A 40-year-old man presents to the ED with a painful and swollen jaw. Two days ago he had a tooth extraction where the gums and jaw were swollen and painful. "Nodules" are felt below the surface of the tissues which are not lymph nodes. Which member of the gingival normal flora will grow contiguously into the damaged tissues, producing tissue swelling and ultimately, if untreated, will develop sinus tracts that will erupt to the surface, liberating the "nodules"?

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Quizplus · Accepted Answer

Actinomyces israelii grows contiguously in tissues, crossing anatomic barriers and causing a lumpy jaw, which is characterized by swelling and, sometimes, sinus tract formation with sulfur granules (3D colonies). It also invades bone. M. tuberculosis may be hematogenously spread to any tissue but is not associated with tooth extraction. Nocardia can also cause a similar infection, but the source is usually environmental nocardiae introduced by trauma; therefore, it generally involves extremities.

A 40-Year-Old Man Presents to the ED with a Painful