SUMMARY TABLE: Mycobacteria

ORGANISM GENERALITIES CULTURAL DSS OTHERS

MOT Motility

AEROBIC Slow growing pathogenic

- bacteria = Hydrophobic GRAM:
non- spore forming cell surface
Gram (+) Positive
(except m. marinum) Hydrophobic = bact. will
(generally)
Mycobacteria clump, nutrients cannot
spp. easily penetrate
APPEARANCE UNDER ACID-FAST
MICROSCOPE: Fastidious, resist
Major Groups Formation of visible NM

▶️ ▶️ ▶️
of Mycobact.: Very thin, Slight curve or colonies in 2-60 days at decolorization
1. MTC straight rods, (0.2 to 0.6 × 1 opt. Temperature. Phagocytosed MTC systemic Granuloma /
2. NTM to 10μm). MTC multiply hypersensitivity tubercle forms *Cell wall - N-glycolyl
NaOH - reduces muramic acid, high
Branching morph. in some contamination but also
reduces recovery of
space 🙂
** this one belongs to MTC but here lang nako g put to save lipid content
hydrophobic barrier
=

mycobact. spp.

signs and symptoms are

Intracellular pathogens Primary tuberculosis -typically dss of respiratory tract.
similar for other dss.
● Common presenting symptoms include
DSS OUTCOMES DIAGNOSTIC TESTS Inhalation single such as influenza, acute
MTC low-grade fever, night, sweats, fatigue,
● Tissue Necrosis – ● Tuberculin / PPD viable organism bronchitis, and
Mycobacterium anorexia (loss of appetite), and weight loss.
Caseous Necrosis test NM pneumonia.
Tuberculosis
● Meningeal or Miliary ● quantiFERON-TB (close contact
Complex Pulmonary tuberculosis usually has a productive cough,
(disseminated) TB Gold setup usually necessary) range from
along with low-grade fever, chills, myalgias (aches), and
● Organ involvement asymptomatic - acutely
sweating.
symptomatic.

M. africanum NM

Penetrates GIT mucosa or

Ingestion of milk
M. bovis invade lymphatic tissues of NM
from infected cow
oropharynx

Attenuated strain of M. bovis

- Bacillus Calmette-Guérin
M. Bovis BCG NM
Immunize susceptible (BCG)
individuals against TB

M. caprae NM

M. canettii NM

M. microti NM

M. pinnipedii NM

1.7 billion ppl or ⅓ of

Cause most of human TB world population are
M. tuberculosis NM
esp. In developed countries infected
15-20% develop dss..
 Present everywhere in env..
-
sometimes colonize the skin, Trauma1,
respiratory and GI tracts of inhalation of
healthy individuals infectious
MTC - humans can be colonized by these mycobacteria without aerosols2, and
In 1959, Runyon classified necessarily developing an infection or disease. 130 species NTM are
Nontuberculous ingestion3; NM
NTM into 4 groups - recognized
mycobacteria
categorized into 2: a few dss. are
1. Slow-growing NTM nosocomial or
(Runyon groups I-III) iatrogenic infxn.
2. Rapid growers
(Runyon group IV)

POTENTIALLY PATHOGENIC
Develop pigment on
Chronic pulmo ds. - Kansasii
exposure to light after
GROUP 1 Extra pulmo. ds.- Kansasii
being grown in the dark
Photo- Slow-growing NTM - Cervical lymphadenitis - Kansasii NM
chromogens - Cutaneous ds. - Kansasii, Marinum, Novocastrae
take longer than 7 days
Pulmo ds. - Asiaticum, Intermedium
to appear on solid media.
Bacteremia - Marinum

M. kansasii Common in white males ● Chronic pulmo ds. Aerosols NM Reservoir - tap water

● Cutaneous ds Contaminated Reservoir- freshwater &

M. marinum Spore forming NM
● Bacteremia water, trauma saltwater

M. novocastrae ● Cutaneous ds NM

M. asiaticum Primarily in Australia ● Pulmo ds. NM

M. intermedium ● Pulmo ds. NM

CANNOT be cultivated in
M. leprae NM
artificial media

POTENTIALLY PATHOGENIC & NONPATHOGENIC

Chronic lymphadenitis. - Interjectum
Cervical lymphadenitis- Tusciae (rare)
Develop pigment in
Cervical adenitis- Szulgai & Scrofulaceum (children)
GROUP 2 dark or light. rarely recovered in the
Pulmo ds. - Szulgai (middle aged men), Kubicae,
Scoto- Slow-growing NTM clin lab.
Heckeshornense
chromogens take longer than 7 days
Bacteremia - Scrofulaceum
to appear on solid media.
Bursitis - Szulgai
Skin infxn. Scrofulaceum
NOT APPLICABLE - Hiberniae, Cookie, Gordonae

M. Interjectum ● Chronic lymphadenitis.

M. tusciae ● Cervical lymphadenitis (rare) Tap water

 ● Cervical adenitis
M. szulgai Water & soil
● Pulmo ds. (middle aged men)

M. ● Cervical adenitis (children)

scrofulaceum

M. kubicae ● Pulmo ds.

M. ● Pulmo ds.
heckeshornense

M. hiberniae NA

NA Sphagnum moss (habitat),

M. cookie
surface waters in NZ.

M. gordonae NA

POTENTIALLY PATHOGENIC & NONPATHOGENIC

Lymphadenitis. - heidelbergense
Cervical lymphadenitis- MAC, malmoense,
haemophilum
Cutaneous - ulcerans, haemophilum
UNPIGMENTED
Subcutaneous - ulcerans
GROUP 3 whether in dark or light.
Pulmo infxn.. - MAC, xenopi, malmoense
Non- photo- Slow-growing NTM
Bacteremia -
chromogens take longer than 7 days
Bursitis -
to appear on solid media.
Skin infxn.
Disseminated disease - MAC , xenopi, genovense,
haemophilum, shimoidei
TB like pulmonary infxn. - shimoidei, simiae
NOT APPLICABLE -

● Cervical lymphadenitis - w/o AIDS

M. avium ● Pulmo infxn- w/o AIDS Natural waters & soil
complex
● Disseminated disease (w or w/o AIDS)

● Pulmo infxn.. (adults)

M. xenopi Aerosols Hot water taps in hospitals
● Disseminated disease

● Mild hydrogen
chloride (HCl) ● Cutaneous - ulcerans
Infection occur in tropical / ● NaOH ● Subcutaneous - ulcerans
M. ulcerans
temperate climate ● Oxalic acid
May reduce the recovery (African buruli & Australian bairnsdale ulcer)
of M.ulcerans

M. malmoense England, Wales, Sweden ● Pulmo infxn..(chronic)

● Disseminated disease (w AIDS) Isolated from pet birds &

M. genovense
dogs
 ● Disseminated disease
M. haemophilum ● Cutaneous
● Cervical lymphadenitis (children)

M. ● Lymphadenitis (children) Isolated form sputum,

heidelbergense urine, gastric aspirate

● TB like pulmonary infxn.

M. shimoidei
● Disseminated ds,

M. simiae ● TB like pulmonary infxn.

DIAGNOSTIC TESTS: MTC

Tuberculin / Purified Protein Derivative test quantiFERON-TB Gold setup

Delayed hypersensitivity cell-mediated quantification of

immunity to certain antigenic components of the interferon-gamma released from
organism sensitized lymphocytes in
heparinized whole blood that has
been incubated overnight w/
synthetic peptides simulating 2
proteins in M. tuberculosis.

● culture extract of M. tuberculosis is injected ● Enzyme-linked

Intracutaneously. immunosorbent assay
● After 48-72 hours, an infected individual (ELISA)
shows a delayed hypersensitivity reaction to ● assesses responses to
the PPD multiple antigens
● diameter of the induration is measured ● Less subject to reader bias
and error
● unaffected by previous BCG
vaccination

● not 100% sensitive or specific,

● (+) reaction does not necessarily signify
the presence of TB
 L 12SUMMARY TABLE: Branching or Partcially Acid-Fast Bacilli, Gram (+) Bacilli (Actinomycetes)

BIOCHEMICAL
Gram
MOT HABITAT
● Gram (+) Positive
ORGANISM GENERALITIES CULTURAL DSS (generally) OTHERS

Tests
Tests (-) Motility
(+)

Immunocompromised individuals -
PARTIALLY invasive pulmonary infections and
ACID-FAST disseminated infections
AEROBIC GRAM
ACTINOMYCETES Complications following pulmonary Gram (+) (often with
STRICTLY AEROBIC infection: (more info page 2 sa notes) beaded
traumatic
- Substrate ● Pleural effusions appearance)
inoculation
Form branched hyphae - extend ● Necrosis and abscess formation Soil
or Cat
filaments along agar ● spread hematogenously via the Water NM ACID FAST
inhalation
- surface blood Variably* acid-fast
Genus Ubiquitous ● Disseminated infection - lesions in
NOCARDIA brain

Causes 3 types of skin infections

(immunocompetent) - predominantly
by N. brasiliensis (check below)

Facultative intracellular
pathogens

Virulence
● Stage of growth
at the time of
infection
● Resistance to
intracellular major causes Nocardia infections
N. asteroides killing comprises >80% of infections
● Tropism of
neuronal tissue
● inhibit
phagosome
-lysosome fusion
● Production of
large amounts of
catalase and
hemolysins

major causes Nocardia infections

1. Mycetoma - chronic, localized,
N. brasiliensis
painless, subcutaneous
infection
 2. Lymphocutaneous infections
3. Skin abscesses or cellulitis

N. otitidiscaviarum major causes Nocardia infections

Isolated
AEROBIC
from soil GRAM
-
Genus and farm
Branching and Gram (+)
animals,
RHODOCOCCUS, filamentous bacteria ,
inhalation Cat
GORDONIA, can fragment into rods ACID FAST
fresh water
TSUKAMURELLA and cocci Partially* acid-fast
and
saltwater

1. Pulmonary infxns,
2. Bacteremia
3. Skin, urinary tract, wound infxn.
4. Endophthalmitis
Rhodococcus
5. Peritonitis
spp.
6. Catheter associated sepsis
7. Abscesses: prostatic/splenic,
thyroid, renal, brain, subcutan.,
8. Osteomyelitis

Facultative intracellular
pathogens
-
opportunistic
pathogens

Virulence most commonly associated with human

● Cell wall mycolic disease, particularly in
acids (role in immunocompromised patients (e.g. HIV
R. equi inhalation
intracellular px)
survival)
● Production of
interleukin-4
(IL-4)
● Granuloma
formation

1. Skin infxn
2. Chronic pulmo dss
Gordonia spp. 3. Catheter associated sepsis
4. Wound infection (sterna)
5. Bacteremia

1. Peritonitis
Tsukamurella sp. 2. Cather associated sepsis
3. Skin infection
 NON ACID-FAST able to grow on
AEROBIC routine lab
ACTINOMYCETES penetratin
media sheep bld
g wound
● CA abrasions
● Sabourau in the skin GRAM
d or trauma
Gram (+)
Dextrose to the
● BHIA, Infection usually associated with epidermis
mycetomas- chronic, granulomatous (most ACID FAST
Genus Branching filaments but they grow NON* acid-fast,
lesions of the skin common)
STREPTOMYCES, very slowly. Can why? Do not
ACTINOMADURA, be overgrown by Inhalation, contain mycolic
DERMATOPHILUS, the other normal ONLY acids in their cell
NOCARDIOPSIS thermo- envelopes
flora present on
contaminated philic
specimens. actino-
mycetes
Particularly true
for Nocardiae

S. somaliensis Africa, Saudi, Mexico, SA Sandy soil

S. anulatus Most common in US Also includes S. albus: Soil

1. Actinomycetoma penetratin
2. Pericarditis g wound
A. madurae Tropical, subtropical 3. Bacteremia abrasions Soil
4. Brain abscess in skin
A. pelletieri, A. Unknown
Tropical, subtropical
latina Possibly soil

trauma to
the
epidermis by
Unknown
insect
Skin
bites/thorns
commensal
Worldwide- humid, Exudative dermatitis with scab
D. congolensis or
tropical, subtropical (dermatophilosis) Or contact
with tissues
Saprophyte
of infected
in soil
animals thru
abrasions in
skin

Nodocardis is
suspected:
Multiple spec.
for culture
N. dassonvillei
Worldwide- humid, Smears (+) in ⅓
Actinomycetoma
**TABLE STOPPED tropical, subtropical of cultures unknown unkown
Other skin infxns.
AT NODOCARDIA
SPP Material from
draining sinus
tracts as
excellent spec.
 Actinomycetoma is if the mycetoma is Ubiquitous:
caused by an actinomycete water, air,
Thermophilic soil,
Worldwide inhalation
actinomyctes responsible for hypersensitivity compost
pneumonitis. piles, dust,
hays