Nocardia and actinomyces can be differentiated by

Both are Gram +, filamentous rods, slow growing, produce sulfur granulesNocardia is acid fastNocardia spp:General characteristicsCultural characteristics*Strict aerobe*Acid fast ( 1 % H2SO4 )*Selective media - Colistin -nalidixic acid agar, Buffered charcoal yeast agar*Selective growth by inoculating at 45 deg C*Also grows in Sabouraud dextrose agar and LJ mediumBiochemical reactions*Catalase positive, urease positiveClinical features*Causes pneumonia, mycetoma DiagnosisTreatment*Paraffin bait technique for isolation*Culture*PCR assay*CotrimoxazoleActinomyces spp:General characteristicsCultural characteristics*Gram positive nonmotile, nonsporing, non-capsulated filaments*Anaerobic or microaerophilic and non-acid fast*Spidery molar teeth colony in solid media ;*Fluffy ball at bottom of liquid mediumClinical featuresFour main clinical forms of Actinomycosis:*Cervicofacial with indurated lesions on the cheek (Lumpy jaw)- most common (60% cases)*Thoracic (pleural and pericardium)*Abdominal - around caecum (20% cases)*Pelvic- associated with IUCDsDiagnosisTreatment*Sulphur granules contain gram-positive bacilli surrounded by clubs - Sunray appearance *Actinomycotic grains or sulfur granules ++- size ranges from 0- 5 mm*Inoculation of the granules into thioglycollate liquid medium or in BHI agar incubated anaerobically at 37degC*Serology: gel diffusion and IFT*Penicillin or tetracyclineRef: Ananthanarayan 9th edition, p322