dental hygiene, including loss of an adult tooth, which appears to be the focus of the current infection. There are two open ulcers on the outside of the swollen cheek. Small yellow "grains" are seen in one of the ulcers. Gram stain shows purple-staining fine filaments. What is the most likely disease?

Question

Quizplus · Accepted Answer

The disease syndrome is lumpy jaw, which is a form of mycetoma. The location of the lesions and presenting signs seen in this patient suggest actinomycotic mycetoma, a bacterial infection caused by the Actinomyces part of the gingival crevices flora. (Students: You needed a nonfungal question!) Yeasts will also stain Gram-positive. Remember that Actinomyces is a Gram-positive anaerobic bacterium that is not acid-fast.

A Recent Immigrant from Rural Brazil Presents with a Swollen