MICROBIOLOGY LECTURE SERIES

LUZ GREGORIA LAZO-VELASCO, MD

Mycobacterium avium Complex

Mycobacterium kansasii
Mycobacterium scrofulaceum
Mycobacterium marinum & Mycobacterium
ulcerans
Mycobacterium fortuitum Complex
Mycobacterium chelonae-abscessus

Mycobacterium avium Complex

MAC; MAI (Mycobacterium avium intracellulare)
complex
infrequently cause disease in immunocompetent
humans
most common opportunistic infections of bacterial
origin in patients with AIDS
the risk of developing disseminated MAC infection in
HIV-infected persons greatly increased with
CD4+ lymphocyte count <100/mL

Mycobacterium avium Complex

increase risk for disseminated MAC infection :
Pneumocystis jirovecii infection
severe anemia
interruption of antiretroviral therapy
patients with cystic fibrosis and pulmonary
alveolar proteinosis
causes Lady Windermere syndrome- indolent
pulmonary MAC disease in middle-aged to
elderly women in the absence of chronic lung
disease; nodules in middle lobe & lingual
cavitation

Mycobacterium avium Complex

Other manifestations:
Pericarditis
Soft tissue abscesses
Skin lesions
LN involvement
Bone infections
CNS lesions
Treatment : resistant to 1st line drugs
Clarithromycin or Azithromycin + EMB
Rifabutin, clofazimine, fluoroquinolones,
amikacin

Mycobacterium kansasii

Photochromogen
Produce pulmonary and systemic disease
indistinguishable from tuberculosis
Tx: RMP + EMB + INH
Mycobacterium scrofulaceum
Scotochromogen
chronic cervical lymphadenitis in children
Tx: surgical excision of involved cervical lymph nodes
resistant to anti-TB drugs

Mycobacterium marinum & Mycobacterium

ulcerans

Occur in water
Superficial skin lesions (Ulcers, swimming pool
granulomas)
Tx: surgical excision, tetracyclines, RMP, EMB
Mycobacterium fortuitum Complex
Saprophytes found in soil & water
Grow rapidly in culture, form no pigment
Superficial & systemic disease in humans
Tx: amikacin, doxycycline, cefoxitin, erythromycin,
RMP

Described by Hansen in 1873 (9 years before Kochs

discovery of the tubercle bacilli)
Not cultivated on nonliving bacteriologic media
Causes leprosy
Typical acid-fast bacilli-singly, in parallel bundles or in
globular masses
regularly found in scrapings from skin or mucous
membranes (particularly the nasal septum) in
patients with lepromatous leprosy

bacilli often found within the endothelial cells of

blood vessels or in mononuclear cells
when bacilli from human leprosy (ground tissue nasal
scrapings) are inoculated in foot-pads of mice, local
granulomatous lesions develop with limited
multiplication of bacilli

Clinical findings
insidious onset
lesions involve the cooler tissue of the body:
skin, superficial nerves, nose, pharynx, larynx, eyes
and testicles
skin lesion: pale, anesthetic macular lesions 1-10 cm in
diameter; diffuse or discrete erythematous,
infiltrated nodules 1-5 cm
in diameter; a diffuse skin
infiltration

Clinical findings
Neurologic disturbances:
nerve infiltration and thickening anesthesia
neuritis
paresthesia
trophic ulcers
bone resorption
shortening of digits

Feature

Tuberculoid
Leprosy

Lepromatous
Leprosy

Type of lesion

One or few lesions

with little tissue
destruction
Few

Many lesions with

marked tissue
destruction
Many

Likelihood of
transmitting leprosy

Low

High

Cell-mediated response

Present

Reduced or
absent

Lepromin ST

Positive

Negative

Number of acid-fast
bacilli

 Diagnosis
1. Scrapings with a scalpel blade from skin or
nasal mucosa or from a biopsy of earlobe skin
are smeared on a slide and stained by the ZiehlNeelsen technique.
2. Biopsy of skin or of a thickened nerve gives a
typical histologic picture

 Treatment
1. Sulfones (dapsone) - first-line therapy for both
tuberculoid and lepromatous leprosy.
2. Rifampin or clofazimine included in initial
treatment regimens
3. minocycline
4. clarithromycin
5. some flouroquinolones

Epidemiology
transmission most likely to occur when small
children are
exposed for prolonged periods to heavy
shedders of bacilli
Nasal secretions
Incubation period: probably 2-10 years

Prevention and Control

thorough examination of household contacts and close

relatives (complete skin & peripheral nervous system
examination)

The U.S Public Health Service National Hansens Disease

Program does not recommend routine dapsone prophylaxis

A therapeutic trial may be indicated for patients whose signs

and symptoms are suggestive of leprosy but who do not have
a definitive diagnosis.