Title: Return of the White Plague: The Mycobacteria
1Return of the White PlagueThe Mycobacteria
- Obligate pathogens
- Mycobacterium. tuberculosis - TB
- Mycobacterium bovis - bovine TB
- Mycobacterium. leprae - Hansen's disease
(leprosy) - Environmental Mycobacteria
- Mycobacterium avium complex
- Mycobacterium intracellulare
- M. kansasii
- M. marinum
- M. ulcerans
- others
2Mycobacterium tuberculosis
Phthisis (wasting) Consumption The English
Disease White Plague Decay TB Tuberculosis
3Famous People and Tuberculosis
King Tutankhamen Egyptian pharaoh ca1358-1340BC Ca
rdinal Richelieu French statesman 1581-1642 Baruch
Spinoza Dutch Philosopher 1632-1677 Simon
Bolivar Venezuelan leader 1783-1830 John
Keats English Poet 1795-1821 Elizabeth
Browning English Poet 1806-1861 Edgar Allen
Poe American writer/Poet 1809-1849 Frederic
Chopin Polish Composer 1810-1849 Emily
Bronte English novelist/Poet 1818-1848 Robert
Louis Stevenson Scottish writer 1850-1894 Anton
Chekhov Russian writer 1860-1904 Eleanor
Roosevelt American first lady 1884-1962 D.H.
Lawrence English writer 1885-1930 Eugene
ONeill American playwright 1888-1953 George
Orwell English novelist 1903-1950 Vivien
Leigh English actress 1913-1967
4Famous People and Tuberculosis
5TB Sanitarium
6Robert Koch 1843-1910
Basically, if 1. An organism can be isolated
from a host suffering from the disease and 2.
The organism can be cultured in the laboratory
and 3. The organism causes the same disease
when introduced into another host and 4. The
organism can be re-isolated from that host then
The organism is the cause of the disease and the
disease is an infectious disease.
7Bacterial cell wall structure
Mycobacterium
Gram -
Gram
Lipid Peptido- Lipid
Porins Mycolate Acyl
LAM arabino- Bilayer
glycan LPS
Lipids
Lipo-arabino galactan
mannin
8M. Tuberculosis the organism
Acid fast sputum
Acid fast tissue
Colony morphology Lowenstein-Jensen medium
Aurimine fluorescence
9Risk factors for TB
- Recent M. tuberculosis infection
- HIV infection
- Immune suppression
- Diabetes or end stage renal disease
- Severe malnutrition
- Substance abuse
10Tuberculosis primary infection route
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12TB Symptoms
- Sensation of not feeling well
- Cough, at first with yellow or green mucus and
occasionally bloody later in the disease. - Fatigue
- Shortness of breath
- Weight loss
- Slight fever, night sweats
- Pain in the chest, back, or kidneys, and perhaps
all three - Can be confused with
- Carcinoma of the lung
- Pneumonia
- Allergic aspergillosis
- Sarcoidoisis, silicosis
- Anorexia nervosa, diabetes, hyperthyroidism
13TB Diagnosis
- Mantoux test skin test for memory T cells
- Chest x-ray tubercles
- Identification or isolation of Mycobacterium
tuberculosis from sputum
14TB testing with PPD
15M. Tuberculosis Macrophage interaction
TB
16Tuberculosis - Lungs
Caseation necrosis
Chest X-ray
Miliary TB
17Tuberculosis hematogenous extension
Extrapulmonary
Lymph nodes
Liver
Bones
18TB Incidence
8-9 million new cases/year 2-3 million deaths/yr
19TB Prevalence
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27DOTS Direct Observed Therapy-Short Course
DOTS Peru
10-90
LI
gt90
NR
DOTS blister pack
lt10
28gt 15 of total cases Worldwide
29BCG Vaccination Bacillus Calmette Guerin - a
Mycobacterium bovis strain
Annual vaccination of infants - WHO 1999
30Mycobacterium lepraeLeprosy Hansens Disease
(Fra "Atlas Colorié de Spedalskhed", 1847. Tegnet
av J.L. Losting)
31Leprosy
- Lepromatous Leprosy
- Many skin lesions
- Damage to facial cartilage and bone
- Symmetrical peripheral nerve damage and
anesthesia - High infectivity
- Many Mycobacteria in macrophages
- High serum antibody levels
- Low Th1 response to M. leprae
- Th2 response--gthumoral immunity (not protective)
- Tuberculoid Leprosy
- Few skin lesions
- Severe peripheral nerve damage
- Organisms present at low levels
- Low infectivity
- Strong Th1 response to M. leprae antigens
32 500,000 cases Worldwide
Treatment Dapsone (1940s-1970s)
Rifampicin (1970s-) Multidrug Therapy-
Dapsone, Rifampicin, Clofazamine
33Mycobacterium avium Comples (MAC)
Organisms Mycobacterium avium opportunist in
AIDS Mycobacterium intracellulare
immunocompetents
- Environmental Reservoirs
- Water - natural, water systems, hot tubs,
swimming pools - Soil
- Protozoans
- Animals
- Humans
- Interactions with Protozoans
- M. avium, M. fortuitum, M. marinum survive inside
Acanthamoeba - Inhibit lysosomal fusion
- May kill protozoan
- Survive encystment and use cysts to survive
starvation and toxic stresses