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  1. 1. MycobacteriumSaddam AnsariTbilisi State Medical University
  2. 2. Kingdom: BacteriaPhylum: ActinobacteriaOrder: ActinomycetalesSuborder: CorynebacterineaeFamily: MycobacteriaceaeGenus: Mycobacterium
  3. 3.  Mycobacterium Tuberculosis Mycobacterium Leprae(uncommon)
  4. 4. Lipid Rich Cell WallMycolic acids
  5. 5. Acid-Fast (Kinyoun) Stain Cord growth(Serpentinearrangement) ofvirulent strains. Kinyoun similarto Ziehl-NeelsenStain
  6. 6. Ziehl-Neelsen StainProcedure 1. Cover with tissue paper or if notthen without paper its possible. 2. Flood slide with carbolfuchsin, theprimary stain, for 3-5 minutes whileheating with steam or heating on hotplate.
  7. 7. Continued… 3. Remove paper cover, decolorizeslide with a mixture of hydrochloricacid and ethanol. 4. Counterstain with methylene blue orMalachite green.
  8. 8. Pathogenic MycobacteriumM. tuberculosis Complex◦ M. tuberculosis - Common◦ M. leprae - Uncommon◦ M. africanum◦ M. bovis Rare◦ M. ulceransAll are Strictly Pathogenic
  9. 9. Continued…Runyon Group I (Slow growingphotochromogens)◦ M. kanasii - Common◦ M. marinum◦ M. simae UncommonAll are usually pathogenic not strictly
  10. 10. Continued…Runyon Group II (Slow growingscotochromogens)◦ M. szulgai◦ M. scrofulaceum Uncommon◦ M. xenopiUsually pathogenicSometimes pathogenic
  11. 11. Continued…Runyon Group III (Slow growingnonchromogens)◦ M. avium complex – common◦ M. genavense◦ M. hemophilum uncommon◦ M. malmoenseStrictly pathogenicUsually pathogenic
  12. 12. Continued…Runyon Group IV (Rapid growers)◦ M. fortuitum◦ M. chelonae Common◦ M. abscessus◦ M. mucogenicum UncommonSometimes pathogenic
  14. 14. Structure and Physiology Weakly gram positive Strongly acid fast Aerobic bacilli
  15. 15. Mycobacterium TuberculosisStained with Fluorescent Dye
  16. 16. Lipid rich cell wall, makes organismresistant to◦ Disinfectants◦ Detergents◦ Common antibacterial antibiotic
  17. 17. Virulence Capable of intracellular growth inunactivated alveolar macrophages Disease primarily host response toinfection
  18. 18. Epidemiology Worldwide , one third of the populationis infected 16 million existing cases and 8 millionnew cases Most common in Southeast Asia,Sub- Shaharan Africa and EasternEurope
  19. 19. Continued…Patients at the greatest risk are the◦ Immunocompromised patients (HIV)◦ Drug and alcohol abusers◦ Homeless◦ Individuals exposed to infected patientsHumans are only the reservoirPerson to person infection by aerosols
  20. 20. Diseases Primary infection is lungs Dissemination to any other site occursmostly in the immunocompromisedand untreated persons
  21. 21. Diagnosis Positive PPD Chest X-Ray Microscopy and culture – it is sensitive
  22. 22. Treatment, Prevention andControl Multiple drugs regimens andprolonged treatment are required toprevent development of drugresistance strains MDR-TB is global health threat
  23. 23. Continued… Treatment include isoniazid andrifampin for 9 months + pyrazinamide+ ethambutol or streptomycin Immunoprophylaxis with BCG inendemic countries Control- active surveillance ,prophylactic and therapeuticinterventions and monitoring of thecase
  24. 24. Progression of Pulmonary TBPneumoniaGranuloma formation with fibrosisCaseous necrosis• Tissue becomes dry & amorphous (resemblingcheese)• Mixture of protein & fat (assimilated very slowly)Calcification• Ca++ salts depositedCavity formation• Center liquefies & empties into bronchi
  26. 26. Structure and Physiology Weakly gram positive Strongly acid fast bacilli Lipid rich cell wall Unable to culture on artificialmedium
  27. 27. Virulence Capable of intracellular growth Disease primarily from host responseto infection
  28. 28. Epidemiology Common in Africa and Asia Armadillos are naturally infected andare reservoir Lepromatous form of disease is highlyinfectious Spreads by inhalation of aerosols Individual in direct contact withpatients are at greater risk
  29. 29. Forms of Diseases Tuberculoid form of leprosy Lepromatous form of leprosy Intermediate form of leprosy
  30. 30. Diagnosis Microscopy is sensitive for thelepromatous but not for tuberculoidform Skin testing is required for tuberculoidleprosy Culture cannot be used
  31. 31. Treatment, Prevention andControl Dapsone with or without rifampin is usedto treat tuberculoid form Clofazimine is added for the lepromatousform Therapy is usually prolonged For prophylaxis –DAPSONE Control – by prompt recognition andtreatment of infected patients
  32. 32. Lepromatous form
  33. 33. Tuberculoid form
  34. 34. Pre and Post Treatment