Mycobacteria

Mycobacterium
Genus species Mycobacterium tuberculosis Mycobacterium leprae Mycobacterium marinum
Slender, beaded bacilli, non-sporing, not stained by
Gram’s method. Use Ziehl Neelsen. Lipid: Mycolic
acid (Granuloma formtn), waxes, phosphatides.
Protein: responsible for tuberculin test.
Polysaccharides
Culture X grow on ordinary media Inoculation of footpads of mice/
Grow on Lowenstein-Jensen medium armadillos
2-3 weeks incubation at 37°C Animals develop slow-growing
Shld b kept 6-8 weeks b4 discard granulomas at injctn site
X grow in vitro
Agnc
structure
Growth Obligate aerobe, Slow growing. X grow at body T
characteristics
tionducPro

Enxymes&
others
Toxin Endo
Exo
Habitat Swimming pool, aquarium.
Pathology Tuberculosis 4 types: Fish tank granuloma.
Lepromatous Disease in fish & human.
Tuberculoid Skin ifxn/ deeper ifxn-arthritis,
Border line lepromatous osteomyelitis assctd w aquatic
Border line tuberculoid xtvt
Epidemiology Spread in community is slow Often
subclinical
Quite ifxs but low xpression of disease in
infctd person
Widespread, tropical climate, 10million
cases worldwide
Aetiology Post 1° ifxn
-Endogenous: reactivation of latent fociformed d/r 1°
ifxn
-Exogenous: reinfection by inhalation of infctd
respirtry scrtn from open tuberculosis case
Pathogenesis 1° ifxn Incbtn period: 3-5yrs
Orgnsms engulfd by alveolar mΦ in whch they survive Route of infctn: inhalation
& multiply In tuberculoid leprosy, pt is capable of
Non-resident mΦ attrctd to site, ingest mycobacteria, mounting effective CMI response, makes
carry via lymphtc to local hilar LN, stimulate CMI it possible for mΦ to destroy
Post 1° ifxn
Modifd by dvlpmnt of host HS
Latent period d/r which tubercle bacilli remain
dormant b4 initiatg actve disease years after 1° ifxn
CMI plays important role
Lesion Slowly progressive, chronic granulomatous ifxn whch Lepromatous Confined to cooler skin surface
most often affects lung Diffuse & scattered lesion e.g nose
1° ifxn Commonly involve mucous membranes
Primary complex- Gohn focus w marked enlargement Numerous M leprae present in lesion
of regional hilar LN Progressive & severe
Post 1° ifxn Tuberculoid
> localizd + fibrootic Localized lesion
Often involves lung, commonly apices Shows early nerve involvement &
If untreated, chronic progressive disease devlps + anaesthesia
exudation + caseation surroundd by dense fibrosis Scanty m leprae in lesion
Can cavitate Benign & often self healing

Clinical signs 1° ifxn

Many asymptomatic/ vague & non-spcfc symptoms-
malaise, fever, anorexia, sweat, weight loss,
tachycardia. Cough x prominent
Post 1° ifxn
Non specfc ill health + fever
Resprtry symptom: cough, haemoptysis, pneumonic
illness that fails to respond to conventional Abtc
Complication Spread of 1° ifxn
Tuberculous bronchopneumonia
Miliary tuberculosis
Tuberculous meningitis
Bone & joint tuberculosis
Genitouinary tuberculosis- renal, endometrial
Diagnosis Direct microscopy: Specimen- skin biopsy, lesion scrapings
-Fluorescent microscopy w auramine staining AFB staining
 -Ziehl Neelsen
Specimen: depends on suspctd ifxn site. E.g renal-
early morning urine
Skin test: Tuberculin test reagents
-Old Tuberculin- x used anymore
-PPD: Obtained by chemical fraction of OT. Used
currently
+ve result 4-6weeks after ifxn: local erythema &
indurtn, 48-72hrs later
Treatment 2 months: Isoniazid, Rifampicin, Ethambutol Dapsone, Rifampicin, Cifozamine
4/7/10 months: Isoniazid, Rifampicin Control: pt isolation
Vaccine: BCG
Atypical mycobacteria
A gp of miscellaneous mycobacteria of low pathogenicity for man
Also called MOTT (Mycobacteria other than tuberculosis)
Culture: Generally grow on Lowenstein Jenson medium
Sometimes at lower (25°C) / higher T (45°C) than normal