KOCHS DISEASE : TUBERCULOSIS

Robert Koch (1882)

Isolated the mammalian tubercle

bacillus on

Heat Coagulated Bovine Serum

and proved its causative role in

Tuberculosis

by satisfying

Kochs Postulates

Robert Koch
NO ONE IS SAFE FROM TUBERCULOSIS
UNTIL EVERY ONE IS SAFE.
 Tuberculosis is an architypal chronic granulomatous
inflammatory reaction of the tissues to the
presence of causative agent Mycobacterium
tuberculosis,being characterized by a local
aggregation of large number of macrophages,some
of which undergo striking structural & functional
alterations in the form of their transformation to
epithelioid cells,foreign body giant cells & Langhans
giant cells i.e. formation of TUBERCLE.
Mycobacterium
Organisms belonging to the genus
Mycobacterium are----
1.Very Thin
2.Rod shaped
3.0.2 to 0.4 X 2 to 10 m
4.Non motile
5.Sometimes showing filamentous branching like
fungus.
6.Forming mould like pellicle in liquid culture.
CLASSIFICATION OF MYCOBACTERIA
Typical Mycobacteria
M tuberculosis

M bovis

M bovis BCG

M africanum

Non-Cultivable Mycobacteria

M leprae
 MYCOBACTERIUM TUBERCULOSIS
Scientific classification
Kingdom: Bacteria
Mycobacterium tuberculosis
Phylum: Actinobacteria
Order: Actinomycetales
Suborder: Corynebacterineae
Family: Mycobacteriaceae
Genus: Mycobacterium
Species: M. tuberculosis

Binomial name
 Straight or slightly curved rod
3 m X 0.3 m
Occurring slightly in pairs or small clumps
Are ACID FAST & ALCOHOL FAST
Resist decolourization by 20% sulphuric acid & absolute alcohol for 10
minutes.
MORPHOLOGY OF MYCOBACTERIUM
TUBERCULOSIS
 ZIEHL NEELSEN STAIN

FLUORESCENT STAIN
(AURAMIN O &
RHODAMINE.)

STAINING BY :
Mycobacteriumtuberculosis:ZiehlNeelsenstain
Mycobacteriumtuberculosis:ZiehlNeelsenstain.
Mycobacterium Tuberculosis Stained with
Fluorescent Dye
Mycobacterium tuberculosis :
Electron Micrograph.
Lipid Rich Cell Wall Of Mycobacterium tuberculosis
Mycolic acids

CMN Group: Unusual cell

wall lipids (mycolic acids,etc.)

(Purified Protein Derivative)

 ACID FASTNESS OF
MYCOBACTERIUM TUBERCULOSIS
IS DUE TO PRESENCE OF
A HIGH MOLECULAR WEIGHT
HYDROXY ACID CONTAINING
CARBOXYL GROUPS
CALLED
MYCOLIC ACID
IN THE BACTERIAL CELL WALL OR
TO A SEMIPERMIABLE MEMBRANE
AROUND THE CELL.
 Resistance of M tuberculosis
Killed at 60C in 15 20 mins,
Killed on exposure to sunlight for 2 hrs,
Remain viable for 8 10 days in Droplet Nuclei,
Cultures remain viable at Room temp.
for 6 8 months,

Survive exposure to 5% Phenol, 15% Sulphuric acid, 3% Nitric

acid, 5% Oxalic acid and 4% NaOH.

Sensitive to Formaldehyde & Glutaraldehyde.

Killed with Tincture Iodine in 5 mins. & by

80% Ethanol in 2 10 mins.
 Cultural Characteristics
Slow Growing Bacteria.

Generation Time 14 15 hrs.

Optimum Temp - 37C

Optimum pH 6.4 7,

Eugonic (5% Glycerol luxuriant growth),

Require Egg, Blood, Potato or Serum for good

growth.
 CULTURE MEDIA
SOLID MEDIA
Egg-based Media: Blood containing Media:
Lowenstein-Jensen (LJ) Tarshis Medium
Medium
Dorset Medium
Agar-based Media:
Serum containing Media: Middlebrook 7H10
Loefflers Medium
Middlebrook 7H11
Potato-based Media: Middlebrook Biplate
Pawlowskys Medium (7H10/7H11 S Agar).
MYCOBACTERIUM TUBERCULOSIS :
Lowenstein-Jensen Medium.

Colonies are dry, rough, raised,

irregular with wrinkled
surface.
They are creamy white initially,
becoming yellowish or buff
coloured on further incubation.
Colonies of Mycobacterium tuberculosis on Lowenstein-
Jensen medium.
M. tuberculosis bacterial colonies
Eight Week Growth of Mycobacterium tuberculosis
on Lowenstein-Jensen Agar
 Airborne transmission of
droplet nuclei

Deposit in alveolar spaces of lungs

Transmission
Pulmonary tuberculosis is a disease of
respiratory transmission, Patients with
the active disease (bacilli) expel them
into the air by:
coughing,

sneezing,

shouting,

or any other way that will expel

bacilli into the air

TUBERCULOSIS IS THE MOST IMPORTANT COMMUNICABLE
DISEASE IN THE WORLD
SPARING NO AGE, NO SEX, & NO
NATIONALITY.
VIRULENCE FACTORS

Cord Factor
Sulphatid
Lipo-Arabino Mannan (LAM)
Heat Shock Protein
Mac-1 Integrin
Antigen 85 Complex
Pathogenesis of M. tuberculosis
Diagram
of a
Granuloma
NOTE: ultimately a
fibrin layer develops
around granuloma
(fibrosis), further
walling off the
lesion.
Typical progression
in pulmonary TB
involves caseation,
calcification and
cavity formation.
 Typical Progression of
Pulmonary Tuberculosis
Pneumonia
Granuloma formation with fibrosis
Caseous necrosis
Tissue becomes dry & amorphous (resembling cheese)
Mixture of protein & fat (assimilated very slowly)

Calcification
Ca++ salts deposited

Cavity formation
Center liquefies & empties into bronchi
Necrosis: Soft White Cheese
This patient was referred to the tuberculosis clinic with the question of otitis media. There
was no otitis. The patient had lost weight and had signs and symptoms of systemic illness.
The pre-auricular lesion was cold to the touch and was apparently fluctuating. The abscess
was aspirated. A Gram stain showed no organisms and careful examination of a Ziehl-
Neelsen stained smear revealed acid-fast bacilli.
She has tuberculosis of peripheral lymph nodes. Although lymphatic
tuberculosis may appear to be a localized disease process, it is not as the systemic
signs and symptoms in this child indicate. At least five lesions can be seen, but it
is likely that there are more less apparent ones in deeper structures.
While peripheral lymphatic tuberculosis is most frequently found around the neck, the axilla
may also affected. Several lymph nodes may be matted together as in this patient. Some
nodes have undergone liquefaction leading to discoloration of the skin.
This abscess was close to breaking through the skin, yet it felt cold to the touch
and the child felt remarkably little pain when the lesion was touched. Such a
finding should raise a high index of suspicion for tuberculosis.
This patient has chronic peripheral lymphatic tuberculosis with some lesions
healed with scaring, while others are still showing activity.
The lesion in the hand is shown here in close-up.
This patient had tuberculosis of the ankle. The bacteriologic diagnosis was
made by demonstrating acid-fast bacilli from the visible secretions draining
from a sinus.
Warty skin tuberculosis is a perhaps difficult to diagnose manifestation of
tuberculosis of the skin if it is not thought of. This patient testifies to the
remarkable efficacy of modern anti-tuberculosis chemotherapy in such a
patient.