MYCOBACTERIA MYCOBACTRERIUM TUBERCULOSIS DISEASE Tuberculosis CHARACTERISTICS Aerobic, acid fast rods.

. High lipid content of cell wall prevents dyes used in Grams stain fr staining org. Lipids include mycolic acid and wax D Grows very slowly - require drugs for long period (months) Produce catalase, - required to activate isoniazid to active drug. HABITAT AND Habitat is human lungs. TRANSMISSION Transmission via respiratory droplets produced by coughing. MYCOBACTERIUM LEPRAE Leprosy Aerobic, acid-fast rods cannot be cultured in vitro Optimal growth at less than body temperature lesions are on cooler parts of the body - skin - nose - superficial nerves. Humans are reservoir. Also found in armadillos. Most important mode of transmission nasal secretions of patients with lepromatous form. - have higher num of org. Prolonged exposure is necessary. Lesions - mostly in cooler parts of body - e.g. skin and peripheral nerves. In tuberculoid leprosy, destructive lesions due to cell-mediated response to organism. Nerve damage cause loss of sensation. In lepromatous leprosy - cell mediated response to M. leprae is lost - large num of org appear in lesions and blood. No toxin or virulence factors are known Acid-fast rods abundant in lepromatouds leprosy few in tuberculoid form. Culture and serologic tests are not done Lepromin skin test (+) in tuberculoid (-) in lepromatous form. Dapsone plus rifampin for tuberculoid Clofazamine is added to regimen for lepromatous form or if org is R to dapsone. Treatment at least 2 years.

PATHOGENESIS

Granulomas and caseation mediated by cellular immunity - e.g. macrophages and CD4 positive T cells (delayed sensitivity) Cord formation correlates with virulence. No exotoxin or endotoxin. Immunosuppression increases risk of reactivation and dissemination.

LAB DIAGNOSIS

TREATMENT

Acid fast rods seen with Ziehl-Neelsen stain. Slow growing on Lowenstein-Jensen(L.J) medium. Organism produce Niacin and catalase (+). Purified protein derivative (PPD) skin test - (tuberculin test Mantoux test is (+) if induration measure 10 mm or more appears 48 hours after inoculation. Induration caused by delayed hypersensitivity response. (+) skin indicates person infected but not necessarily person has TB Long therapy (6-9 months) with 3 drugs isoniazid, Rifampin,parazinamide, a 4th drug used in severe cases e.g meningitis In immunocompromised patients

PREVENTION

those with AIDS the chance of Isoniazid R org is high as in Southeast Asians. Most patients become non-infectious ithn 2 wks of adequate therapy. Treatment of latent (asymptomatic) infections consists of Isoniazid taken for 6- 9 months. Multidrug R (MDR) stains emerged & require other drug combinations. BCG vaccine containing live, attenuated Mycobacterium bovis org prevent / limit extent of disease but not prevent with M. Tuberculosis. Vaccine widely used in Europe and Asia but rarely in US.

Dapsone for close family contacts. No vaccine is available.