B4.1 MYCOBACTERIA Flashcards by 횐호 강

MAJOR GENERA AND SPECIES TO BE CONSIDERED

I. Mycobacterium tuberculosis Complex
II. Nontuberculous Mycobacteria

How well did you know this?

Not at all

Perfectly

I. Mycobacterium tuberculosis Complex spp

✓ M. tuberculosis
✓ M. bovis
✓ M. bovis BCG
✓ M. africanum
✓ M. caprae
✓ M. canettii
✓ M. microti
✓M. pinnipedii

How well did you know this?

Not at all

Perfectly

II. Nontuberculous Mycobacteria subgroups

A. Slow-Growing Nonphotochromogens
B. Photochromogens
C. Scotochromogens
D. Rapid-growing, potentially pathogenic

How well did you know this?

Not at all

Perfectly

A. Slow-Growing Nonphotochromogens spp

✓ M. avium complex
✓ M. intracellulare
✓ M. celatum
✓ M. ulcerans
✓ M. gastri

✓ M. genavense
✓ M. haemophilum
✓ M. malmoense
✓ M. shimoidei
✓ M. xenopi

✓ M. heidelbergense
✓ M. branderi
✓ M. simiae
✓ M. triplex
✓ M. conspicuum

How well did you know this?

Not at all

Perfectly

M avium complex

✓ M. avium
subsp. avium
subsp. silvaticum
subsp. paratuberculosis

How well did you know this?

Not at all

Perfectly

B. Photochromogens spp.

✓ M. kansasii
✓ M. asiaticum
✓ M. marinum

How well did you know this?

Not at all

Perfectly

C. Scotochromogens spp.

✓ M. szulgai
✓ M. scrofulaceum
✓ M. interjectum
✓ M. gordonae
✓ M. cookii
✓ M. hiberniae
✓ M. lentiflavum
✓ M. conspicuum
✓ M. heckeshornense
✓ M. tusciae
✓ M. kubicae
✓ M. ulcerans
✓ M. bobemicum

How well did you know this?

Not at all

Perfectly

D. Rapid-growing, potentially pathogenic spp.

✓ M. fortuitum
✓ M. chelonae
✓ M. abscessus subsp. abscessus
✓ M. abscessus subsp. Bolletii
✓ M. smegmatis

✓ M. peregrinum
✓ M. immunogenum
✓ M. mucogenicum
✓ M. neworleansense
✓ M. brisbanense

✓ M. senegalense
✓ M. porcinum
✓ M. houstonense
✓ M. boenickei
✓ M. wolinskyi

✓ M. goodii
✓ M. septicum
✓ M. mageritense
✓ M. canariasense
✓ M. alvei

✓ M. novocastrense
✓ M. cosmeticum
✓ M. setense
✓ M. leprae

How well did you know this?

Not at all

Perfectly

Non-cultivatable spp

✓ M. leprae

How well did you know this?

Not at all

Perfectly

SPECIMEN COLLECTION AND TRANSPORT
* Recommend container

sterile, wide-mouth cup
with a lightly fitted lid

How well did you know this?

Not at all

Perfectly

SPECIMEN COLLECTION AND TRANSPORT * Delayed longer than 1 hour transport method

refrigerated at 4°C
except blood

How well did you know this?

Not at all

Perfectly

Respiratory specimens

✓ spontaneously expectorated sputum
✓ normal saline-nebulized induced sputum
✓ transtracheal aspirate
✓ bronchoalveolar lavage
✓ bronchoalveolar brushing
✓ laryngeal swab
✓ nasopharyngeal swab

How well did you know this?

Not at all

Perfectly

Body fluids specimens

✓ pleural fluid
✓ pericardial fluid
✓ joint aspirate
✓ peritoneal fluid
✓ cerebrospinal fluid
✓ stool
✓ urine
✓ pus

How well did you know this?

Not at all

Perfectly

Body tissues specimens

✓ blood
✓ bone marrow biopsy/aspirate
✓ solid organ
✓ lymph node
✓ bone
✓ skin

How well did you know this?

Not at all

Perfectly

a. Sputum and Other Respiratory Secretions * Preferred specimen

Early-morning
specimen collected on 3 consecutive days

How well did you know this?

Not at all

Perfectly

Sputum and Other Respiratory Secretions * Method of choice

Spontaneously produced sputum

How well did you know this?

Not at all

Perfectly

Required volume for Sputum and Other Respiratory Secretions

5 to 10 ml

How well did you know this?

Not at all

Perfectly

Type of sputum needed

->deep cough expectorated sputum or
aerosol of hypertonic saline induced

How well did you know this?

Not at all

Perfectly

Microscopy results for Sputum and Other Respiratory Secretions to confirm a diagnosis

<10 SEC and >25 pus cells

from two of the first three sputum direct
smears (+)

How well did you know this?

Not at all

Perfectly

Others Sputum specimens

Bronchial washing, bronchoalveolar lavage (BAL), or transbronchial biopsy-> Bronchoscopy

How well did you know this?

Not at all

Perfectly

Specimen to recover mycobacteria swallowed during the night

Gastric Aspirates and Washings

Gastric Aspirates and Washings used for which patients

✓ patients who do not produce sputum
by aerosol induction
✓ children younger than 3 years->
specimen of choice
✓ senile, nonambulatory patients

obtained in morning after an overnight
fast, before the patient arises and before
exertion empties the stomach

Gastric Aspirates and Washings

Gastric Aspirates and Washings collection method

3 specimens within 3 days

Used to neutraliz Gastric Aspirates and Washings specimen

sodium carbonate or buffer to PH 7.0

required volume for Gastric Aspirates and Washings

20 to 25 ml

Preferred specimen for Urine Specimens

First morning midstream specimens daily for at least 3 days

Volume required for urine specimens

entire volume or, minimum of 15 mL

Specimen used that identifies patients at risk for developing disseminated mycobacterial disease resulting from Mycobacterium avium complex (MAC) (AIDS) * do not use preservative * utilized in automated equipment

Stool

Stool automated equipment used

MGIT 960

Blood medium

MYCO/F bottle

Specimen used for * disseminated mycobacterial infection-> MAC ✓ Isolator lysis-centrifugation system > quantitative data

Blood

Blood automated equipment used

✓ Bactec MGIT 960 system * BacT/ALERT 3D or BacT/Alert MB

Specimen for tissue and other body fluids

Pleural, pericardial, peritoneal, joint aspirates and CSF

Volume Required for CSF

2 ml

Volume Required for exudates and pericardial and synovial fluids

3 to 5 ml -

Volume Required for abdominal and chest fluids

10 to 15 ml

Volume Required best type of specimen for skin lesion or wound

Aspirate

Volume Required to prevent dehydration

10 to 15 mL sterile NSS

Specimens that needs to undergo DIGESTION AND DECONTAMINATION

Sputum, gastric washing, BAL, bronchial washing, and transtracheal aspirate

Specimens that needs to undergo DECONTAMINATION

Voided urine, autopsy tissue, abdominal fluid, and any contaminated fluid

1. liquefy sample through digestion of proteinaceous material (mucin) -> enables mycobacteria to use nutrients of the medium 2. allow chemical decontaminating agent to kill the nonmycobacterial organisms ->concentrated with centrifugation

DIGESTION AND DECONTAMINATION OF SPECIMENS

DIGESTION AND DECONTAMINATION OF SPECIMENS Factors

concentration of the chemical agent, exposure time, and temperature

REAGENTS for Digestion and decontamination main

2%-4% Sodium Hydroxide N-Acetyl-L-cysteine-Sodium Hydroxide (NALCNaOH) Benzalkonium Chloride (Zephiran)-Trisodium Phosphate (Z-TSP) 5% Oxalic Acid 1% Cetylpyridium Chloride

REAGENTS for Digestion and decontamination others

a. 4% H2SO4 b. Sputolysin (Dithiothreitol)-Oxalic Acid c. 20% Chlorox d. 1% Cetylpyridium Chloride + 2% NaCI e. Sputolysin + 2% NaOH f. 2 parts of Antiformin (Na Hypochlorite) to 1 part sputum

* digestant and decontaminating agent * commonly used decontaminant (2ml sputum + 2ml NaOH)

2%-4% Sodium Hydroxide

*>recommended technique *>use in MGIT 960 NALC or Dithiothreitol > liquetying agent NaOH ->decontaminant

N-Acetyl-L-cysteine-Sodium Hydroxide (NALCNaOH)

_______ -> liquefies sputum rapidly ; long exposure time to decontaminate ________ -> shortens exposure time and destroys many contaminants

(Zephiran)-Trisodium Phosphate (Z-TSP) Benzalkonium Chloride Benzalkonium Chloride (Zephiran)-Trisodium Phosphate (Z-TSP)

* decontaminate specimens contaminated with P. aeruginosa

5% Oxalic Acid

prolong the shelflife of sputum up to 8 days * ideal for transport of specimen

1% Cetylpyridium Chloride

Procedure for digestion and decontamination

1. Specimen + Digestant 2. Mix and stand at room temp for several minutes 3. Centrifuge ->SG: 0.79 to 1.07 4. Decant 5. Sediments for smears and cultures