Mycobacteria (Fan) - 4/28/16 Flashcards

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1
Q

General Characteristics of mycobacteria (8)

A
  • Thin, rod shaped
  • Obligate aerobe
  • Non-motile
  • Cell wall contains N-glucolylmuramic acid (instead of N-acetylmuramic acid) and has very high lipid content
  • Acid fast (3% HCl, heated)
  • Slow growing (doubling time: 30 h –> 4-8 weeks to form colonies)
  • Do not form endospores
  • Over 100 species (Mtb complex vs NTMs)
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2
Q

Gram- bacteria cell wall vs. Mycobacterial-specific cell wall features

A

Gram- bacteria:

  • Lipid layers
  • Peptidoglycan
  • Porins
  • LPSs

Mycobacterial-specific features:

  • Lipid layer
  • Peptidoglycan
  • Porins
  • Arabinogalactan
  • Mycolate (C54-C78) - very long lipids (protective)
  • Acyl lipids

Difficult to stain

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3
Q

Describe the Mtb complex.

A

Components: M. tuberculosis, M. bovis, M. bovis BCG, M. africanum, M. microti, M. canetti

All may cause TB in humans and animals

Non-pigmented colonies

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4
Q

Mtb disease overview.

A

1/3 of the world’s population is infected

Pathogenesis:

  • Inhalation of organisms produces disease in 15-20%
  • M. bovis from milk
  • M. bovis BCG from vaccination (in immune-compromised people)
  • Disease may occur many years after exposure
  • Small % of patients develop disseminated disease

Spectrum of disease:

  • Low grade fever, night sweats, anorexia, weight loss
  • Productive cough w/ pulmonary infection + fever, chills, myalgia, and sweating
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5
Q

How is TB transmitted?

A

Spread person to person through the air via droplet nuclei –> bacilli reach alveoli of lungs –> bacilli multiply in alveolar macrophages –> within 2-8 wks, cell mediated immunity develops and activated macrophages surround tubercle bacilli (these cells form a barrier shell called a granuloma, that keeps bacilli contained and under control)

Mtb may be expelled when an infectious person (coughs, sneezes, speaks, sings)

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6
Q

Two types of TB testing:

  1. Tuberculin Skin Testing (TST)
  2. Interferon-gamma release assays (IGRAs)
A

TST:
Measure ring of INDURATION (not ring of redness) 2-3 days after (delayed-type hyper-sensitivity)

IGRAs:

  • Like TSTs, IGRAs measure a person’s immune reactivity to Mtb
  • Principle is the same but you cut off the last step so you don’t wait for interferon gamma to induce local inflammation
  • 3 separate measurements of IFN-gamma are obtained:
    1) Whole blood alone (baseline level of IFN-gamma)
    2) Whole blood + Mtb peptides (TB specific antigen): IFN-gamma release in response to RECOMBINANT, SPECIFIC Mtb antigens (not cross reactive w/ BCG)
    3) Whole blood + non-specific activator of WBCs (mitogen): demonstrates that WBCs are present and capable of secreting IFN-gamma
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7
Q

IGRA or TST?

A

IGRA may be used in place of (but not in addition to) TST

IGRA preferred when:

  • Testing patients that are unlikely to return for reading
  • Testing BCG-vaccinated individual

TST preffered when:
- Testing children

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8
Q

Risk factors for Mtb progression

A
  • Persons with HIV infection

- Infants/children

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9
Q

Latent TB infection (LTBI) vs. Active Disease

A

Latient:

  • No symptoms
  • Does not feel sick
  • Cannot spread TB bacteria to others
  • Usually has a skin test or blood test result indicating TB infection
  • Normal chest x-ray and negative sputum smear
  • Needs treatment for LTBI to prevent active TB disease

Active:

  • Has symptoms (bad cough, coughing up blood/sputum, weakness, weight loss, fever)
  • Usually feels sick
  • May spread TB bacteria to others
  • Usually has a skin test or blood test result indicating TB infection
  • May have abnormal chest x-ray or positive sputum smear/culture
  • Needs treatment to treat (multiple drug therapy)
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10
Q

Laboratory diagnosis of mycobacterial infections:

A
  • Specimens
  • Specimen processing
  • Direct detection
  • Cultivation
  • Identification
  • Antimycobacterial susceptibility testing
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11
Q

Specimen

A
  • Respiratory (sputum)
  • Urine (clean catch)
  • Stool
  • Tissue and body fluids
  • Blood - immunocompromised patients
  • Wounds - aspirate > swab
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12
Q

Specimen processing

A

Specimens collected from normally sterile sites can be directly stained and inoculated to media

Specimens from non-sterile sites must first be decontaminated before further analysis

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13
Q

Direct pathogen visualization

A
  • Acid-fast stain (cording)
  • Fluorochrome stain (more sensitive than acid fast stain)

Contamination is an important consideration

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14
Q

Cultivation

A

Solid media and liquid media inoculated or all specimens, incubated for 8 wks

Liquid media reduces average turn-around time (TAT) from 17 days to 10 days

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15
Q

Identification

A

Acid fast stain

Nucleic acid probes for Mtb complex, MAI, M. kansasii and M. gordonae

Probe negative isolates require additional work: morphology, pigment production, biochem mostly replaced by DNA sequencing and other molecular methods

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16
Q

Why are Mtb NAATs superior to smear examinations?

A

Greater specificity in smear positive cases

Greater sensitivity than smears (~50-80% of smear negative, culture positive specimens are NAAT positive)

*does not replace.. but should be used in conjunction w/ conventional diagnostic procedures (smears, cultures)

17
Q

Non-Tuberculous Mycobacteria (NTMs)

  • Pathogenesis may include trauma, inhalation of infectious aerosols, or ingestion
  • Can be divided into 5 groups based on growth and pigment formation:
A

Group 1: Photochromogens
- M. kansasii, M. marinum (low temp)

Group 2: Scotochromogens
- M. gordonae, M. xenopi, M. scrofulaceum

Group 3: Nonphotochromogens
- M. avium complex (MAC), M. ulcerans (low temp)

Group 4: Rapid Growers (5 days, no pigment)
- M. abscessus, M. chelonae, M. fortuitum

Group 5:
- M. leprae

18
Q

Group 1: M. kansasii

A

Causes chronic pulmonary infection involving upper lobes of lungs, resembles Mtb clinically

Tap water major reservoir

Rare cause of extrapulmonary disease

Dissemination is rare except in AIDS

Responds quickly to antimicrobial therapy

Slow growth

Sometimes cording is observed

Photochromogen (forming pigment only after exposure to lights)

ID by DNA probe

19
Q

Group 1: M. marinum

A

Cutaneous infection associated w/ exposure to salt/freshwater following trauma

Causing “swimming pool granuloma” or “fish tank granuloma”

Most common in southern coastal states

Grows slowly at 30 degrees Celsius (no growth at 36 degrees Celsius)

Photochromogenic

ID: Biochemical/molecular

20
Q

Group 2: M. gordonae

A

Most commonly recovered NON-PATHOGENIC NTM

Found in soil and water

Colonizes respiratory tract

Long, wide, branching, beaded AFB

Scotochromogen (pigmentation in dark or light)

DNA probe for ID

21
Q

Group 2: M. xenopi

A

Grows best at 42 degrees Celsius, found in hot water systems

Causes chronic pulmonary disease in adults with underlying COPD

Rare, extrapulmonary disease in immunocompromised

Scotochromogen

22
Q

Group 3: Mycobacterium avium Complex (MAC)

A

M. avium + M. intracellular + M. paratuberculosis

Most commonly isolated Mycobacterium spp.

Environmental reservoir

Slow growth

Usually non-chromogenic

Important pathogen in immunocompromised and immunocompetent hosts

23
Q

Group 4: Rapid growers

A

Growth species level ID and antibiotic susceptibility tests are important

24
Q

Group 5: M. leprae

A

Cannot be cultivated in vitro (armadillo animal model)

Spread from person-person, most likely via nasal secretions

Long incubation

Causes single, multiple or widespread anaesthetic skin lesions