Download - Mycobacterium
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Mycobacterium
Saddam Ansari Tbilisi State Medical University
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Kingdom: BacteriaPhylum: ActinobacteriaOrder: ActinomycetalesSuborder: Corynebacterinea
eFamily:
Mycobacteriaceae
Genus: Mycobacterium
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Mycobacterium Tuberculosis
Mycobacterium Leprae (uncommon)
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Lipid Rich Cell WallMycolic acids
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Acid-Fast (Kinyoun) Stain
Cord growth (Serpentine arrangement) of virulent strains.
Kinyoun similar to Ziehl-Neelsen Stain
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Ziehl-Neelsen Stain Procedure1. Cover with tissue paper or if
not then without paper its possible.
2. Flood slide with carbolfuchsin, the primary stain, for 3-5 minutes while heating with steam or heating on hot plate.
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Continued…3. Remove paper cover,
decolorize slide with a mixture of hydrochloric acid and ethanol.
4. Counterstain with methylene blue or Malachite green.
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Pathogenic MycobacteriumM. tuberculosis Complex
◦M. tuberculosis - Common◦M. leprae - Uncommon◦M. africanum◦M. bovis Rare◦M. ulcerans
All are Strictly Pathogenic
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Runyon Group I (Slow growing photochromogens)
◦M. kanasii - Common ◦M. marinum ◦M. simae Uncommon
All are usually pathogenic not strictly
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Runyon Group II (Slow growing scotochromogens)
◦M. szulgai◦M. scrofulaceum Uncommon◦M. xenopi
Usually pathogenic Sometimes pathogenic
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Runyon Group III (Slow growing nonchromogens)
◦M. avium complex – common ◦M. genavense◦M. hemophilum uncommon ◦M. malmoense
Strictly pathogenic Usually pathogenic
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Runyon Group IV (Rapid growers)
◦M. fortuitum◦M. chelonae Common ◦M. abscessus ◦M. mucogenicum Uncommon
Sometimes pathogenic
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MYCOBATERIUMTUBERCULOSIS
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Structure and PhysiologyWeakly gram positiveStrongly acid fastAerobic bacilli
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Mycobacterium Tuberculosis Stained with Fluorescent Dye
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Lipid rich cell wall, makes organism resistant to
◦Disinfectants◦Detergents◦Common antibacterial antibiotic
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Virulence Capable of intracellular growth in
unactivated alveolar macrophages
Disease primarily host response to infection
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Epidemiology Worldwide , one third of the
population is infected
16 million existing cases and 8 million new cases
Most common in Southeast Asia, Sub- Shaharan Africa and Eastern Europe
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Patients at the greatest risk are the
◦Immunocompromised patients (HIV)◦Drug and alcohol abusers◦Homeless ◦Individuals exposed to infected
patients
Humans are only the reservoir Person to person infection by aerosols
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Diseases Primary infection is lungs
Dissemination to any other site occurs mostly in the immunocompromised and untreated persons
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DiagnosisPositive PPD
Chest X-Ray
Microscopy and culture – it is sensitive
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Treatment, Prevention and ControlMultiple drugs regimens and
prolonged treatment are required to prevent development of drug resistance strains
MDR-TB is global health threat
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Continued…Treatment include isoniazid and
rifampin for 9 months + pyrazinamide + ethambutol or streptomycin
Immunoprophylaxis with BCG in endemic countries
Control- active surveillance , prophylactic and therapeutic interventions and monitoring of the case
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Progression of Pulmonary TB
Pneumonia
Granuloma formation with fibrosis
Caseous necrosis• Tissue becomes dry & amorphous (resembling
cheese)• Mixture of protein & fat (assimilated very
slowly)
Calcification• Ca++ salts deposited
Cavity formation• Center liquefies & empties into bronchi
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MYCOBACTRIUM LEPRAE
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Structure and PhysiologyWeakly gram positive
Strongly acid fast bacilli
Lipid rich cell wall
Unable to culture on artificial medium
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Virulence Capable of intracellular growth
Disease primarily from host response to infection
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Epidemiology Common in Africa and AsiaArmadillos are naturally infected
and are reservoirLepromatous form of disease is
highly infectious Spreads by inhalation of aerosolsIndividual in direct contact with
patients are at greater risk
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Forms of DiseasesTuberculoid form of leprosy
Lepromatous form of leprosy
Intermediate form of leprosy
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DiagnosisMicroscopy is sensitive for the
lepromatous but not for tuberculoid form
Skin testing is required for tuberculoid leprosy
Culture cannot be used
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Treatment, Prevention and ControlDapsone with or without rifampin is
used to treat tuberculoid form Clofazimine is added for the
lepromatous formTherapy is usually prolonged
For prophylaxis –DAPSONE
Control – by prompt recognition and treatment of infected patients
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Lepromatous form
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Tuberculoid form
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Pre and Post Treatment
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