Mycobacteria

 slender, aerobic rods that grow in straight or branching chains.

 have a unique waxy cell wall composed of unusual glycolipids and lipids including mycolic acid, which
makes them acid-fast.
 will retain stains even on treatment with a mixture of acid and alcohol.
 weakly gram positive.

Tuberculosis

 serious chronic pulmonary and systemic disease caused most often by M. tuberculosis.
 source of transmission is humans with active tuberculosis who release mycobacteria present in sputum

a. Primary Tuberculosis
-always begins in the lungs
-inhaled bacilli implant in the distal airspaces of the lower part of the upper lobe or the
upper part of the lower lobe, usually close to the pleura
-1- to 1.5-cm area of gray-white inflammation with consolidation emerges, known as the Ghon
focus
-focus undergoes caseous necrosis

b. Secondary Tuberculosis
-lesion is usually a small focus of consolidation, less than 2 cm in diameter, within 1 to 2 cm of
the apical pleura.
-Histologically, the active lesions show characteristic coalescent tubercles with central caseation

c. Progressive pulmonary tuberculosis

-ensue in older adults and immunosuppressed people.
-apical lesion expands into adjacent lung and eventually erodes into bronchi and vessels.
-evacuates the caseous center, creating a ragged, irregular cavity that is poorly walled off by
fibrous tissue.
-(+) hemoptysis.

d. Miliary pulmonary disease

-occurs whe organisms draining through lymphatics enter the venous blood and circulate back to
the lung
-lesions are either microscopic or small, visible (2-mm) foci of yellow-white consolidation
scattered through the lung parenchyma
-resemblance of these foci to millet seeds

Mycobacterium avium Complex

 are separate species, but the infections they cause are so similar
 common in soil, water, dust, and domestic animals.
 Clinically significant infection with MAC is uncommon except among people with T-cell
immunodeficiency
 causes widely disseminated infections, and organisms proliferate abundantly in many organs, including
the lungs and gastrointestinal system.
 Patients are feverish, with drenching night sweats and weight loss

 The hallmark of MAC infections in patients with HIV is abundant acid-fast bacilli within
macrophages.
 enlargement of involved lymph nodes, liver, and spleen, or localized to the lungs.
 a yellowish pigmentation to these organs secondary to the large number of organisms present
in swollen macrophages.
Leprosy

 Hansen disease, is a slowly progressive infection caused by M. leprae that mainly affects the skin
and peripheral nerves.
 low communicability

A. Tuberculoid leprosy

-begins with localized flat, red skin lesion that enlarge and develop irregular shapes with
indurated, elevated hyperpigmented margins and depressed pale centers (central healing).
-Nerves become enclosed within granulomatous inflammatory reactions and, if small (e.g., the
peripheral twigs), are destroyed.
- (+)skin anesthesias and skin and muscle atrophy

B. Lepromatous leprosy

-involves the skin, peripheral nerves anterior eye chamber, upper airways (down to the larynx),
testes, hands, and feet
-vital organs and CNS are rarel affected, presumably because the core temperature is too high
for growth of M. leprae
-contain larg aggregates of lipid-laden macrophages (lepra cells), often filled with masses
(“globi”) of acid-fast bacilli

Spirochetes
 gram-negative, slender corkscrew-shaped bacteria with axial periplasmic flagella wound around a
helical protoplasm.
 Treponema pallidum subsp. pallidum is the microaerophilic spirochete that causes syphilis, a chronic
venereal disease with multiple clinical presentations.

Syphilis

 Chronic sexually transmitted disease

 penicillin treatment

a. Primary Syphilis.
-occurring approximately weeks after infection, features a single firm, nontender raised,
red lesion (chancre) located at the site of treponemal invasion on the penis, cervix, vaginal
wall, or anus.
b. Secondary Syphilis.
-marked by painless, superficial lesions of the skin and mucosal surfaces.
-2 to 10 weeks after the primary chancre
-Skin lesions frequently occur on the palms or soles of the feet
c. Tertiary Syphilis
1. Cardiovascular syphilis
-accounts for more than 80% of cases
-leads to slowly progressive dilation of the aortic root and arch, which causes aortic
valve insufficiency and aneurysms of the proximal aorta
 2. Neurosyphilis
-may be symptomatic or asymptomatic.
-Asymptomatic neurosyphilis, which accounts for about one third of neurosyphilis
cases
- (+)CSF abnormalities

3. Benign tertiary syphilis

-formation of gummas in bone, skin, and the muco us membranes ofthe upper airway
and mouth
-Gummas are nodular lesions probably related to the development of delayed
hypersensitivity to the bacteria.

Lyme Disease

 is a common arthropod-borne illness caused by the spirochete, Borrelia burgdorferi, which can be
localized or disseminated with a tendency to cause persistent chronic arthritis.

Stage 1 (localized infection)

spirochetes multiply and spread in the dermis at the site of a tick bite, causing an expanding area
of redness, often with a pale center. This lesion, called erythema migrans, may be accompanied
by fever and lymphadenopathy. The rash spontaneously disappears in 4 to 12 weeks.

Stage 2 (disseminated infection)

spirochetes spread hematogenously throughout the body and cause secondary skin lesions,
lymphadenopathy, migratory joint and muscle pain, cardiac arrhythmias, and meningitis often
associated with cranial nerve involvement

Stage 3 (persistent infection)

manifests many months after the tick bite. B. burgdorferi usually causes a chronic arthritis
sometimes with severe damage to large joints. Less often, patients will have polyneuropathy and
encephalitis that vary from mild to debilitating.