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Tb Tb Presentation Transcript

  • MYCOBACTERIA Jaime A. Santos
  • MYCOBACTERIA: CHARACTERISTICS thin,nonmotile and nonspore forming rods obligate aerobes slow growing cell wall has high lipid content and mycolic acid generally catalase positive acid-fast
  • MYCOBACTERIA: CHARACTERISTICS thin,nonmotile and nonspore forming rods obligate aerobes slow growing cell wall has high lipid content and mycolic acid generally catalase positive acid-fast View slide
  • CLASSIFICATION Mycobacterium View slide
  • CLASSIFICATION Mycobacterium M. tuberculosis MOTT M. leprae complex (Nontuberculous) M. tuberculosis M. bovis Runyon 1 to IV M. microti M. africanum
  • M. TUBERCULOSIS optimal growth:  37 C/ 5-10% CO2/ pH 6.0-7.6. in vivo, it can use a variety of enzymes for anaerobic metabolism requires complex media such as Löwenstein Jensen doubling time of ~18 hours.  Colonies visible in 3-6 weeks multiplies intracellularly in phagosome and prevents phagolysosome fusion
  • M. TUBERCULOSIS CELL WALL
  • M. TUBERCULOSIS CELL WALL
  • VIRULENCE FACTORS Mycolic acid glycolipids Catalase, peroxidase and trehalose 6,6 and lipoarabinomannan dimycolate  (cord - help resist the host factor)- cause cell oxidative response  granuloma formation Sulfatides and trehalose dimycolate- toxic to animal models
  • MAGNITUDE OF TB PROBLEM >1/3 of world’s population infected 8-9 million new cases annually 3 million deaths annually ~1.3 million of these new cases are in children with ~500 thousand deaths annually Philippines ranks no.1 in Western-Pacific
  • BACILLI INHALED 2 - 6 wks CMI PATHOGENESIS
  • IMMUNE RESPONSE
  • IMMUNE RESPONSE
  • IMMUNE RESPONSE
  • IMMUNE RESPONSE
  • CLINICAL MANIFESTATIONS asymptomatic other symtoms and signs depending on the fever organ involved e.g. CNS, bone, renal cough >3 weeks chest pain hemoptysis lymphadenpathy
  • CHILDHOOD TB asymtomatic ~50% failure to make a quick return to health after an cough/wheezing > 2 infection e.g. weeks measles,tonsillitis or pertussis fever > 2 weeks failure to respond to painless cervical and/or appropriate antibiotics other lymphadenopathy as in AOM or poor weight gain pneumonia
  • DIAGNOSIS SIGNS AND SYMPTOMS HISTORY OF EXPOSURE CHEST X-RAY TUBERCULIN TEST BACTERIOLOGIC DIAGNOSIS: SMEAR, CULTURE, PCR HISTOLOGIC
  • CHEST X-RAY
  • CHEST X-RAY
  • CHEST X-RAY
  • TUBERCULIN TEST Mantoux test 0.1 ml of solution containing or equivalent to1g ( 5 TU PPD-S) read at 48-72 hours using ballpoint pen method results recorded in mm delayed-type hypersensitivity
  • TUBERCULIN TEST Mantoux test 0.1 ml of solution containing or equivalent to1g ( 5 TU PPD-S) read at 48-72 hours using ballpoint pen method results recorded in mm delayed-type hypersensitivity
  • CULTURE incubated at 35° to 37° C in an atmosphere of 5 to 10% CO2 cultures should be examined weekly for 8 weeks. solid media e.g. Lowenstein-Jensen allows visualization of colony morphology but requires 3-4 weeks broth systems detecting 14C labelled CO2 (BACTEC) require only 5-12 days
  • ANTI-TB DRUGS isoniazid (H) - 5 to 10 mg/kg ( max 300 mg) rifampicin (R) - 10 to 15 mg/kg (max 600 mg) pyrazinamide (Z) - 15 to 30 mg/kg (max 2 gm) ethambutol (E) - 15 to 25 mg/kg (max 2.5 gm) streptomycin (S) - 20 to 30 mg/kg (max 1 gm) second-line drugs PROBLEM OF DRUG RESISTANCE
  • MOTT Nontuberculous mycobacteria (NTM) are soil and water organisms noncommunicable Disease develops in setting of trauma/surgery or immunosuppression. INH resistant Diagnosis is by acid fast staining of the specimen; followed by culture and/or 16s rRNA probes culture
  • RUNYON CLASSIFICATION Group Growth Pigment Examples Disease 1. similar to TB yellow-orange on light 1. M. kansasii I slow (photochromogen) 2. M. marinum 2. swimming pool granuloma yellow-orange in light II slow or dark M. scrofulaceum cervical adenitis (scotochromogen) M. avium intracellulare similar to TB, III slow no pigment complex (MAC) esp. in AIDS M. fortuitum soft tissue, lung, bone, IV rapid (5 days) no pigment M. cheilonae CNS, eye infections
  • MYCOBACTERIUM LEPRAE cannot be cultured can be grown in armadillos or in mouse footpads optimal T for M. leprae is lower than core body temp, so it grows on skin and superficial nerves found in macrophages and Schwann cells. complex cell wall has lipoarabinomannan (LAM) & a unique M. leprae-specific phenolic glycolipid (PGL-1).
  • MYCOBACTERIUM LEPRAE cannot be cultured can be grown in armadillos or in mouse footpads optimal T for M. leprae is lower than core body temp, so it grows on skin and superficial nerves found in macrophages and Schwann cells. complex cell wall has lipoarabinomannan (LAM) & a unique M. leprae-specific phenolic glycolipid (PGL-1).
  • LEPROSY anesthetic plaques, symmetric skin and asymmetric nodules, plaques, peripheral nerve leonine (i.e., lion-like) trunk involvement, facies, loss of paucibacillary eyelashes and body hair, multibacillary
  • LEPROSY tuberculoid lepromatous anesthetic plaques, symmetric skin and asymmetric nodules, plaques, peripheral nerve leonine (i.e., lion-like) trunk involvement, facies, loss of paucibacillary eyelashes and body hair, multibacillary
  • LEPROSY (HANSEN’S DISEASE) M. leprae causes leprosy, which is also known as Hansen’s Disease. The incubation period for leprosy is 5-7 years. Prolonged exposure required to become infected 8 million infected with 600,000 new cases annually
  • LEPROSY (HANSEN’S DISEASE) M. leprae causes leprosy, which is also known as Hansen’s Disease. The incubation period for leprosy is 5-7 years. Prolonged exposure required to become infected 8 million infected with 600,000 new cases annually
  • LEPROSY AND THE IMMUNE SYSTEM
  • DIAGNOSIS clinical signs lepromin skin test (mainly of immune status) biopsy and histology
  • TREATMENT dapsone, rifampin, clofazimine, and either ethionamide or prothionamide Paucibacillary cases (tuberculoid and borderline tuberculoid) x 6 months, dapsone alone is usually given for up to 3 years after disease inactivity lepromatous or borderline lepromatous leprosy may require primary treatment for 3 years, with dapsone alone continued for the rest of the patient's life antiinflammatory drugs; wound care
  • Thank you!