This document provides an overview of Non-Tuberculous Mycobacteria (NTM) and Mycobacterium leprae, the bacterium that causes leprosy. It discusses the characteristics, pathogenicity, epidemiology, clinical presentation, diagnosis, treatment and prevention of NTM and leprosy. Key points include that NTM can cause disease in immunocompromised individuals, M. leprae causes the chronic disease leprosy which primarily affects the skin and peripheral nerves, and treatment involves multidrug therapy to cure the infection and prevent disability.

1. Non-Tuberculous Mycobacteria (NTM) Mycobacterium leprae Dr Kamran Afzal Asst Prof Microbiology

4. Reservoir of Mycobacteria Soil, water, animals Yes M chelonae Soil, water, animals Yes M fortuitum Unknown No M ulcerans Soil, water, birds Possibly M avium- intracellulare Soil, water Possibly M scrofulaceum Fish, water Rarely M marinum Water, cattle Rarely M kansasii Human No M leprae Human, cattle No M bovis Human No M tuberculosis Reservoir Environmental contaminant Mycobacterium

9. ‘ Buruli’ ulcer

10. Epidemiology

12. Global Leprosy Case-load : 1985 Vs 2000 Vs 2003 The dramatic decline is attributed to the effective use of multi-drug therapy(MDT) 0.6 Million 2000 0.5 Million < 1 Million 12 Million 2003 1998 1985 NIL- Multi-Drug Resistance following MDT is NOT reported 11.2 million 100% 1/10,000 14 2000 NIL - Multi-Drug Resistance following MDT is NOT reported High-since single drug-dapsone was given for long periods, in low doses 5. Drug Resistance 13.5 million Accurate Data Not Available 4. Patients Cured 100% < 10% 3. Patients on MDT < 1/10,000 10/10,000 2. Global Prevalence 9 122 1. Number of Countries with Prevalence Rates of > 1/10,000 population 2003 1985 Parameter

13. Global Leprosy Situation In January 2004 Prevalence as of 1 January 2004

21. Leprosy Types Ridley-Jopling Classification Nil Many with globi Many with globi LL Poor Few Moderate BL Partial None Few BB Less good None None or few BT Good None None TT Immune response Bacilli in nasal smears Bacilli in skin smears Leprosy type

24. Lepromatous and Tuberculoid Leprosy Tuberculoid leprosy Low infectivity Localised infection Normal serum Ig Normal T cell response Poor growth of mycobacteria in macrophages (Pauci-bacillary) Positive Lepromin test Lepromatous leprosy High infectivity Disseminated infection Hyper-gammaglobulinaemia Non-responsive Florid growth of mycobacteria in macrophages (Multi-bacillary) Negative Lepromin test

29. Clinical Picture

30. Clinical Picture

33. Effects of sensory loss Sensory fibre loss Decreased sensation Patient may not feel • HEAT • PAIN • TOUCH • PRESSURE Because of NO PAIN, Patient neglects injuries Decreased sensation

34. Effects of sensori-motor loss

38. ZN staining

44. Treatment