1) Mycobacteria are acid-fast bacilli with a thick cell wall containing mycolic acids, contributing to their hardiness. Identification methods have advanced from biochemical reactions to genetic analysis using probes, mass spectrometry, and sequencing.
2) There are over 170 mycobacterial species split into two groups - the TB complex and non-tuberculous mycobacteria. Identification and classification systems have evolved from the Runyon system based on pigmentation and growth rate.
3) Proper handling and processing of specimens is important for recovery of mycobacteria, including decontamination to remove competing bacteria and centrifugation to pellet the acid-fast bacilli for staining and culture.
coccidian parasite is a very important topic for pg entrance........so every important point about it have been discussed in detail......take a look at it...
Clostridium are anerobic gram positive rod shaped spore forming organisms responsible to cause various life threatening diseases in humans like Gas gangrene, Tetanus, Botulism, etc
In this slide, I will teach you about gram-positive cocci which streptococcus agalactiae. I will tell you about its diseases, transmission, pathogenesis, characteristics, lab diagnosis, treatment, and prevention in a short and easy way.
coccidian parasite is a very important topic for pg entrance........so every important point about it have been discussed in detail......take a look at it...
Clostridium are anerobic gram positive rod shaped spore forming organisms responsible to cause various life threatening diseases in humans like Gas gangrene, Tetanus, Botulism, etc
In this slide, I will teach you about gram-positive cocci which streptococcus agalactiae. I will tell you about its diseases, transmission, pathogenesis, characteristics, lab diagnosis, treatment, and prevention in a short and easy way.
Mycobacterium tuberculosis-importance of TB day,classification of Mycobacterium species,Details on Mycobacterium tuberculosis-morphology,culture,resistance,biochemical reactions,antigenic characters,mode of transmission,pathogenesis,complications,lab diagnosis,treatment,DOTS Strategy and prophylaxis
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2. Mycobacteria
Acid Fast Bacilli (AFB)
Thick outer cell wall contains complex mycolic acids (mycolates) and
free lipids, contributes to the hardiness of the genus
Once stained, AFB resist de-colorization with acid alcohol (HCl),
hence the term acid fast
Difference of AFB stain vs. modified or partial acid fast (PAF) stain
AFB stain uses HCl to decolorize Mycobacteria (+) Nocardia (-)
PAF stain uses H2SO4 to decolorize Mycobacteria (+) Nocardia (+)
AFB stain poorly with Gram stain / beaded Gram positive
Aerobic, no spores, rarely branch
Kinyoun AFB stain Gram stain
3. Identification of the Mycobacteria
For decades, identification algorithm started with determining the
ability of a mycobacteria species to form cartenoid pigment in the
light or dark; followed by biochemical reactions, growth rate, and
optimum temperature for growth. Obsolete
With expanding taxonomy, biochemical reactions were unable to
separate and identify most of the newly recognized species, so
replaced with High Performance Liquid Chromatography (HPLC)
methods. Now also obsolete
Current best methods for identification include:
Genetic probes (DNA/RNA hybridization)
MALDI-TOF Mass Spectrometry to analyze cellular proteins
Sequencing 16 sRNA for precise genetic sequence information
4. Mycobacteria Taxonomy currently >170 species
with 2 Taxonomic groups
Group 1 - TB complex organisms
Mycobacterium tuberculosis
M. bovis
Bacillus Calmette-Guerin (BCG) strain
Attenuated strain of M. bovis used for vaccination
M. africanum
Rare species of mycobacteria
Mycobacterium microti
Mycobacterium canetti
Mycobacterium caprae
Mycobacterium pinnipedii
Mycobacterium suricattae
Mycobacterium mungi
Group 2 - Mycobacteria other than TB complex (“MOTT”) also
known as Non-Tuberculous Mycobacteria
5. Non tuberculous mycobacteria that cause disease
(1) Slowly growing non tuberculosis mycobacteria
M. avium-intracullare complex
M. genavense
M. haemophilum
M. kansasii (3) Mycobacterium leprae
M. malmoense
M. marinum
M. simiae
M. szulgai
M. ulcerans
M. xenopi
M. smegmatis
(2) Rapid growing mycobacteria (growth in <= 7 days)
M. fortuitum group
M. abscessus
M. chelonae
M. mucogenicum
6. Mycobacteria that rarely if ever cause disease!
If so, only in the immunocompromised!
Slowly growing nontuberculous
mycobacteria
Mycobacterium gordonae
M. gastri
M. celatum
M. scrofulaceum
M. terrae complex
7. Algorithm for identification of MOTT
- historically speaking
Based on the “Runyon System”
System used to classify non-tuberculous mycobacteria
Based on carotenoid pigment production when exposed to incandescent
light bulb & growth rate
Four Runyon groups
Photochromogen = Pigment produced only when exposed to light
Scotochromogen = Pigment produced in both light and dark
Non-photochromogen = No pigment produced in either light or dark
Rapid Grower = Growth rate (<= 7 days)
8. The Light Test – Determine if mycobacteria can produce a yellow
carotenoid pigment after being exposed to 8 hours of light/ after
light exposure, incubate for 24 hours and observe for pigment.
Group I Photochromogen
Turns yellow only after light exposure Group III
Non-photochromogen
No pigment produced in dark
or after light exposure
Group II Scotochromogen
Yellow pigment present in dark or
with light exposure
9. Runyon Classification System Classification
Group I - Photochromogen – turns yellow when exposed
to light, no color in the dark. Growth in 2 -3 weeks
M. kansasii
M. simiae
M. szulgai photochromagen when incubated at 25˚C*
M. marinum
Group II - Scotochromogen – yellow pigment in dark or
exposure to light. Growth 2 – 3 weeks
M. gordonae
M. scrofulaceum
M. xenopi (most strains)
M. szulgai scotochromogen when incubated at 37°C*
10. Runyon Classification continued
Group III – Non-photochromogen – No pigment produced in
the light or dark, growth in 2-3 weeks
M. avium-intracellulare complex
M. haemophilum
M. xenopi (some strains)
Group IV – Rapid growers, grow in <=7 days
M. fortuitum group
M. abscessus
M. chelonae
M. mucogenicum
M. smegmatis
11. AFB Laboratory
Safety
Level 3 biosafety precautions required in AFB laboratories that process, identify and
perform susceptibility testing on mycobacteria species
Level 2 Hepa filter biosafety cabinet with return air vented to the outside
Biosafety certified at least yearly per regulation to insure proper operations
Room under negative air flow, anteroom for safety gear donning, and contiguous autoclave
Must wear a 95 respirator mask (yearly mask fit required) or PAPR (powered air purifying
respiratory mask) when working with organisms even when inside the biosafety cabinet
Gloves and disposable surgical gowns for culture work
Plastic cups with tight lids used during high speed centrifugation
Biosafety Cabinet
PAPR
Vented to outside
12. Specimen collection
Sputum – 3 early morning collections, or
1 early morning, plus 2 collected at least 8 hours apart
Bronchial lavage fluid
Tissues or Lesions
CSF or sterile body fluids
Urine – 3 to 5 early morning collections
Stool – Primarily for M. avium-intracellulare complex
Gastric – usually only children unable to produce sputum,
must neutralize gastric to pH 7.0 after
collection in order for AFB to survive in stomach acid
Blood / Bone marrow in disseminated disease
Automated systems – AFB blood culture bottles
manufactured specifically for AFB detection
13. AFB Specimen Processing
Start to Finish!
5 ml of specimen pipetted into conical Falcon tube
Decontaminate and liquify sputum specimen for 15 minutes with:
5 ml of 4% NaOH (increases the pH to 9) to kill contaminating bacteria
N-acetyl-L-Cysteine – liquifies mucus plugs
After 15 min - fill tube with phosphate buffer to neutralize to pH (7.0)
Centrifuge for 30 minutes – using safety cups with tight lids
3000 X g to pellet the AFB (speed is important – AFB are buoyant)
Pour off the supernatant
Prepare concentrated slide from pellet for AFB staining
Dilute the pellet with small amount of sterile saline for culture
Incubate culture media @ 37˚C, 5-10% CO2 for 6–8 weeks
14. Why Decontaminate Specimens?
Slow growing mycobacteria will be overgrown by “contaminating”
bacteria in the sputum specimen unless they are killed in the
decontamination step:
Competing bacteria/yeast grow approximately 24 x faster than
AFB – these organisms are killed by the increased pH created
by the addition of 4% NaOH
Must also release the AFB from mucus plugs in the sputum
specimen - this is accomplished with the addition of the
N-acetyl-L-Cysteine
15. Specimen Decontamination/Digestion of potentially
contaminated specimen types (respiratory)
Routine processing:
4% NaOH with N-acetyl-L-cysteine
Processing: special circumstances/ cystic fibrosis
Process sputum with oxalic acid to eliminate mucoid
strains of Pseudomonas aeruginosa
4% NaOH will not kill these mucoid strains
Oxalic acid should not be used routinely for processing all
specimens, will decrease yield of AFB in culture
Both 4% NaOH and Oxalic acid can kill AFB if left on
specimen > 15 minutes.
16. Specimen Centrifugation
Centrifugation at 3000 X g (high speed) with safety cups
Speed of centrifugation is important –
AFB are lipid laden and they will float if not rapidly centrifuged
Pellet to bottom of tube so they are not decanted with supernatant
Speed of centrifugation can effect the sensitivity of the AFB stain
Pour off supernatant into waste
Pellet used for stains/culture
17. Manual Plating/Culture Media
Middlebrook – Synthetic media
Clear colored solid agar and liquid media
Synthetic = Known chemical ingredients added for optimal growth
Used for both culture and susceptibility testing
Autoclave to sterilize the media
Lowenstein-Jensen – Egg based
Solid agar, green due to addition of malachite green
Ingredients: Hens egg, glycerol, and potato flour
Used for culture only
Sterilize by inspissation – drying
Cultures incubated at 37˚C , 5-10% C0₂ for 6-8 weeks
18. Automated Detection of AFB
BD BACTEC MGIT 960 automated instrument for AFB
Middlebrook 12B liquid media used for the culture of AFB
BACTEC detection method
As AFB grow in the 12B media, the AFB respire CO₂ and the amount of O₂ is
decreased over time. The lower level of O₂ causes fluorescence of the indicator and at
the bottom of the tube and indicates organism growth in the tube.
Incubation at 37˚C for 6 weeks
Fluorescence
NAP test /Identification of TB complex organisms
using MGIT 960 instrument
NAP = chemical (p-nitro-α-acetylamino-B-hydroxypropiophenone)
TB complex does not grow in the tube containing NAP
Non-tuberculous species grow in the tube containing the NAP chemical
MGIT 960
19. Acid Fast Stains for Mycobacteria
Carbol Fuchsin based stains
Carbol Fuchsin is red colored stain of the AFB
Potassium permanganate is the background blue counterstain
Two methods:
Ziehl-Neelsen (ZN) – heat used to drive stain into lipid laden AFB
Kinyoun – High % of phenol in stain drives stain into AFB
Read numerous microscopic fields for 5 minutes, using light microscopy
using 100x oil objective
20. Fluorochrome based stain
Auramine Rhodamine stain
Fluorescent stain
Rods stain fluorescent yellow with black background
Read on 25X or 40X for 2 min, viewing numerous fields using
a fluorescence microscope
Based on nonspecific fluoro-chrome that binds to the mycolic
acids in the mycobacteria
Considered more sensitive than ZN or Kinyoun stains for
concentrated patient specimen slide examination
21. Acid Fast Mycobacteria morphology
Mycobacterium avium complex
Organisms are routinely shorter than TB
(Kinyoun stain) without cording. The
organisms tend to clump.
M. tuberculosis - Organisms are long
rods and can appear as if they are sticking
together [due ti cord factor]
In broth
cultures -
ropes of AFB
can form due to
cord factor
22. Direct Detection of TB from Respiratory Specimens
using Molecular Amplification
FDA cleared DNA PCR that detects TB complex organisms in < 2 hrs for
both AFB smear positive and negative sputum specimens:
Cepheid Xpert-TB RIF Assay (rtPCR) tested on the Genexpert instrument
Detects TB complex organism gene sequence and rifampin resistance gene (rpoB)
Sensitivity of assays
99% for AFB concentrated smear (+) specimens
75% for AFB concentrated smear (-) specimens
Test of diagnosis, not cure
Residual rRNA and DNA can be present for up to 6 months after initial
diagnosis and start of therapy
Must confirm all tests with AFB culture and sensitivity (gold standard)
Currently, no FDA cleared assay for non-tuberculous mycobacteria spp.
23. PPD (Purified Protein Derivative)
Mantoux test/TB skin test
Detects latent or current TB exposure
False positive reactions can occur in patients immunized with BCG
@ 25% false negative reactions
Usually due to low T cell numbers or T cell reactivity, such as occurs with high dose
steroids.
Technical problems with PPD administration and test interpretation can also lead to
false negative or false positive reactions
Measures delayed hypersensitivity (T cell response) to TB complex
antigens (not specific for TB)
Measure (mm) area of induration at injection site
>=15mm positive (check for history of BCG)
>=10mm positive in immune suppressed or just exposed to TB and part of an
outbreak investigation
24. Cell Mitogen assays –
Interferon Gamma Release Assays (IGRA)s
QuantiFERON-TB-Gold Plus (QFTP)
CD4 and CD8 T cells in patient whole blood samples are stimulated
with TB specific antigens.
If patient has active or latent exposure to TB, the stimulated T cells
will produce gamma interferon
Automated EIA assay measures amount of gamma interferon
produced
Quantitative endpoint indicates a positive or negative reaction
Indeterminate reactions can occur, if T cells are absent or inactive
due to medications
No false positive reactions from immunization with BCG
Sensitivity >=80%, does NOT replace culture for disease diagnosis
Sensitivity similar to PPD/ but has improved specificity
25. Mycobacterium tuberculosis
Optimal Temp 37˚ C, Growth in 12 –25 days
Buff colored, dry cauliflower-like colony
Manual tests for identification – old school
Niacin accumulation test positive
Niacin produced from growth of TB on egg containing medium (LJ)
Nitrate reduction test positive
Current identification methods:
Molecular DNA/RNA hybridization probe for MTB complex
MALDI-TOF mass spectrometry for M. tuberculosis
16 sRNA sequencing for M. tuberculosis
26. Mycobacterium tuberculosis
Cord factor – Due to high lipid content
in cell wall, rods stick together and
develop long ropes when grown in broth
media – unique to M. tuberculosis
Long AFB / stick together
27. Susceptibility testing of TB
Two methods for testing
(1) Agar dilution (indirect proportion method)
Antibiotics embedded in solid agar and TB inoculated onto media quadrants
(2) Liquid 7H12 medium containing anti-TB antibiotic solutions
Tested on automated Bactec MGIT 960 system
Primary TB drug panel / 5 drugs
Isoniazid Ethambutol
Pyrazinamide Streptomycin
Rifampin
If resistant to primary drugs, second line drugs tested
Fluoroquinolones, Kanamycin, Amikacin, and Capreomycin
If patient remains culture positive after four months on treatment/
retest the TB susceptibility / possible drug resistant strain
28. Tuberculosis
Classic disease is slowly progressive pulmonary infection cough,
weight loss, and low grade fever, presentation can vary depending
on degree of immune suppression:
Ghon’s complex: Lesion with calcified foci of infection and an associated lymph
node
Miliary TB: Wide spread dissemination of infection via the bloodstream, occurs
most often in AIDS, elderly, children, immunosuppression and with some
medications (Remicade- infliximab)
Secondary tuberculosis: mostly in adults as reactivation of previous infection
Granulomatous inflammation much more florid and widespread than in primary disease.
Upper lung lobes are most affected, and cavitation can occur.
TB is spread by respiratory droplets
All patients with high level of suspicion require respiratory isolation precautions
TB infection
Lung nodules
29. Pathology of Mycobacterium tuberculosis
Hallmark of Mycobacterium tuberculosis infected tissue is
necrotizing granulomatous inflammation,
• composed of epithelioid histiocytes surrounding a central
necrotic zone, and
• accompanied by a variable number of multinucleated giant cells
and lymphocytes.
• Non-necrotizing granulomas can also be present.
Nodule with
cavitation
Necrotizing
granuloma
30. TB in HIV/AIDS patients
Worldwide -TB is the most common opportunistic infection affecting
HIV/AIDS patients
TB more likely to be multi-drug resistant (at least INH and Rifampin)
With progressive decline of cell mediated immunity (low CD4 count) –
greater risk of extra pulmonary (miliary) dissemination
Granulomas with/without caseation can occur
Miliary TB
31. M. tuberculosis outside the lung
Scrofula –Unilateral lymphadenitis (cervical lymph node)
most often seen in immunocompromised adult or children/
caseous necrosis often present
Fine needle aspiration for diagnostic specimen
M. tuberculosis most common in adults
M. avium complex and other MOTT (2-10%) in children
Pott’s disease - TB infection of the spine
Secondary to an extra-spinal source of infection (1* pulmonary)
Manifests as a combination of osteomyelitis and arthritis
that usually involves more than 1 vertebra.
32. Mycobacterium bovis
Produces disease in warm blooded animals, cattle
Spread to humans by inhalation of droplets or raw milk products
Disease in humans similar to that caused by TB
Differentiation of M. bovis from M. tuberculosis
M.bovis M. tb
Nitrate Negative Positive
Growth in T2H* No growth Growth
Pyrazinamidase enzyme Negative Positive
Pyrazinamide susceptibility Resistant Susceptible
*(Thiophene-2-carboxylic hydrazide)
M. bovis BCG (Bacillus Calmette-Guerin)
BCG is an attenuated strain of M. bovis
Used for TB vaccination in countries with high prevalence of TB
Instillation of BCG into bladder can be used to treat bladder cancer / some patients become
infected with the M. bovis BCG
33. Mycobacterium ulcerans
Buruli ulcer in Africa and known as Bairnsdale ulcer in Australia
Localized painless skin nodule evolves rapidly to ulceration and can
become disabling, due to production of mycolactones (cell cytotoxin)
Endemic in tropical areas with limited medical care, mild skin trauma with
exposure to contaminated stagnant waters leads to progressive and
destructive ulcers, peak age group 5-15 yrs
Optimum growth temp @ 30˚ C
Does not grow well or at all at 37*C
**Skin lesions suspect for AFB should be cultured at both 30˚ and 37˚C
Difficult / slow growing requiring 3- 4 weeks/ molecular techniques preferred
34. Mycobacterium kansasii
Culture 37* C, 10-20 days
Photochromogen
Niacin accumulation test negative
Nitrate reduction positive
Tween 80 positive / tests for presence of the lipase enzyme
68*C catalase positive
AFB are larger than TB - rectangular and very beaded with Shepherd’s
crook shape
Clinical disease mimics pulmonary TB but less likely to disseminate
Disease acquired from contaminated tap water
Predisposition for diseased lung (COPD)
More likely seen in immune suppressed, pneumoconiosis, alcohol abuse, and HIV
Produces granulomatous inflammation in lung
35. Mycobacterium marinum
Photochromogen
Optimum temp for growth is 30˚ C
Grows poorly or not at all at 37°C
Grows in 5-14 days
Normal habitat is contaminated fresh and salt water
Infection associated with skin trauma occurring in water, such as
Swimming pools (swimming pool granuloma)
Cleaning fish tanks with bare hand and arm
Ocean (surfing)
Punctures from fish fins
36. Mycobacterium marinum
Disease: Tender, red or blue/red subcutaneous nodules develop at
the site of trauma after 2-3 weeks
Biopsy skin nodules for culture and histopathology
Lesions classically spread up arm along lymphatics,
Infection appears similar to diseases Sporotrichosis, Nocardiosis,
and infection with rapid growing Mycobacteria species
37. Mycobacterium szulgai
Scotochromogen at 37˚C / Photochromogen at 25˚C
Only AFB species that has a different light test result based on temperature
of incubation
Grows at 37 ˚C in 12 - 25 days
Rare cause of pulmonary
disease in adults associated with
alcohol abuse , smoking and COPD
or those with AIDS and immune suppressed
Symptoms similar to TB
25˚ C - Photochromogen
37˚ C - Scotochromogen
38. Mycobacterium xenopi
Scotochromogen
Thermophilic AFB with growth at 42˚C
Capable of growing in hot water systems and is the
usual source of infection
Growth in 14 - 28 days
Egg nest type colony produced on solid media
Rare cause of pulmonary disease
Clinical disease is like TB
Occurs in patients with preexisting lung disease (chronic obstructive
pulmonary disease or bronchiectasis) and HIV/AIDS
39. M. avium complex
M avium & M intracellulare most common species in this complex,
The complex includes eight species of environmental and animal AFB
Non-photochromogen
All species biochemically and genetically very similar
Growth at 37 ˚C / 7 – 21 days
Smooth / creamy colony / buff colored
Short rods, not beaded, irregular clumps of AFB
Inert in biochemical reactions
Identify using
Molecular DNA/RNA hybridization probe (M. avium complex)
MALDI-TOF mass spectrometry (species within complex)
16s rRNA sequencing (species within complex)
40. M. avium complex clinical correlation
Disease in the somewhat normal host
Adults mostly have chronic pulmonary disease, fibro-cavitary or
nodular bronchiectatic disease presentation
Elderly adults with prior lung damage (COPD) produces chronic
cough
Children – chronic granulomatous inflammation with lymph node
involvement / scrofula
M. chimaera (a species within the M. avium complex)
Environmental / nosocomial pathogen
Recently in the news as a contaminate in heater–cooler units used in cardiac
surgery/ aerosolized water from instrument positive with M. chimaera
The airborne transmission of M. chimaera over an open surgical field caused post
surgical infections
41. M. avium complex (MAC)
HIV/AIDS – common opportunistic infection in AIDS
Nonspecific low grade fever, weakness, weight loss, picture of
fever of unknown origin rather than a pulmonary infection
Diagnosis: Isolation of MAC from an AFB blood cuor
bone marrow culture
Abdominal pain and/or diarrhea with malabsorption
Positive AFB smears from stool specimens
In tissue:
Pathology: non-necrotizing more so than granulomatous
High organism load in infected tissue
AFB are small (short) rods and not beaded
Does not have cord factor
42. M avium-complex in lymph node tissue
(AFB Kinyoun stain) – packed with AFB
Granulomatous inflammation
lung tissue (H&E stain)
Bowel -Lamina propria expanded from
predominately Lymphohistocytic infiltration
43. Grows in <=7 days, more rapid than other mycobacteria species
Low virulence organisms, with most species found as environmental
contaminates
20 species – 3 species most common
M. fortuitum skin and surgical wound infections, catheter sites
M. chelonae skin infections in immune suppressed, catheter sites
M. abscessus chronic lung infection and skin infection in immune suppressed
Biochemical reactions:
All species Arylsulfatase positive
M. fortuitum: Nitrate reduction positive
Iron uptake positive
M. chelonae and M. abscessus: Nitrate negative
Rapid Grower Mycobacteria species
44. MALDI-TOF and 16 sRNA sequencing for identification
Antibiotic therapy assisted by directed susceptibility tests
Varying susceptibility patterns/ clarithromycin primary therapy
Molecular genetic testing can assist with clarithromycin testing
45. Miscellaneous
M. gordonae –
Scotochromogen
Rarely if ever causes infection
Commonly found in tap water
Find it’s way into AFB cultures as a laboratory contaminant
Use sterile/distilled water in AFB culture collection and
processing to prevent culture contamination
46. Miscellaneous pathogenic species
Mycobacterium haemophilum
Fastidious AFB, requires addition of hemoglobin or hemin to
culture media for growth
Will not grow on LJ media or in automated systems (Middlebrook 12B
media) without the addition of hemin supplements
Grows best at 30*C
Disease:
Painful subcutaneous nodules and ulcers, primarily in AIDS patients or
immunosuppressed
Lymphadenitis in children
47. Mycobacterium leprae
Leprosy – Hansen’s Disease
Affects the skin, peripheral nervous system and mucous membranes
Clinical signs and symptoms aid in diagnosis: Peripheral neuropathy with nerve
thickening, numbness in earlobes or nose, loss of eye brows
Infection by person-person spread via inhalation of infectious droplets
Curable with early diagnosis and appropriate therapy (dapsone with rifampin or
clofazimine
Two types of leprosy / most often found in India, Brazil and Indonesia
Lepromatous – Severe disfiguring lesions, large numbers of AFB in lesions
Tuberculoid - Less severe and fewer lesions, lower numbers of AFB in lesions
Non-culturable on laboratory media
PCR performed from tissue for definitive diagnosis
Armadillo is a natural reservoir of M. leprae