Mycobacteria

DR. Noura AL-Sweih

Mycobacterium
Acid and alcohol fast bacilli
[AAFB] or [AFB] Why??
Thick, lipid-rich,
waxy cell wall
Description
Slender, beaded, AFB
Ziehl-Neelsen stain/
ZN stain
Mycobacterium

Not grow on
ordinary media,
grow slowly on
Lowestein-
Jensen medium /
LJ
Mycobacterium
Divided into two main groups
A- Typical / Tubercle bacilli
Mycobacterium tuberculosis
Mycobacterium bovis
Tuberculosis
Mycobacterium africanum
Mycobacterium leprae
Leprosy
Mycobacterium
B- Mycobacterium other than
tubercle bacilli (MOTT) /
Environmental mycobacterium ,
saprophytes or opportunistic
pathogens
Divided into 4 groups according to
their production of pigment & rate of
growth
 Group I Photochromogens
 Group II Scotochromogens
Slow growers
Mycobacterium Tuberculosis
Pathogenesis
Main virulence factor  is the ability
to survive within macrophage
Immune response is cell-mediated
immunity
Protective immunity  recovery
Nature of immune response change
with time
Mycobacterium Tuberculosis
Definition
 Tuberculosis is a
chronic granulomatous
disease caused by three
related species
 M. tuberculosis human
tubercle bacilli
 M. bovis bovine tubercle
bacilli
 M. africanum 
intermediate form /
Mycobacterium Tuberculosis
Tuberculosis
Usually affects lung, but many other
organs may be affected
Incidence is increasing due to
emergence of AIDS cases
Mycobacterium Tuberculosis
Epidemiology
Human tuberculosis is
transmitted by inhalation
Bovine tuberculosis is
transmitted by ingestion of
contaminated milk
According to WHO
100 million infected yearly
8-10 million develop
disease
4-5 million become
 Mycobacterium Tuberculosis
Clinical infections
Mycobacterium Tuberculosis
Primary tuberculosis
Inhalation of bacilli
↓
Replicate inside
macrophage
↓
(Ghon focus = initial
lesion )
MycobacteriumTuberculosis
 Ghon focus
& Primary complex
 Enlarged hilar LN

 Activated macrophages
⇓
 Fuse & form giant cell
⇓
 Granuloma with necrotic center 
Caseation
Primary complex Granuloma &
caseation
Mycobacterium Tuberculosis
 Limit primary infection / not all bacilli
died some remain dormant
 Few cases  disseminate 
meninges, bone, joint, kidney (Miliary
Tuberculosis)
Mycobacterium Tuberculosis
Post-Primary Tuberculosis
Reactivation or Reinfection
Often affect upper lobes of lung
Same granulomatous reaction but
more tissue necrosis
Cavitations
Bacilli gain access to sputum
Open TB / Infectious
Dissemination is unusual
Tuberculosis
Mycobacterium Tuberculosis
Mycobacterium Bovis
Ingestion of Bacilli
Primary complex involves
Tonsil & cervical lymph node
Scrofula
Intestine [ileocecal region]&
mesenteric lymph node
Primary Complex
Scrofula
Mycobacterium Tuberculosis
Tuberculin Test
Test done by using
Purified Protein
Derivative [PPD]
Intracutaneous
injection Mantoux
method
Used as Diagnostic
test, but with limited
usefulness?
Used to identify
patients who are
Treatment of Tuberculosis
First-line anti-tuberculosis drugs
Rifampicin + isoniazide +pyrazinamide
+/- ethambutol
Why Combination??
Action of anti-TB drugs depend on
population dynamic of MTB within the
lesion
Mutation to drug resistance occurs at
low & constant rate in all
mycobacterium population
Combination therapy is needed to
prevent selection of resistance & MDR-
Treatment of Tuberculosis
Three stages of replication
 Free active replicating MTB in
cavity
 Slowly replicating in
macrophage in acidic PH
 Few are Dormant / Persister
Treatment of Tuberculosis
Antituberculosis drugs

Sterilizing   Bacteristati
Bactericidal c

Rifampicin Isoniazide Ethinomide

Pyrazinami Ethambutol P-
de Streptomyc aminosalicy
in lic acid
 
Treatment of tuberculosis
Anti-microbial activity of Anti-
TB
 Isoniazide/ rapid bactericidal
against free replicating bacilli & no
effect against dormant bacilli
 Pyrazinamide/ active at acidic PH
and kill slowly replicating bacilli
 Rifampicin/kill dormant bacilli &
bactericidal against rapidly and
slowly replicating bacilli
Treatment of Tuberculosis
Treatment Regimen
Short courses are based on
intensive regimens
Intensive phase of Rifampicin +
Isoniazide + Pyrazinamide for 2
months if there is resistance
ehambutol may be used as fourth
drug
Continuation phase of Rifampicin +
Isoniazide for 6 months
Treatment of Tuberculosis
Three phases of response to
therapy
Phase 1( first 1-2 weeks)
Large No. of actively replicating
bacilli killed by mainly by Isoniazide
and Rifampicin
Phase 2 ( 2-8 weeks)
Less active bacilli are killed by
Rifampicin & Pyrazinamide
Phase 3 ( Continuation phase)
Control of Tuberculosis
 Earlydetection & effective
treatment
 Vaccination/ BCG
It is a living attenuated vaccine
Derived from M.bovis
It is given intracutaneously
 Chemoprophylaxis
Contact with open TB
Isoniazide alone
Mycobacterium Leprae
Leprosy
Infection often causes severe
disfigurement & deformity
Still prevalent in some parts > 5
million case
Description
AFB/ like TB BUT
Not grow in any type of artificial
media /vitro
Mycobacterium Leprae
Pathogenesis
Target is nerve cells  Nerve damage
The progression of the disease is
determined by immune response to
the bacilli
– Tuberculoid Leprosy (TT)/ few bacilli &
strong immune reaction
– Borderline Tuberculoid (BT)
– Borderline Lepromatous (BL)
– Lepromatous Leprosy (LL) / Many bacilli &
no immune response
Leprosy
MOTT/ Mycobacteria Other Than

tuberculosis bacilli
 Divided into 4 groups according to
their production of pigment & rate
of growth
  * Group I Photochromogens

 * Group II Scotochromogens Slow

growers
 
 * Group III Non-chromogens

 * Group IV Rapid
 MOTT/ Mycobacteria Other Than
tuberculosis bacilli

MOTT of Clinical Importance:

 Name Growth character
Infection
 M.kansasii Photochromogen
Pulmonary
 M.Scrofulaceum Scotochromogen
Lymphadenitis
&pulmonary
 M.Avium – Most
common Intacellulare Non-Chromogen
At ypi cal M ycobac te rium
MOTT/ Mycobacterium Other Than
tuberculosis bacilli

Treatment:

 Most are resistant to Anti-TB

 . A 74-year old man developed vertebral
osteomyelitis and his blood culture grew
Gram-positive cocci. Which of the
following is a possible etiological agent?
 Staphylococcus saprophyticus
 Klebsiella pneumoniae
 Staphylococcus aureus
 Mycobacterium tuberculosis
 Haemophilus influenzae
 . A 74-year old man developed chronic
vertebral osteomyelitis and his blood
culture grew no microoganism. Which of
the following is a possible etiological
agent?
 Staphylococcus saprophyticus
 Klebsiella pneumoniae
 streptococcus pyogenes
 Mycobacterium tuberculosis
 Haemophilus influenzae
A 2-day old newborn developed
septicemia. The following is a
common causative agent
 Haemophilus influenzae
 Mycobacterium tuberculosis
 Streptococcus agalactiae (Group
B streptococcus)
 Boredetella pertussis
 Clostridum tetani
A 48-year old lady, a known case
of diabetes mellitus presented with
cellulitis in her left foot and
diagnosed as a case of diabetic
foot. Foot swab grew β- hemolytic
Gram-Positive cocci arranged in
chain and resistant to bacitracin.
 What is the most likely pathogen?
 What other infection this organism
may cause in diabetics?
 A 6-year old girl had sore throat and fever
three days before visiting her family doctor.
Next day still complaining of sore throat, fever
and generalized erythema. On examination
she had fever 38.60C with red anterior
pharynx and soft palate and generalized
maculopapular skin rashes were seen this girl
most likely had
 Brucellosis
 Enteric fever
 Toxic shock syndrome
 Scarlet fever
 Scalded skin syndrome
 A 10-year old boy had Buffy eyes and dark
urine 2-days before visiting his doctor. On
examination the child had edema and high
blood pressure. Urine routine examination
revealed proteinuria and hematuria. The
doctor suspected that he might be a case of
post streptococcal acute glomerulonephritis.
The doctor should
 Take the travel history from the parents
 Send throat swab for routine culture
 Start penicillin prophylaxis to prevent
recurrence
 Look for antibodies to streptolysin O (ASO)
 Cefotaxime is the drug of choice for all
of the following clinical cases EXCEPT A
 2-year old child with pneumococcal
meningitis
 3-days old neonate with Escherichia
coli meningitis
 9-year old Pakistani girl with enteric
fever
 4-year old boy with right knee joint
arthritis
 Erythromycin is the drug of choice
for all of the following clinical
cases EXCEPT A
 6-year old girl with tonsillitis and
allergic to penicillin
 12-year old girl with
Mycoplasma pneumonia
 3-year old boy with whooping
cough
 27-year old man with
Food poisoning
 Dairyproducts
 Chinese food
 Japanese fresh seafood
 Chicken
 Home made canned food
 Hamburger