Mcobacterium tuberculosis

M any bacteriological stain due to high lipid content in its wall, hence Ziehl-Neelsen staining, or acid-fast staining, is used. Despite this, it is considered a Gram-positive bacterium. While do not seem to fit the Gram-positive category from an empirical standpoint (i.e., they do not retain the crystal violet stain), they are classified as acid-fast Gram-positiv. tuberculosis requires oxygen to grow. It does not retain e bacteria due to their lack of an outer cell membrane Mycobacterium Tuberculosis Morphology?

Mycobacterium tuberculosis is a pathogenic bacterial species. It is the causative agent of most cases of tuberculosis. Mycobacterium tuberculosis was first discovered by Robert Kock in 1882. The most common way to test for TB is through the tuberculin skin test, chest radiographs, and acid-fast stains. As far as morphology is concerned, it is an obligate aerobe. They are considered an acid-fast gram positive bacterium because of their lack of an outer cell membrane. This bacteria divides very slowly compared to others, dividing every 15 to 20 hours.

while M. bovis is usually pathogenic for animals. MORPHOLOGY

This is a close-up of a ''Mycobacterium tuberculosis'' culture revealing this organisms colonial morphology. Note the colorless rough surface, which are typical

morphologic characteristics seen in tuberculosis colonial growth. Macroscopic

Mycobacterium

M. bovis was causing TB in the animal kingdom long before invading humans. However, after the domestication of cattle between 8000-4000 BC, there is archaeological evidence of human infection by M. bovis probably through milk consumption. M. tuberculosis is probably a humanspecialized form of M. bovis developed among milk-drinking Indo-Europeans who then spread the disease during their migration into western Europe and Eurasia. By 1000 BC, M. tuberculosis

What are Mycobacteria?

Tuberculosis complex organisms are: and pulmonary TB had spread throughout the known world.

Obligate aerobes growing most successfully in tissues with a high oxygen content, such as the lungs.

Facultative intracellular pathogens usually infecting mononuclear phagocytes (e.g. macrophages). Slow-growing with a generation time of 12 to 18 hours (c.f. 20-30 minutes for Escherichia coli). Hydrophobic with a high lipid content in the cell wall. Because the cells are hydrophobic and tend to clump together, they are impermeable to the usual stains, e.g. Gram's stain. Known as "acid-fast bacilli" because of their lipid-rich cell walls, which are relatively impermeable to various basic dyes unless the dyes are combined with phenol. Once stained, the cells resist decolorization with acidified organic solvents and are therefore called "acid-fast". (Other bacteria which also contain mycolic acids, such as Nocardia, can also exhibit this feature.)

The video shows M. tuberculosis cells subjected to the Ziehl-Neelsen acid-fast staining procedure, a commonly used diagnostic method for Mycobacteria:

How is TB diagnosed? SIGNS AND SYMPTOMS

Symptoms of tuberculosis include:

Fever Night-time sweating Loss of weight Persistent cough Constant tiredness Loss of appetite LABORATORY DIAGNOSIS 1. DIRECT MICROSCOPE Sample collection: septum and blood and microscopic examination of sputum., Detection of significant numbers of acid-fast bacilli (using the Ziehl-Neelsen stain) in sputum or tissue samples is considered a positive diagnosis Ziehl-Neelsen acid-fast staining procedure:

1. 2. 3. 4.

Heat fixes cells on glass microscope slide. Flood the slide with carbol fuchsine stain. Heat the slide gently until it steams (5 min). Pour off the carbol fuchsin. Wash slide thoroughly with waterDecolourize with acidalcohol (5 min). 5. Wash slide thoroughly with water.

6. Flood slide with methylene blue counterstain for 1 min. 7. Wash with water. 8. Blot excess water and dry in hand over bunsen flame

2. CULTURE TECHNIQUE 3. SEROLOGY Although disease may confirm by laboratory culture of the bacterium (difficult, dangerous and slow - takes at least 4 weeks). Diagnosis of tuberculosis is made by a positive tuberculin skin test, an immune reaction to a small quantity of tuberculosis antigens. 4. MOLECULAR TECHNICS P C R: Polymerase chain reactions It can be confirmed by X rays of the chest
PCROther mycobacteria are also acid-fast. If the smear is positive, PCR or gene probe tests can distinguish M. tuberculosis from other mycobacteria. Even if sputum smear is negative, tuberculosis must be considered and is only excluded after negative cultures.

Main article: Tuberculosis radiology

Chest

X-ray and

CT

Tuberculosis creates cavities visible in x-rays like this one in the patient's right upper lobe. In active pulmonary TB, infiltrates or consolidations and/or cavities are often seen in the upper lungs with or without meditational or hilar lymphadenopathy or pleural effusions (tuberculosis pleurisy). However, lesions may appear anywhere in the lungs. In disseminated TB a pattern of many tiny nodules throughout the lung fields is common - the so-called military TB. In HIV and other immunosuppressed persons, any abnormality may indicate TB or the chest X-ray may even appear entirely normal. Abnormalities on chest radiographs may be suggestive of, but are not necessarily diagnostic of, TB. However, chest radiographs may be used to rule out the possibility of pulmonary TB in a person who has a positive reaction to the tuberculin skin test and no symptoms of the disease.

Cavitation or consolidation of the apexes of the upper lobes of the lung or the tree-in-bud sign may be visible on an affected patient's chest X-ray. The tree-in-bud sign may appear on the chest

PATHOGENICITY
CTs of some patients affected by tuberculosis, but it is not specific to tuberculosis Transmission of TB occurs primarily by the aerosol route but can also occur through the gastrointestinal tract. Coughing by people with active TB produces droplet nuclei containing infectious organisms which can remain suspended in the air for several hours. Infection occurs if inhalation of these droplets results in the organism reaching the alveoli of the lungs. Only 10% of immunocompetent people infected with M. tuberculosis develop active disease in their lifetime the other 90% do not become ill and cannot transmit the organism. However, in some groups such as infants or the immunodeficient (e.g. those with AIDS or malnutrition), the proportion who develop clinical TB is much higher. In the lung, the organism is taken up by alveolar macrophages and carried to lymph nodes, from where it may spread to multiple organs. Two to eight weeks after infection, cell mediated immunity (CMI) and hypersensitivity (DTH) develop leading to the characteristic reaction to the tuberculin test and, in immunocompetent individuals, containment of infection. Inflammatory immune responses eventually result in lung damage.

TREATMENT How is TB treated?

In many countries, vaccination against TB is routinely practised. The Bacillus Calmette-Guerin (BCG) vaccine is a live, attenuated strain of Mycobacterium bovis which was introduced in . The first effective treatment for TB was developed in the - streptomycin.TB is currently treated by means of combination therapy, using cocktails of 3-4 drugs with different properties:

Antibacterial activity: e.g. isoniazid, rifampin, streptomycin Inhibiting the development of resistance: e.g. isoniazid, rifampin, ethambutol

.EPIDEMIOLOGY A couple of decades ago, we thought so. Sadly, that was not the case:Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis Tuberculosis has returned, reaching epidemic proportions worldwide. Over one-third of the world's population has latent tuberculosis; 15 million Americans are infected with this highly contagious, airborne respiratory disease. TB chooses hosts indiscriminately; the middle-class is not immune...