Assignment on Mycobacteria

Name: ALOMGIR HOSSAIN

Roll: 1910861106
Course: GEB-202
Year: 2nd Year
Medical Microbiology

Mycobacteria
Mycobacteria are immobile, slow-growing rod-shaped, gram-positive
bacteria with high genomic G+C content (61-71%). Due to their special
staining characteristics under the microscope, which is mediated by mycolic
acid in the cell wall, they are called acid-fast. This is also the reason for the
hardiness of mycobacteria.

Mycobacterium is a genus of Actinobacteria, given its own family, the Mycobacteriaceae.

Over 190 species are recognized in this genus. This genus includes pathogens known to
cause serious diseases in mammals, including tuberculosis (Mycobacterium
tuberculosis) and leprosy (Mycobacterium leprae) in
human. The Greek prefix myco- means "fungus," alluding to the way mycobacteria have
been observed to grow in mold -like fashion on the surface of cultures. It is acid fast and
cannot be stained by the Gram stain procedure.
 Scientific classification

Domain: Bacteria

Phylum: Actinobacteria

Order: Actinomycetales

Suborder Corynebacterineae
:

Family: Mycobacteriaceae

Genus: Mycobacterium
Characteristics of Mycobacteria:-

Mycobacteria can be divided into three groups:

 Mycobacterium tuberculosis complex – causative pathogen of

tuberculosis
 Nontuberculous mycobacteria (NTM)
 Mycobacterium leprae – causative pathogen of leprosy

Mycobacterium tuberculosis complex

The pathogens that cause tuberculosis are mycobacteria that belong to the
M. tuberculosis complex. This complex comprises the following species:

 M. tuberculosis
  M. bovis (subsp. bovis and caprae)
 vaccine strain M. bovis BCG (Bacille Calmette-Guérin)
 M. africanum
 M. canettii
 M. microti
 M. pinnipedii

These species are, with the exception of M. bovis BCG, considered to cause
tuberculosis (TB) in humans and animals. Despite their close genetic
similarity, these organisms differ considerably with regard to epidemiology,
pathogenicity and their host spectrum.

M. tuberculosis is considered to be the main cause of TB in humans.

In 1882 the German physician and microbiologist Robert Koch discovered M.

tuberculosis to be the causative pathogen of phthisis. Based on this
discovery, diagnosis of the disease could considerably be improved. Koch
published his findings on March 24th 1882 in the Berlin Society of
Physiology. Therefore, March 24th is now known to be World Tuberculosis
Day, initiated by the World Health Organization (WHO).

Tuberculosis infections usually arise from patients, who suffer from active
and thus infectious pulmonary tuberculosis. The pathogens are transmitted
via droplet infection through the air by coughing or sneezing. The risk of
infection is increased by bad hygiene conditions and in densely populated
areas. As the pathogens infect cells of the immune system, so-called
macrophages, especially infants and immunocompromised persons are at
risk. In most cases the immune system succeeds in fighting the bacteria or
in encapsulating them. Mycobacteria can then persist in the body for several
years as latent tuberculosis without causing any symptoms. It cannot be
predicted when and if reactivation occurs. Even though every organ can be
affected, the disease is manifested as pulmonary tuberculosis in 80% of the
patients.

M. bovis is the major cause of bovine tuberculosis. It can be transmitted to

humans by the consumption of unpasteurised milk or in rare cases via
inhalation of dust in barns. Nowadays this infection is quite rare in central
Europe as the cattle population is largely free of tuberculosis.
M. bovis can be divided into two subspecies, M. bovis subsp. bovis and M.
bovis subsp. caprae. While the latter is sensitive to pyrazinamide (PZA), M.
bovis subsp. bovis is resistant.
The BCG vaccine strain, which was developed from M. bovis, is rarely used
nowadays in most European countries because its effectiveness is unclear,
side effects are frequent and the epidemiologic situation does not require
vaccination. Nevertheless, the WHO still recommends BCG vaccination for
children under one year of age in high risk countries.

A heterogeneous group of strains that can mainly be found in Africa and

which exclusively causes TB in humans, is called M. africanum. M.
canettii was mainly isolated from small rodents, whereas M. pinnipedii was
detected in seals. On very rare occasions these pathogens were found to
cause TB in humans. 
 

Tuberculosis

TB can be found all around the world and other than HIV/AIDS and malaria it
is one of the most frequent infectious diseases. Recent estimations suggest
that one third of the world’s population is infected with tuberculosis.
According to the WHO, each year more than nine million people are newly
infected with TB and about two million die from it. About 95% of all newly
infected patients live in developing countries. The facts that more and more
resistant mycobacteria emerge and that co-infections with HIV are frequent
make it even more difficult to fight TB.

There are four important parameters for the containment of TB:

 Early diagnosis
 Prevention of disease spreading
 Effective treatment with antituberculotics
 Prevention of resistance development
 

Nontuberculous mycobacteria

The group of nontuberculous mycobacteria (NTM), formerly called atypical or

ubiquitous mycobacteria, contains over 150 species. NTM can be found
ubiquitously in nature and show a broad diversity regarding where they can
be found and how they adapted to certain environmental conditions. They
can be detected in soil, ground and drinking water as well as in food like
pasteurized milk or cheese. In general, NTM are less pathogenic.
Nevertheless, they can cause illness in humans, especially in
immunocompromised persons or those who suffer from previous pulmonary
diseases.

The M. avium complex (MAC) comprises the species M. avium and M.

intracellulare that range among the most important and most frequent
pathogenic NTM. Just like M. kansasii, M. malmoense and M. xenopi they
mostly cause pulmonary infections. M. marinum is responsible for skin and
soft tissue infections like aquarium granuloma. Typically patients got in
contact with an aquarium.

Diagnostics of NTM is often difficult. The decision if an infection requires

treatment can only be made when the same pathogen is detected in
different samples from one patient.

NTM can be cultivated on common liquid and solid culture media. According
to their growth rate and production of pigments, they are classified into 4
groups (RUNYON classification):
Group I: photochromogen (strains producing pigments under the influence
of light), slow-growing NTM (e.g.  M. kansasii, M. marinum)
Group II: skotochromogen (strains producing pigments even in the dark),
slow-growing NTM (e.g. M. scrofulaceum, M. gordonae)
Group III: non-chromogen (strains do not produce pigments), slow-growing
NTM (e.g. M. avium, M. haemophilum)
Group IV: rapid-growing NTM (e.g. M. abscessus, M. chelonae)

Currently NTM are classified according to their growth rate and are divided
into slow-growing (SGM) and rapid-growing (RGM) mycobacteria. They
belong to the RGM group if under ideal conditions they grow within less than
seven days and to the SGM group if they need more than seven days to
grow.

There is no standard therapy for the treatment of NTM infections. Therapy

always depends on the respective species and its resistances to antibiotics.

In the last decades an increase in the number of NTM infections could be

observed worldwide, but especially in countries with low tuberculosis
prevalence. Therefore, reliable diagnostics provide the basis for successful
therapy.
 

Leprosy

Leprosy is a chronic infectious disease that is caused by Mycobacterium

leprae. The bacterium (“Hansen’s bacillus”) was first described in 1873 by
the Norwegian physician Gerhard H. Armauer Hansen. Due to its slow
proliferation rate with a generation time of 10 to 14 days, the incubation
period can last several months or even years. To become infected one must
be in close contact with a patient. Even though the exact mechanism of
transmission is unclear, droplet infection is suspected. Only 5% of all people
can develop leprosy, the rest is genetically immune. Nevertheless they can
become carriers and infect someone else.

Most leprosy infections are without pathological findings and heal

spontaneously. According to WHO guidelines leprosy can be divided into
paucibacillary (tuberculoid) and multibacillary (lepromatous) leprosy. The
former progresses slowly and can easily be treated. The latter more
infectious form is characterised by a quick progression of the disease due to
strongly proliferating bacteria and manifests itself with ulcers on hands, feet,
ears or in the face.

In general, leprosy is curable. Nevertheless, if the disease is diagnosed too

late, nerve tracts can be irreversibly damaged. As leprosy can be treated it
is nearly extinct in countries that provide good health care. In contrast, in
many developing countries the disease is still a serious health problem.
People who suffer from leprosy are also facing social problems that go hand
in hand with the disease. Additionally, treatment is getting more difficult as
antibiotic resistances became more and more frequent in recent years.

Leprosy is diagnosed according to the clinical symptoms and by laboratory

diagnostics. Unfortunately, M. leprae cannot be cultivated like other
mycobacteria. Culture and resistance testing is only successful in animal
models and takes about one year. Also microscopic diagnostics of skin or
nasal smears is often difficult as samples are false-negative in 70% of all
cases. Therefore, the detection of bacterial DNA in skin smears using PCR is
usually the method of choice.