Mycobacteria

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Dr. Ashish V.Jawarkar

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Mycobacterium • Name fromMyco and Bacteria, Fungus like bacteria • Because it forms mould like growth on liquid cultures Dr. Ashish V. Jawarkar

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Mycobacteria that infecthumans • M. Tuberculosis – TB • M. Leprae – Leprosy • Non tuberculous mycobacteria / atypical mycobacteria Dr. Ashish V. Jawarkar

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Mycobacterium Tuberculosis • • • • • • • • • Morphology Growth characteristics Biochemicalreactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment Dr. Ashish V. Jawarkar

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Morphology • Neither grampositive, nor negative • Acid fast • They have mycolic acid in their cell wall which makes them acid fast • Difficult to decolorise with organic acids Dr. Ashish V. Jawarkar

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Slightly curved rods Nonmotile Non capsulated Dr. Ashish V. Jawarkar

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• • • • • • • • • Morphology Growth characteristics Biochemical reactions Resistance Pathogenicityand virulence Epidemiology Diseases caused Laboratory diagnosis Treatment Dr. Ashish V. Jawarkar

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Growth characteristics • • • • • Obligate aerobes Growslowly – generation time 15 hours Colonies appear in two weeks Optimum temperature is 37 deg Solid media most commonly used – LJ media Dr. Ashish V. Jawarkar

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Biochemical tests to differentiateMTB from atypical mycobacteria • Niacin test – – adding cyanogen bromide+aniline + ethanol = canary yellow color • Paranitrobenzoic acid – MTB cannot grow in presence of this • Catalase peroxidase test – MTB is weakly positive • Aryl sulfatase test – Negative for MTB Dr. Ashish V. Jawarkar

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Treatment and Resistance •DOTS – directly observed treatment shortcourse – HRZE for 4 months – HR for 2 months • H – isoniazid R – rifampicin Z - Pyrazinamide • E - Ethambutol Dr. Ashish V. Jawarkar

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MDR-TB • Resistant toisoniazid and rifampicin XDR-TB • Resistant to all drugs Dr. Ashish V. Jawarkar

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Pathogenicity and virulence •Its pathogenicity is due to complex lipids like mycolic acid in cell wall.. This makes it – – – – – Acid fast Resistant to antibiotics Resistant to disinfectants like acid and alkalis Resistant to immune system Resistant to destruction by macrophages Dr. Ashish V. Jawarkar

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Epidemiology • Source –Humans with TB • Spread – droplet nuclei – inhaled • India – more than 40 percent population – that is nearly half of us are infected • Only saved due to our immunity • To stop TB – RNTCP – revised national tuberculosis control program has been started – offering DOTS to nearly 15 million patients daily – free of charge Dr. Ashish V. Jawarkar

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Tuberculosis • Pulmonary • Extrapulmonary Dr. Ashish V. Jawarkar

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Pulmonary Dr. Ashish V.Jawarkar

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Lab diagnosis • Sample– sputum for pulmonary, biopsy for extrapulmonary sites • Stain – Zn stain • Culture – LJ media • Raised ESR • PCR – polymerase chain reaction Dr. Ashish V. Jawarkar

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Montoux test • PPD/tuberculinis injected into skin • Look for induration of skin Dr. Ashish V. Jawarkar

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Treatment • DOTS Dr. AshishV. Jawarkar

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Mycobacterium leprae Dr. AshishV. Jawarkar

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• Causes leprosy •Seen in developing countries like India only Dr. Ashish V. Jawarkar

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• • • • Slightly curved rods Singlyor in groups Cigar bundle appearance Lepra cells Dr. Ashish V. Jawarkar

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Growth characteristics • Cannotbe cultivated in vitro on any media • Grown in foot pad of armadillo Dr. Ashish V. Jawarkar

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Biochemical reactions • Cannotbe grown.. • Cannot know biochemical reactions Dr. Ashish V. Jawarkar

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Resistance • Not known Dr.Ashish V. Jawarkar

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• ---- Dr. AshishV. Jawarkar

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Epidemiology • • • • Human disease only Source– nasal secretions Entry – respiratory tract / skin Not highly communicable Dr. Ashish V. Jawarkar

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Diseases caused • • • • • Leprosy Affects skinand nerves Hypoaesthetic patch, thickened nerves Lion face, saddle nose, autoamputation Two main types – tuberculoid leprosy, lepromatous leprosy Dr. Ashish V. Jawarkar

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Tuberculoid leprosy aka paucibacillaryleprosy Dr. Ashish V. Jawarkar

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Tuberculoid leprosy Dr. AshishV. Jawarkar

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Multibacillary leprosy/lepromatous leprosy Dr. AshishV. Jawarkar

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AUTO AMPUTATION Dr. AshishV. Jawarkar

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Lab Diagnosis • Sample– biopsy from nasal mucosa, skin lesions, ear lobes • Stained with modified ZN stain – use 5% H2SO4 instead of 20% • Cannot be cultured Dr. Ashish V. Jawarkar

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LEPROMIN TEST • Methodis similar to tuberculin test • Injected antigen is lepromin • Reaction is read at – 48 hours – fernandez – 3-4 weeks - mitsuda Dr. Ashish V. Jawarkar

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• MDT Dr. AshishV. Jawarkar

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Treatment • Multi drugtherapy consisting of – RIFAMPICIN – DAPSONE Dr. Ashish V. Jawarkar

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NOT COVERED • ATYPICALMYOBACTERIA – Can be asked for short note – 5 marks Dr. Ashish V. Jawarkar

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Mycobacteria

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