Aerobic Gram-Positive Bacilli (2): Mycobaterium

No.
1

Micro.
Mycobacterium
tuberculosis

Disease
Pulmonary
tuberculosis

Notes of Disease
Primary TB:
Classically,
common in children,
also in adults.
Asymptomatic
(~66%): Often in
adults.
Symptomatic
(~33%): Often in
children.
Fever and chest
pain are the most
common.
Common in middle
and lower lung areas.
Cavitation is
uncommon.
Hematogenous
spread to other
organs: Common and
asymptomatic.
Ghons focus:
The lesion forming
after initial infection:
tubercle
(granulomatous
lesion)
Usually peripheral.
Most of the times,
it heals
spontaneously (and
calcifies).
Ghons complex:
Spread of bacilli
from the lung
parenchyma through
lymphatic vessels.
Components:
+ Pulmonary
component (Ghons
focus).
+ Lymphatic
component.
+ Lymph node
component.
Primary progressive
TB:

Treatment
Antimicrobial
treatment of active
disease:
All patients with TB
disease need to be
treated.
Four major drugs
are considered the
firstline agents:
Isoniazid.
Rifampin.
Pyrazinamide.
Ethambutol.
Second line drugs
Fluoroquinolones
(ofloxacin,
levofloxacin,
moxifloxacin)
Streptomycin
Other
aminoglycosides
(kanamycin,
amikacin)
Capreomycin
Ethionamide
Cycloserine
Para-aminosalicylic
acid (PAS)
[]
Standard shortcourse regimen (6
months):
Initial, or
bactericidal, phase:
To kill most of
bacteria, so
symptoms resolve,
and the patient
becomes noncontagious: 2-month
of isoniazid,
rifampin,
pyrazinamide,and
ethambutol.
Continuation phase:
To eliminate
persisting bacteria, so

Prevention
Pre-exposure
prophylaxis:
BCG vaccination:
The only available
vaccine against
tuberculosis.
Benefits:
Lower risk of TB
meningitis and
disseminated
disease in children

Recommendations:
A single dose of
BCG vaccination as
soon as possible
after birth.
As for all live
vaccines:
BCG is
contraindicated in
immune suppressed
individuals.
It is suggested
NOT to administer
BCG to pregnant
women.

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Aerobic Gram-Positive Bacilli (2): Mycobaterium

Extrapulmonary
tuberculosis

After primary
infection:
>90% of
individuals control
bacterial replication
of the bacteria -->
Latency.
<10% of
individuals may
develop primary
progressive disease:
+ Local disease:
Pulmonary TB with
expansion
+ Disseminated
disease: Meningitis,
miliary dissemination
Primary
progressive disease is
more common in
Immunosuppressed:
HIV, chronic kidney
failure, poorly
controlled diabetes
mellitus.
Children.
Elderly.
Post- primary TB:
Also called
reactivation,
adult-type, or
secondary
tuberculosis.
Cough, weight loss,
fatigue, fever, night
sweats, chest pain,
dyspnea, and/or
hemoptysis.
Usually localized to
the upper and
posterior segments of
the upper lobes.
Usually with
cavitation: Highly
contagious.
Lymph-node TB
(tuberculous
lymphadenitis):

preventing relapse: 4month of isoniazid

and rifampin.
Antimicrobial
treatment of latent
infection:
NOT all patients
with latent TB
infection need to be
treated.
Example of
practical approach:
Close contact with
contagious patient:
TST (or IGRA)
positive -->
Treatment.
TST (or IGRA)
negative:
+ <20 yr -->
Treatment for 2
months --> Repeat
test --> Stop if new
test is negative.
+ >20 yr --> Wait 2
months --> Repeat
test --> Treatment if
new test is positive.
TST (or IGRA)
positive, without
exposure to
contagious patient:
<35 yr -->
Treatment.
>35 yr -->
Treatment only if
high risk factors.
HIV-positive
persons with TST (or
IGRA) negative,
often in contact with
TB patients.
Antimicrobial
regimens: 9 months
of isoniazid alone.

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Aerobic Gram-Positive Bacilli (2): Mycobaterium

It may be
associated with
pulmonary disease.
Mainly HIV(+)
patients.
Painless swelling of
the lymph nodes.
Most commonly at
posterior cervical and
supraclavicular sites
(scrofula).
Pleural TB:
Common in primary
tuberculosis.
Tuberculosis of the
upper airways:
Larynx,
pharynx,and
epiglottis.
Complication of
advanced cavitary
pulmonary
tuberculosis.
Genitourinary
tuberculosis: Renal
TB
Skeletal
tuberculosis:
The spine in 40%
of cases: Potts
disease or
tuberculous
spondylitis.
Tuberculous
meningitis:
Most often in
young children.
But also develops
in adults, mainly
HIV(+).
The main source is
hematogenous spread
of primary or postprimary pulmonary
disease.
The disease evolves
over 12 weeks:
Longer than other

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Aerobic Gram-Positive Bacilli (2): Mycobaterium

Primary
manifestations of
infection

2
Mycobacterium
leprae

Erculoid leprosy
and lepromatous
leprosy.

bacterial meningitis.
Miliary or
disseminated TB:
Hematogenous
spread of tubercle
bacilli:
+ In children, after
primary TB.
+ In adults, after
primary TB or postprimary TB.
Small yellowish
granulomas 12 mm
in diameter.
Lethal unless
proper early
treatment.
Skin lesions:
+ Hypopigmented.
+ Sometimes
hypoesthetic or
anesthetic (in TT).
+ Non pruritic.
Peripheral nerves
lesions: Anesthesia
(loss of sensation),
dryness, and loss of
motor function.
Lepromatous:
unrelated to skin
lesion.
Tuberculoid: Loss
of sensation in skin
lesion.

The first-line
antileprosy drugs are:
Rifampin.
Dapsone.
Clofazimine.

Vaccination:
BCG vaccination
is an important
public health
activity
contributing to
leprosy control in
endemic areas.

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