sl 2013

Bacteria
Mycobacteriu
m
tuberculosis

Mycobacteriu
m leprae

MISCELLANEOUS BACTERIA

Characteristics

Epidemiology

Pathogenesis and Virulence

Weakly Gram +
Strongly Acid
Fast
Aerobic
Cell wall:
peptidoglycan
&
lipoarabinogal
actan

Spread: aerosol
Location:
patients with
active TB
infection
Risk Factors:
1. Geographic
(Asia, Eastern
Europe)
2. Exposure to
infected group
At Risk:
1. Immunocomp
2. Drug/Alcohol
abuser,
homeless
3. Exposed
individuals

Virulence
1. Trehalose mycolate or cord
factor: induces granuloma
formation
2. Establishes lifelong infection:
intracellular pathogen
3. Prevent phagolysosome fusion:
sulphatide secretion
4. Phagosome fuses with other
intracellular vesicles for nutrient
access
5. Oxidant inactivation: evade
macrophage killing
6. Stimulate IL-12 and TNF-
release: TH1 CD4+ response
IFN- and nitric oxide release

Weakly Gram +
Strongly Acid
Fast
Aerobic

Spread: aerosol
or personperson contact
Location:
armadillo, soil,
contaminated

Pathogenic Development
1. Macrophages and lymphocytes
are attracted to infectious focus
2. Fuse to form Langhan giant
cells
3. Granuloma formation to
prevent further spread of
bacteria
4. TH1 CD4+ cells attempt to
control and eradicate the
infection via pro-inflammatory
and cell-mediated cytokines
5. Depending on the size of the
focus, the bacteria can either get
eradicated or remain dormant

1. Prolonged contact required

2. Low infectivity: longer duration
for disease development

Diseases
Primary (children): Initial focus
in subpleural part of lung
activate cellular immunity
replication ceases
1. Pneumonia, abscess
formation, cavitation in upper
lobes and hilar
lymphadenopathy
2. Ghons complex: Calcification
of healed primary lesion
(scarring)
3. Nonspecific complaints of
weight loss, cough and night
sweats
4. Sputum: scant or bloody and
purulent; can be associated
with tissue destruction
Secondary (adults):
Reactivation of dormant
tubercle bacilli or reinfection
spread to upper lobe apex
1. Fibrocaseous cavitary lesion
near apex of upper lobe
Miliary: Hematogenous
widespread dissemination of
tubercle bacilli
1. Millet-like seeding in lung
Extrapulmonary:
hematogenous spread of
tubercle bacilli causing tissue
destruction at lymph nodes,
pleura, urogenital tract, bones,
kidneys

Chronic granulomatous lesion of

peripheral nerves and
mucocutaneous tissue (nasal
mucosa)
1. Tuberculoid leprosy: few
skin lesions in cooler body

Lab
Diagnosis
Culture
collection
Acid Fast
Stain
PCR
Various
media: LJ,
Middlebroo
k, BACTEC
460
Chest X-ray

Treatment
RIPE:
Rifampin,
Isoniacid,
Pyrazinami
de,
Ethambutol
BCG vaccine
DOT:
Directed
Observed
Treatment

Tuberculin
(Mantoux
) skin
test:
injection of
PPD intradermally
>5mm: HIV
px,
immunosu
pp,
contact
with TB px
>10mm:
immigrant
s, IV drug
users,
hospital
workers
>15mm: no
risk factors
for TB
Quantiferon
Gold Test:
detect whole
blood IFN-;
immune
reactivity
Acid-fast in
lepromato
us leprosy

Dapsone
Rifampin
Clofazamine

 sl 2013

MISCELLANEOUS BACTERIA

persons
At Risk:
1. Contact with
infected person

Mycobacteriu
m avium
complex
(MAC)

Weakly Gram +
Strongly Acid
Fast
Aerobic

Mycoplasma
pneumoniae

Cell-wall has no
peptidoglycan
but contains
sterol (requires
cholesterol!)
Aerobic
Pleomorphic

Spread: aerosol
At Risk:
1. HIV patients
2.
Chemotherapy
Spread: aerosol
Location:
ubiquitous
Risk Factors:
1. Schools,
prisons, military
settings (close
contact)
At Risk:
1. Children and
young adults

Asymptomatic colonization in
immunocompetent
Dissemination in
immunocompromised
1. P1 adhesion protein: adherence
to ciliated respiratory epithelia
2. Eventual loss of ciliated
epithelia: facilitate bacterial
spread to lungs
**Fried egg appearance!!

tissues (nose, ears, fingers,

testicles), CMI, low infectivity,
lepromin +
2. Lepromatous leprosy:
extensive destruction of skin,
immunity is depressed, high
infectivity, lepromin 1. Development of single
infected nodule: disseminates
in immunocompromised
1. Upper Respiratory Tract
Infection: low grade fever,
headache, dry, non-productive
cough
2. Lower Respiratory Tract
Infection: primary atypical
pneumonia (walking
pneumonia) mild, diffuse
interstitial pneumonia;
tracheobronchitis
**Pneumococcal pneumonia
(Strep) is consolidate, lobar
pneumonia

Other Miscellaneous Bacteria:

U. urealyticum: causes non-gonococcal urethritis
M. hominis: causes pyelonephritis, PID, post-partum fever

Macrolides

Cold
agglutinin
test: Ab
that lyses
RBC in 4C
PCR

Erythomycin
Doxycycline
**Penicillin
resistant
(no cell
wall)