Dr. Ashish V.

Jawarkar

Mycobacterium
Name from Myco and Bacteria, Fungus like bacteria Because it forms mould like growth on liquid cultures

Dr. Ashish V. Jawarkar

Mycobacteria that infect humans

M. Tuberculosis TB M. Leprae Leprosy Non tuberculous mycobacteria / atypical mycobacteria

Dr. Ashish V. Jawarkar

Mycobacterium Tuberculosis
Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Morphology
Neither gram positive, nor negative Acid fast They have mycolic acid in their cell wall which makes them acid fast Difficult to decolorise with organic acids

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Slightly curved rods Non motile Non capsulated

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Growth characteristics
Obligate aerobes Grow slowly generation time 15 hours Colonies appear in two weeks Optimum temperature is 37 deg Solid media most commonly used LJ media
Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

 Niacin test

Biochemical tests to differentiate MTB from atypical mycobacteria

adding cyanogen bromide+aniline + ethanol = canary yellow color

Paranitrobenzoic acid
MTB cannot grow in presence of this

Catalase peroxidase test

MTB is weakly positive

Aryl sulfatase test

Negative for MTB
Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Treatment and Resistance

DOTS directly observed treatment shortcourse
HRZE for 4 months HR for 2 months
H isoniazid R rifampicin Z - Pyrazinamide E - Ethambutol

Dr. Ashish V. Jawarkar

MDR-TB
Resistant to isoniazid and rifampicin

XDR-TB
Resistant to all drugs

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Pathogenicity and virulence

Its pathogenicity is due to complex lipids like mycolic acid in cell wall.. This makes it
Acid fast Resistant to antibiotics Resistant to disinfectants like acid and alkalis Resistant to immune system Resistant to destruction by macrophages
Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Epidemiology
Source Humans with TB Spread droplet nuclei inhaled India more than 40 percent population that is nearly half of us are infected Only saved due to our immunity To stop TB RNTCP revised national tuberculosis control program has been started offering DOTS to nearly 15 million patients daily free of charge
Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Tuberculosis
Pulmonary Extra pulmonary

Dr. Ashish V. Jawarkar

Pulmonary

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Lab diagnosis
Sample sputum for pulmonary, biopsy for extrapulmonary sites Stain Zn stain Culture LJ media Raised ESR PCR polymerase chain reaction
Dr. Ashish V. Jawarkar

Montoux test
PPD/tuberculin is injected into skin Look for induration of skin

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Treatment
DOTS

Dr. Ashish V. Jawarkar

Mycobacterium leprae

Dr. Ashish V. Jawarkar

 Causes leprosy Seen in developing countries like India only

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Slightly curved rods Singly or in groups Cigar bundle appearance Lepra cells

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Growth characteristics
Cannot be cultivated in vitro on any media Grown in foot pad of armadillo

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Biochemical reactions
Cannot be grown.. Cannot know biochemical reactions

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Resistance
Not known

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

 ----

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Epidemiology
Human disease only Source nasal secretions Entry respiratory tract / skin Not highly communicable

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Diseases caused
Leprosy Affects skin and nerves Hypoaesthetic patch, thickened nerves Lion face, saddle nose, autoamputation Two main types tuberculoid leprosy, lepromatous leprosy
Dr. Ashish V. Jawarkar

Tuberculoid leprosy aka paucibacillary leprosy

Dr. Ashish V. Jawarkar

Tuberculoid leprosy

Dr. Ashish V. Jawarkar

Multibacillary leprosy/lepromatous leprosy

Dr. Ashish V. Jawarkar

AUTO AMPUTATION
Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

Lab Diagnosis
Sample biopsy from nasal mucosa, skin lesions, ear lobes Stained with modified ZN stain use 5% H2SO4 instead of 20% Cannot be cultured

Dr. Ashish V. Jawarkar

LEPROMIN TEST
Method is similar to tuberculin test Injected antigen is lepromin Reaction is read at
48 hours fernandez 3-4 weeks - mitsuda

Dr. Ashish V. Jawarkar

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
Dr. Ashish V. Jawarkar

 MDT

Dr. Ashish V. Jawarkar

Treatment
Multi drug therapy consisting of
RIFAMPICIN DAPSONE

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar

NOT COVERED
ATYPICAL MYOBACTERIA
Can be asked for short note 5 marks

Dr. Ashish V. Jawarkar

Dr. Ashish V. Jawarkar