The document discusses Mycobacterium, which includes M. tuberculosis that causes tuberculosis. It describes the characteristics, structures, types, laboratory diagnosis, treatment and drug resistance of mycobacteria.
The document discusses Mycobacterium, which includes M. tuberculosis that causes tuberculosis. It describes the characteristics, structures, types, laboratory diagnosis, treatment and drug resistance of mycobacteria.
The document discusses Mycobacterium, which includes M. tuberculosis that causes tuberculosis. It describes the characteristics, structures, types, laboratory diagnosis, treatment and drug resistance of mycobacteria.
The document discusses Mycobacterium, which includes M. tuberculosis that causes tuberculosis. It describes the characteristics, structures, types, laboratory diagnosis, treatment and drug resistance of mycobacteria.
1 Introduction The organisms that belong to the genus Mycobacterium are Aerobic Although some may grow in reduced oxygen concentrations Non–spore forming Non-motile Very thin Slightly curved or straight rods.
Mycobacterium spp. have an unusual cell wall structure.
The cell wall contains N-glycolylmuramic acid instead of N- acetylmuramic acid, and it has a very high lipid content, which creates a hydrophobic permeability barrier. Mycobacteria are difficult to stain 2 Cont’d Relatively slow growth (two groups) Rapid growers (Visible colonies in <7 days) Slow growers (Visible colonies in > 7 days)
Mycobacteria can be divided into two major groups,
based on fundamental differences in epidemiology and association with disease: Those belonging to the M. tuberculosis complex and the NTM group.
3 Mycobacterium tuberculosis Complex The mycobacterial species that occur in humans and belong to the M. tuberculosis complex include: M. tuberculosis Mycobacterium bovis Mycobacterium africanum Mycobacterium caprae Mycobacterium microti Etc…
All of these species are capable of causing tuberculosis.
The organisms that belong to the M. tuberculosis complex
are considered slow growers, and colonies are nonpigmented. 4 Cont’d M. tuberculosis is the cause of most cases of human tuberculosis, particularly in developed countries.
Inhalation of a single viable organism has been shown to
lead to infection, although close contact is usually necessary.
After ingestion of milk from infected cows, M. bovis may
penetrate the gastrointestinal mucosa or invade the lymphatic tissue of the oropharynx.
An attenuated strain of M. bovis, bacillus Calmette-Guérin
(BCG), has been used extensively in many parts of the world to immunize susceptible individuals against tuberculosis. 5 Cont’d Tuberculosis may mimic other diseases, such as pneumonia, neoplasm, or fungal infections.
Clinical manifestations in patients infected with M.
tuberculosis complex may range from asymptomatic to acutely symptomatic.
Patients who are symptomatic can have systemic
symptoms, pulmonary signs and symptoms, signs and symptoms related to other organ involvement (e.g., the kidneys), or a combination of these features. 6 Laboratory Diagnosis of Mycobacterial Infections Specimens received by the laboratory for mycobacterial smear and culture must be handled in a safe manner.
Acid-fast bacilli can infect almost any tissue or organ of the
body.
Successful isolation of these organisms depends on the
quality of the specimen obtained and the use of appropriate processing and culture techniques by the mycobacteriology laboratory.
Most specimens are respiratory samples
7 Cont’d Processing to recover acid-fast bacilli from clinical specimens involves several complex steps, each of which must be carried out with precision.
Specimens from sterile sites can be inoculated directly
to media (small volume) or concentrated to reduce volume. Other specimens require decontamination and concentration.
8 Mycobacterium tuberculosis colonies on Lowenstein-Jensen agar after 8 weeks of incubation.
Cont’d
9 Cont’d Acid-Fast Stains The cell walls of mycobacteria contain long-chain, multiple cross-linked fatty acids, called mycolic acids. Mycolic acids contribute to the characteristic of acid- fastness that distinguishes mycobacteria from other bacteria. Visualization of acid-fast bacilli in sputum or other clinical material should be considered presumptive evidence of tuberculosis.
10 Cont’d Fuchsin Acid-Fast Stains. The classic carbolfuchsin stain (Ziehl-Neelsen) requires heating of the slide for better penetration of the stain into the mycobacterial cell wall Hence, it is also known as the hot stain procedure. With Ziehl-Neelsen staining, Mycobacterium spp. appear red or have a red-blue, beaded appearance, whereas nonmycobacteria appear blue.
11 Cont’d
12 Treatment Drug-resistant tuberculosis is a major health threat
More than 500,000 cases of multidrug-resistant (MDR)
tuberculosis occur each year.
MDR tuberculosis is resistant to rifampin and isoniazid,
the two drugs most often used as effective treatment against tuberculosis.
Strains of extensively drug-resistant tuberculosis (XDR TB)
are emerging that are resistant not only to rifampin and isoniazid, but also to quinolones and other drugs, such as aminoglycosides. 13 Cont’d To prevent the selection of resistant mutants, treatment of tuberculosis requires four drugs: Isoniazid
