Your SlideShare is downloading. ×
Mycobacteria48
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Mycobacteria48

1,989
views

Published on

Mycobacteria48

Mycobacteria48


0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,989
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
161
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. MYCOBACTERIA CORYNEBACTERIA LEGIONELLA www.freelivedoctor.com
  • 2. KEYWORDS
    • Acid Fast
    • Tuberculosis (TB)
    • M. tuberculosis (MDR, XDR)
    • M. avium - M. intracellulare complex
    • M. bovis
    • M. leprae
    • Tubercle
    • PPD
    • Tuberculin
    • Mycobactin
    • Cord factor
    • BCG
    • Leprosy (Hansen's Disease)
    • AIDS and TB
    • Runyon groups
    • Mycolic acids
    • Diphtheria
    • C. diphtheriae
    • Loeffler's agar
    • Tellurite agar
    • Metachromatic bodies
    • Diphtheria toxin
    • Schick test
    • Diphtheroids
    • Legionella pneumophila
    • Legionnaires disease
    • Pontiac fever
    • Legionella micdadei
    • Pittsburg pneumonia
    www.freelivedoctor.com
  • 3. Mycobacterium tuberculosis obligate aerobe acid-fast rods www.freelivedoctor.com
  • 4.
    • M. tuberculosis
    • major human disease
      • healthy people
    • problems
        • association with AIDS
        • multiple drug-resistance
    Tuberculosis (TB, consumption) www.freelivedoctor.com
  • 5.
    • M. avium- M. intracellulare complex ( M. avium )
    • non-AIDS
        • infection almost never
    • AIDS
        • major bacterial opportunist
    • multiple drug-resistance
    www.freelivedoctor.com
  • 6.
    • spread from cattle
    • infected cattle are culled
      • positive skin test
    • rarely seen in US
    M. bovis www.freelivedoctor.com
  • 7. M. leprae
    • leprosy
    • major disease of third world
    • rare in US
    www.freelivedoctor.com
  • 8. Transmission -tuberculosis
    • M. tuberculosis causes disease
        • healthy individuals
    • transmitted man-man
    • airborne droplets
    www.freelivedoctor.com
  • 9. Pathogenesis of tuberculosis
    • infects lung
    • distributed within macrophages
    • facultative intracellular pathogen
        • inhibits phagosome-lysosome fusion
    www.freelivedoctor.com
  • 10. Cell-mediated immunity -tuberculosis
    • infiltration
      • macrophages
      • lymphocytes
    • granulomas
    • tubercules
    www.freelivedoctor.com
  • 11. Laboratory diagnosis - tuberculosis
    • skin testing
      • delayed hypersensitivity
      • tuberculin
      • protein purified derivative, PPD
    • X-ray
    www.freelivedoctor.com
  • 12. Positive skin test -tuberculosis
    • indicates exposure to organism
    • does not indicate active disease
    www.freelivedoctor.com
  • 13.
    • Other minor pathogenesis factors
    • tuberculosis
    • mycobactin
      • siderophore
    • cord factor
      • damages mitochondria
    www.freelivedoctor.com
  • 14. Laboratory diagnosis M. tuberculosis
    • acid fast bacteria
      • sputum
    www.freelivedoctor.com
  • 15. Laboratory diagnosis M. tuberculosis (culture)
    • grows very slowly
      • two weeks or longer
      • non-pigmented colonies
      • niacin production
        • differentiates from other mycobacteria
    www.freelivedoctor.com
  • 16. Tuberculosis
    • polymerase chain amplification
      • rapid diagnosis
    www.freelivedoctor.com
  • 17. Antibotic treatment - tuberculosis
    • extensive time periods (e.g. 9 months)
    • organism grows slowly, or dormant
    • two or more antibiotics
      • e.g. rifampin and isoniazid
      • resistance minimized
    www.freelivedoctor.com
  • 18. Tuberculosis and Drug resistance
    • Multiple drug resistant (MDR)
      • resistant to first line drugs
    • Extremely drug resistant (XDR)
      • Resistant to some of the second line drugs
      • Nearly un-treatable
    www.freelivedoctor.com
  • 19. Vaccination
    • BCG vaccine
      • an attenuated strain of M. bovis
      • not effective
    • in US,
      • incidence is low
      • vaccination not practiced
      • immunization interferes with diagnosis
    www.freelivedoctor.com
  • 20. Mycobacterium leprae www.freelivedoctor.com
  • 21. Leprosy (Hansen's Disease)
    • M. leprae
      • causative agent
    • chronic disease
      • disfigurement
    • rarely seen in the U.S.
    • common in third world
      • millions of cases
    • infects the skin
      • low temperature
    www.freelivedoctor.com
  • 22.
    • ulcers, resorption of bone
    • worsened from careless use of hands (nerve damage)
    www.freelivedoctor.com
  • 23.
    • tuberculoid
    • few organisms
    • active cell-mediated immunity
    • lepromatous
    • many organisms
    • immunosuppression
    Leprosy www.freelivedoctor.com
  • 24.
    • in vitro
      • unculturable
    • in vivo growth
      • low temperature
      • armadillo
      • mouse footpad
    Production of M. leprae antigens and pathogenesis studies www.freelivedoctor.com
  • 25.
    • lepromin
      • skin testing
    • acid-fast stains
      • skin biopsies
    • clinical picture
    Leprosy www.freelivedoctor.com
  • 26. Other mycobacterial species (including M. avium )
    • infect immunocompromised host
    • not transmitted man –man
      • - healthy people
    • M. avium – common
    • Other species - rare
    www.freelivedoctor.com
  • 27.
    • tuberculosis-like
    • leprosy-like
    Mycobacterial diseases www.freelivedoctor.com
  • 28.
    • M. avium is much less virulent than M. tuberculosis
      • does not infect healthy people
      • infects AIDS patients
    • M. avium infects
      • when CD4 (helper T cell) count greatly decreased
    • M. tuberculosis infection
      • infects healthy people
      • infects AIDS patients
        • earlier stage of disease
        • more systemic
    • Mycobacteria and AIDS
    www.freelivedoctor.com
  • 29.
    • systemic disease (versus pulmonary)
      • greater in AIDS
    • lesions often lepromatous
    Clinical features with AIDS www.freelivedoctor.com
  • 30.
    • selected primarily for M. tuberculosis
    • if M. avium involved other antibiotics included
    Antibiotic therapy www.freelivedoctor.com
  • 31. Other species
    • pigmented or not
    • pigmentation
        • in the light
        • in the dark
    • growth
        • fast
        • slow
    www.freelivedoctor.com
  • 32.
    • cellular fatty acid profiles
    • mycolic acid profiles
    • genetic markers
    Mycobacterial species identification www.freelivedoctor.com
  • 33. Mycolic acids
    • mycobacteria
    • longest chain length
    • strongly acid fast
    • nocardia
    • intermediate chain length
    • weakly acid fast
    • corynebacteria
    • shortest chain length
    • not acid fast
    www.freelivedoctor.com
  • 34. Corynebacterium diphtheriae Gram positive strict aerobe pleomorphic (e.g. club-shaped) www.freelivedoctor.com
  • 35.
    • infection
      • upper respiratory tract (pharynx)
      • pseudomembrane
      • chocking
      • bacteria do not spread systemically
    • .
    Diphtheria www.freelivedoctor.com
  • 36. This child has diphtheria resulting in a thick gray coating over back of throat. This coating can eventually expand down through airway and, if not treated, the child could die from suffocation CDC www.freelivedoctor.com
  • 37. Diptheria toxin
    • spreads
    • systemic and fatal injury
    www.freelivedoctor.com
  • 38.
    • B binds to host cell
    • A inhibits protein synthesis
    • ADP-ribose moiety (NADH) attaches
      • elongation factor 2 inhibited
    Diphtheria toxin www.freelivedoctor.com
  • 39. Treatment
    • anti-toxin
    • antibiotic
    www.freelivedoctor.com
  • 40.
    • disease vanished in US
      • without immunization will return
    • toxoid (+ pertussis and tetanus) DPT
    • neutralizing antibodies
    • colonization not inhibited
      • found in normal flora
    Immunization against diphtheria (infant) www.freelivedoctor.com
  • 41.
    • Schick skin test
      • toxin
    Testing immunity www.freelivedoctor.com
  • 42. Diphtheria toxin
    • coded by bacteriophage tox gene
      • not synthesized if iron present
      • iron-repressor complex forms
      • inhibits expression of tox gene
    www.freelivedoctor.com
  • 43.
    • growth Loeffler's medium
    • stain for polyphosphate granules
    • metachromatic
      • polyphosphate granules (pink) cell (blue)
    • tellurite agar
    • reduction by bacteria
    • tellurium precipitation
    • black colonies
    Identification - C. diphtheriae www.freelivedoctor.com
  • 44. Identification – Exotoxin production
    • in vivo
    • in vitro
    www.freelivedoctor.com
  • 45.
    • diphtheroids
      • other corynebacteria
      • propionibacteria
    • C. diphtheriae should not be confused with:
    www.freelivedoctor.com
  • 46. Legionella pneumophila
    • Gram negative rod
    • Stains poorly
    www.freelivedoctor.com
  • 47.
    • Legionnaire's disease
      • pneumonia
      • fatal if not treated
      • erythromycin
    • Pontiac fever
      • flu-like
      • milder
      • self-limiting
      • myalgia (muscle pain)
      • no pneumonia
    Legionella pneumophila www.freelivedoctor.com
  • 48. Transmission
    • contaminated air
      • infected water supply
    • not spread person-person
    www.freelivedoctor.com
  • 49.
    • small epidemics
      • healthy people
    • more frequently
      • sick or elderly
      • hospitals
      • immunocompromised
    Legionnaires disease www.freelivedoctor.com
  • 50.
    • no growth conventional agar
      • e.g. sheep blood agar
    • media must contain
      • iron
      • cysteine
      • e.g. charcoal yeast extract agar
    • isolation clinical specimens
      • poor
    Identifcation of Legionella www.freelivedoctor.com
  • 51.
    • environmental reservoir
      • pools of stagnant water
      • hot water towers
      • air conditioning systems
      • intracellular growth, protozoa
    • facultative intracellular pathogen
      • humans
    Legionella pneumophia www.freelivedoctor.com
  • 52.
    • Legionella pneumophila
      • several serogroups
      • most infections, serogroup 1
    • Legionella micdadei
      • Pittsburg pneumonia
    • Other Legionella
      • occasional disease
      • legionellosis
    Legionellae www.freelivedoctor.com
  • 53.
    • fatty acid profiling
    • DNA-DNA hybridization
    • 16S rRNA sequence
    • detection of antigen in urine
    • serology
    Identification of Legionella www.freelivedoctor.com