1. Mycobacteria Nontuberculous Mycobacteria & Actinomycetes 2013274038_ 조수진 _ 자료조사, 퀴즈, 발표 2013274041_ 백지영 _ 자료조사, 퀴즈 2013274016_ 하려미 _ 자료조사, 퀴즈 2013274048_ 우민경 _ 자료조사, 퀴즈 2013274035_ 양그림 _ 자료조사, 퀴즈, PPT

2. 목 차 ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆목 차 ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ Genus Mycobacterium Tuberculosis Leprosy Nontuberculous Mycobacteria Actinomycetes

4. Genus Mycobacterium Contains mycolic acids and waxes → “Acid Fastness” Long, slender, straight/curved rods Does not form capsules, flagella or spores Strict aerobes Slow growth rate Colonies of some members contain yellow, orange or pink carotenoid pigments -Others are colorless Highly significant human pathogen

5. Tuberculosis Leprosy

6. Mycobacterium tuberculosis = Tubercle Bacillus Gram-positive, Acid Fast Bacillus (AFB) Contains waxes & a cord factor –prevents mycobacteria from being destroyed by macrophages Intracellular parasites

7. Epidemiology of Tuberculosis People in developing countries are often infected as infants –Harbor the microbe for many years –Reactivated in young adulthood US highest case rates : –Non-white males over 30 years of age –Non-white females over 60 years of age –New immigrants from certain areas of Asia, South America & Africa –In AIDS patients

8. Epidemiology of Tuberculosis Increasing proportion of Mycobacterium tuberculosis infections resistant to first-line drugs (isoniazid, rifampin) = MDR-TB(Multidrug-resistant tuberculosis) Needs second-line drugs → less effective, more toxic, costlier Rise of XDR-TB (extensively drug-resistant tuberculosis) infections → resistant to at least 3 second-line drugs growing problem, even as total cases of TB declines

9. Transmission of Tuberculosis Transmitted by fine droplets of respiratory mucus suspended in air Tiny particles inhaled into bronchioles & alveoli Pronounced in people sharing closed, small rooms with limited access to sunlight & fresh air Factors that increase susceptibility to TB : –Inadequate nutrition –Debilitation of immune system –Poor access to medical care –Lung damage –genetics

10. Initial infection and primary tuberculosis Latent and recurrent tuberculosis Extrapulmonary tuberculosis The Course of Infection and Disease

11. 1. Initial infection and primary tuberculosis Lung infection The bacilli are phagocytosed by alveolar macrophages and multiply The immune system mounts a complex : caseous lesions The Course of Infection and Disease

12. Tubercle The centers of tubercles break down 1. Initial infection and primary tuberculosis The Course of Infection and Disease

13. The bacilli can remain latent and become reactivated in people with weakened immunity Gradually, the patient experiences more severe symptoms: violent coughing, fever, anorexia, weight loss etc. 2. Latent and recurrent tuberculosis The Course of Infection and Disease

14. 3. Extrapulmonary tuberculosis During the course of reactivated TB, the bacilli disseminate rapidly to sites other than the lungs Renal tuberculosis Genital tuberculosis Tuberculosis of the bone and joint Tubercular meningitis The Course of Infection and Disease

15. Clinical Methods of Detecting Tuberculosis 1.Tuberculin sensitivity and testing 2.Roentgenography 3.Acid-fast staining 4.Laboratory cultivation

16. 1. Tuberculin sensitivity and testing Mantoux test Local injection of purified protein derivative(PPD) The injection is done intradermally into the forearm to produce an immediate small bleb => induration Clinical Methods of Detecting Tuberculosis

17. 1. Tuberculin sensitivity and testing BCG (Bacillus Calmette Guerin) A closely related species of Mycobacterium A false negative  The QuantiFERON-TB Gold test Clinical Methods of Detecting Tuberculosis

18. 2. Roentgenography Suggestive of, but never diagnostic of TB 1.Primary tubercular infection -Enlarged lymph nodes in the lower and central lungs 2.Secondary tubercular infection - Extensive infiltration in the upper lungs and bronchi

19. Clinical Methods of Detecting Tuberculosis Fluorescent stain 3. Acid-Fast staining The Ziehl Neelsen stain 4. Laboratory Cultivation

20. Sufficient period (6~24 months) Combines at least two drugs (isoniazid, rifampin, ethambutol, streptomycin….) Rifater = isoniazid + rifampin+ pyrazinamide Vaccine: “Bacillus Calmette Guerin”(BCG) strain of M.bovis UV lamps, negative pressure room Management of Tuberculosis

21. Tuberculosis Leprosy

22. Aerobic acid-fast bacilli Gram positive No spore or flagella Difference: –Does not grow in artificial media or human tissue cultures –Slowest growing of all the species Mycobacterium leprae

23. Epidemiology and Transmission of Leprosy Epidemiology - Not restricted to warm climates -Not highly virulent -Health and living conditions influence disease Transmission - Skin contact - Inhalation of droplet nuclei

24. Once M. leprae has entered, macrophages successfully destroy the bacilli A weakened or slow macrophage and T-cell response leads to intracellular survival of the pathogen. The earliest sign of leprosy appear on the skin of the trunk and extremities The Course of Infection and Disease

25. Tuberculoid Leprosy (TL) The most superficial form Asymmetrical, shallow skin lesions containing very few bacilli Microscopically, lesions appear as enlarged dermal nerves Damage to these nerves results in local loss of pain reception and feeling. Fewer complications More easily treated

26. Disfigurations Chronicity and severe complications Leprosy bacilli grow primarily in macrophages in cooler regions of the body. Afflicted patient develops lepromas which are caused by massive intracellular overgrowth of M.leprae. Lepromatous Leprosy (LL)

27. Diagnosis,Treatment and Prevention of Leprosy Diagnosis Symptomology, microscopic examination of lesions, and patient history Detection of AFB in smears Treatment Needs to be controlled before permanent damage of nerves and other tissues occurs Multidrug therapy needed because of an increase in resistant strains Prevention Constant surveillance of high-risk populations to discover early cases Chemoprophylaxis of healthy persons in close contact with leprotics Isolation of leprosy patients

28. Nontuberculous Mycobacteria (NTM) Infections : Mycobacterium avium complex(MAC) Pulmonary infections 그 외 Mycobacterial Infections

29. Mycobacterium avium complex(MAC) –Enter through the respiratory tract –Blood, bone marrow, bronchi, intestine, kidney, liver –Rifabutin, azithromycin, ethambutol, rifampin Nontuberculous Mycobacteria (NTM)

30. Pulmonary Infections  M. kansaii infection Endemic to some areas Often in adult White males  M. fortuitum complex Postsurgical skin, soft-tissue infections Pulmonary complications In immunosuppressed patients Nontuberculous Mycobacteria (NTM)

31. 그 외 Mycobacterial Infections  M. marinum Swimming pool granuloma Localized nodule →enlarges  M. scrofulaceum Ingestion of food or milk Without complications, but develop scrofula  M. paratuberculosis Chronic intestinal syndrome (Crohn’s disease) Found in cow’s milk Nontuberculous Mycobacteria (NTM)

33. Actinomycetes Non-motile filamentous bacilli Acid-fast Chronic granulomatous disease Actinomyces Nocardia

34. Actinomycosis  Cervicofacial disease A. israelii – oral mucous membrane Swollen, nodules  Thoracic actinomycosis  Abdominal actinomycosis  Uterine actinomycosis - Surgical drainage, drug therapy Actinomycetes

35. Nocardiosis  Widely distributed in the soil  Not infectious  N. brasiliensis – primary N. asteroides, N. caviae – opportunitists  Pulmonary, cutaneous, subcutaneous infections Actinomycetes

36. Q&A

37. Foundations in Microbiology/Talaro Chess/McGrawHill/2012/8 판 /p.570, 585~595 리핀코트의 그림으로 보는 미생물학 /Richard A. Harvey/ 바이오사이언스 /3 판 /p.187 의학미생물학 / 대한미생물학회 / 엘스비어코리아 /2009/6 판 /p.300~303 Reference

38. 1.Which of the following characteristics of the genus Mycobacterium constitutes to its acid- fastness? A) Colored colonies B) Slow growth rate C) Presence of mycolic acids D) Curved rods E) Aerobicity QUIZ

39. 2. What is the name of the solution injected to test tuberculin sensitivity? A) BCG B) PC C) PPD D) AFB E) INH QUIZ

40. 3. Which of the following is NOT a characteristic of M. leprae? A) Gram-positive B) No spores C) Grown in human tissue cultures D) Slowest growing of mycobacteria E) Acid-Fast Bacilli QUIZ

41. 4. In most cases, macrophages destroy M.leprae. However in some cases, the bacilli cause diseases. How does this happen? A) By lesions in the skin B) By Damaging the nerves C) Through intracellular survival of the pathogen D) By inhaling droplet nuclei E) By destroying macrophages QUIZ

42. 5. What is the name of the species which have endemicity to some areas and occur most often in adult White males? A) MAC (Mycobacterium avium complex) B) M. marinum C) M. kansaii D) N. brasiliensis E) A. israelii QUIZ

43. Thank you