GUIDLINE:

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• GUIDLINE
• 2- Clarification for mycobacteria in general
• 3-general characteristics for myco acid fast-
• 4-pathogenicity characteristics
• 5-TB types
• 6- TB primary type
• 7-TB secondary type
• 8- TB diagnosis and treatment

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Mycobacteria (Acid-Fast)

• Mycobacteria is divided into 3 types
• M.tuberculosis
• M.Leprae we didnt take-
• Nontuberculosis Mycobacteria we didnt take-
• They are rods with lipid-laden cell walls, and
  thats what makes them acid fast, how?
• When we have a smear of sputum for example, and
  we cover it with red stain carbofusion -stain
  with high affinity for mycobacterial cell walls
  component, its found in Ziehl-Neelsen stain -and
  heated for better penetration, then poured with
  acid alcohol -95 ethanol and 3 HCL- and then
  counterstained with methylene blue, the cell wall
  lipids will not dissolve when alcohol is applied
  and thus red stain wont be washed off. So
  acid-fast organisms resist decolorization and
  hold fast to their red stain.

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Mycobacteria Group

• Acid-Fast Bacilli
• are obligate aerobic which makes snese because
  they mostly infect the lungs where O2 is abundant
• Their cell call contains protein-polysaccharides
  with high Phospholipids (mycolic acid large
  fatty acid-, waxes) and they act like virulence
  factors (it is loaded with lipids and thats what
  makes them acid-fast ).
• When they attack tissues they cause Necrosis, in
  case of tuberculosis as we took in pathology they
  cause caseous necrosis and forms granuloma where
  they can remain viable.
• Resistant to Dryness, low Acidity, Alcohol and
  detergents (like carbafusion mentioned before)
• Susceptible to UV-light and heat.
• Theyre Common in Human and infected ones are
  Asymptomatic persons -like in case of primary
  asymptomatic tuberculosis which is the common
  type but the primary symptomatic is less common
  and happen mostly in children and elderly or
  immunocompromised patients because they have a
  weak immune system or when reactivation happens-
  , domestic Animal and Birds, Environment
• They kill 3-5 Million yearly.

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• Human/animals Pathogens
• Slow growth in vitro, the culture needs (2-6
  weeks)
• Nonpathogenic species lives in genital tract or
  skin ( like M. smegmatis which has rapid growth
  3-7 days and lives in normal genital secretions).
• Pathogenic species Mostly M. tuberculosis and
  few percentage M. bovis which causes tuberculosis
  in Animals cattle- , and if transmitted through
  Dairy products to humans can cause Intestinal
  tuberculosis. Atypical Mycobacteria
  (nontuberculosis mycobacteria) they are divided
  into pigmented and non-pigmented, common in
  environment and Rarely cause lung Tuberculosis.

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• Pulmonary Tuberculosis
• Exudative, primary type
• Active productive, reactivation, secondary type

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• Pulmonary Tuberculosis/ Exudative type primary-
• Slow intracellular growth in lung tissue
• Incubation time 1-12 months transmitted via
  droplet infection (cough,laugh,..)
• Primarily causes mild Lung lesion infects Mostly
  Children (90)
• Causes Asymptomatic infection discussed earlier
  and Rarely causes active lesions which are
  called (cavitary lesions with air-fluid levels)
  caused by progressive tuberculosis leading to
  severe cases where lung necrosis is developed and
  cavities and holes are formed and theyll be
  filled with fluid which is seen in CT scan and
  chest radiography.
• Recovery even with no treatment most cases will
  control infection and have healing by
  encapsulation and forming granuloma which
  decrease the number but theyre still viable.
• Positive skin tuberculin test its anintradermal
  injecetion of antigenic protein particles from
  killed M.tuberculosis, will reveal if the person
  is infected or not, because many of infected
  individuals will not manifest a clinical
  infection for years. When a positive PPD test
  occurs, you can treat and eradicate the disease
  before it significantly damages the lungs or
  other organs. And we use it when we have suspects
  in person with a low-grade fever and cough or a
  person who has been in contact with infected
  ones.
• We inject it intradermally and within 1-2 days,
  skin will be red, raised and hard (positive)

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• 7. Hypersensivity Immunity
• Asymptomatic infection is not necessary result
  in Disease.
• Active-Productive type Adult infection Most
  adult cases of tuberculosis occur after the
  bacteria have been dormant for some time.
• Happens by Reactivation of old tuberculosis
  lesions
• may present in any Body site, The infection can
  occur in any of the organ systems seeded during
  the primary infection. It is presumed that a
  temporary weakening of the immune system may
  precipitate reactivation. Like in Intestinal
  tract, Kidney and bones.
• Meningitis common in children TB causes subacute
  meningitis and forms granulomas in the brain.
• Lung lesion patient will usually persent with a
  chronic lowgrade fever Cough, Bloody sputum,
  night sweats and weight loss.
• Detection by X-ray and shows positive tuberculin
  test, Larger reaction.

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• Lab Diagnosis
• Direct AFS(acid fast stain) Ziehl-Neelsen stain
• Culture in Lowenstein -Jensen Medium from
  Sputum, urine, Pleural fluid, CSF, Biopsy. we
  have to incubate for at least 6 weeks. However we
  may recognize the first colonies after 2 weeks.
  From these colonies we have to prepare an Acid
  Fast Stain and then do biochemical tests to
  confirm a case of TB.
• PPD
• X-rays
• Treatment Combination of anti-tuberculosis drugs
  for 6-24 months. (Rifampin, streptomyocin,Isoniazi
  d,..)
• Prevention by BCG vaccine ( Bacilli Calemtte-
  Guerin) for Children.

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Chlamydia group

• Chlamydia Cell is Small and it has a Gram-ve wall
  but unlike other G-ves it has few amount of
  liposaccharides and no murmaric acid.
• Its obligate intracellular means it lives inside
  the cells and take ATP from host cells.
• Dimorphic growth has two forms 1)Infectious
  stage(Elementary bodies/ Infectious) which are
  responsible for attaching to the host mucosa cell
  and promoting its entry and then inhibit
  phagosome-lysosome fusion and develop into 2)
  (Inclusion bodies/Reticulate bodies) and
  replication occurs by binary fission.
• There are 3 species only two are required
• Chlamidya Trachomatis
• Chlamidya Pneumoniae

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• Firstly, Chlamydia trachomatis infects eyes and
  genital organs
• Genital tract
• A common cause of STD worldwide causes
  Nonspecific urethritis urethritis isi caused by
  nisseria also and called gonococcal urethritis
  but the one caused by chalmydia is nongonococcal
  urethritis thats why its called NGU or
  nonspecific only for differentiation- and its
  associated with pus. It can also cause
  Prostatitis, Vagnitis and Cervicitis which are
  associated with discharges and the inflamed areas
  are swollen and red, it might lead to infertility
  
• Eyes
• Newborns with chlamydial conjunctivitis
• Pregnant mothers during pregnancy especially in
  the delivery can transmit the disease to her
  fetus, infecting its Eyes causing an inflammatory
  reaction in the conjunctiva and later in the
  cornea, producing trachoma trachoma means
  developing damage in the conjuctiva causing
  blindness and this is associated with blindness
  so it can be so severe. All newborns in the US
  are given erythromyocin eye droplet
  prophylatically.
• infected patients shows mild to severe eyes
  redness, swollen eyelids and discharge from the
  eyes which can be thin and watery or thick and
  yellow..
• Trachoma leads to Blindness if not treated.

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• Secondly, Chlamydia pneumoniae
• Attached to Tracheal Epithelial cells and cause
  acute bronchitis and Atypical pneumonia which is
  Mild-severe pulmonary infection associated with
  mild-sever dry cough, abdominal paing and some GI
  symptoms and it may recover without the need of
  antibiotic not dangerous or fatal- and its
  Common in children in All ages
• Diagnosis treatment its diagnosed by
  Clinical features serological test.
• After 4-8 weeks of chlamidya incubation is
  develops antibodies against it and then could be
  discovered
• Its cultured only in McCoy tissue culture
  livinng culture- because it cant live in
  nonliving cultures because of the need of ATP
  from the host cells.
• PCR test are also used and immunoflourescence
  techniques.
• Treated by Antibiotics and theres No Vaccine

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Chlamydia inclusion bodies/Acid-Fast Mycobacteria
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Mycoplasma group

• The smallest Bacteria and what is unique about it
  that it Lacks Cell Wall but has a Lipid bi-layer
  Membrane paded with cholestrol coating it so
  penicillin cannot attack it because its target is
  peptidoglycans in cell wall which not found-.
• Aerobic and lives in Respiratory/Urinary Mucosa.
• Found in Human, Animals and Birds.
• It has 2 species
• M. pneumoniae Human pathogens. causes mild
  Pharyngitis, Bronchitis, Pneumonia, and
  associated with Dry cough and Fever similar to
  atypical pneumonia-. Most Common in old children
  Young adults and its Less Elderly, Common
  infection in Fall-Winter.
• M.hominis/M.genitalium Part of oral- genital
  flora cause Nonspecific Urethritis, Vaginitis,
  Cervicitis.
• Diagnosis treatment Sputum, Urine Culture,
  Cold-Agglutination Test, ELSA Specific
  antibodies, PCR. TREATMENT Antibiotics and No
  Vaccine.

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Legionella pneumonphila

• It causes Legionnaires disease severe
  pneumonia- which was found in 1976 USA
• Its Thin G-ve Coccobacilli-Filments.
• Facultative Anaerobes and Survive at 0-80 C.
• Lives in Cold/Hot Water, Air Condition, Wet Soil,
  Aerosols ??????Fine sprays.
• Droplet infection.
• Infect Respiratory Mucosa.
• Its a facultative Intracellular parasite that
  settle in the lower RT and is globbed up by
  Monocyte-Macrophage This means that once its
  phagocytosed it inhibits the phagosom-lysosome
  fusion, surviving and replicating intracellularly
• Extracellular growth,Not contagious disease.

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Legionella Pneumophila

• Clinical Features High Fever, dry Cough,
  vomiting, stomach discomfort and Diarrhea. Other
  common symptoms include headaches, muscle aches,
  chest pain, and shortness of breath, Pneumonia,
  Renal Failure, and if it was severe it might lead
  to Death.
• Mostly common in elderly, Immumodeficient
  patients like AIDS pateints and heavy Smoking
  Persons.
• Diagnosis treatment Special Culture Media,
  Blood-sputum culture. Detection by Specific
  antibodies, PCR. Treatment Antibiotics.. No
  Vaccine.
• Legionella pneumophila is the most common cause
  of community acquired pneumonia.

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Spirochetes Group-1

• Theyre Gram-ve and have Spiral forms and Long
  very selinder and tightly coiled- and Have long
  helically coiled cells (5-20um).
• Common Human, Animals, Arthropodes.
• Nonpathogenic /Pathogenic.
• 2 species
• Treponema species Nonpathogenic, and lives in
  Oral cavity.
• Treponema palldium causes Syphilis which is a
  Veneral Disease(STD) transmitted through Sexual
  Contact.
• entering the host via breaches in squamous or
  columnar epithelium.
• It gains access to host's blood and lymph systems
  through tissue and mucus membranes.
• Incub. 2-week-Few Months it changes from Acute
  to Chronic Infection with time (because it has
  stages)

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• Associated with Mucosa/Skin Lesions-Chancre on
  Genitalia, Anal area and Mouth. Its a Systemic
  Disease and can Affect Any Body Organ because of
  its ability to reach blood and lymhp and causes
  Meningitis, Hepatitis, Nephritis, Granulomatous
  lesions.
• Congenital Syphilis happens with infected
  pregnant women, the Treponema pallidum crosses
  placenta and infect the fetus.
• Diagnosis spirochetes cannot be cultured in
  ordinary media and even its G-ve but its too
  small to be seen with light microscope so we use
  special ways like Direct Dark-field Microscopy,
  immunoflurecense and silver stain.
• Serological Test like
• VDRL (Venereal Disease Research Lab).
• Fluorescent Trep. Antibody-Test (FTA).
• No Culture and treated with Antibiotics

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Legionella- Spirochete Cells
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Spirochetes Group-2/ Borrelia

• 1- Borrelia Burgdorferi causes Lyme Disease and
  Common in USA.
• Carried by Biting Insects (Ticks), Wild Animals,
  Rodents and Birds.
• Incubation Few Weeks- Months.
• The primary stage is featured by Single/Multiple
  Skin Erythematic Lesions and then in the upcoming
  stages after years it turns into a Systemic
  Disease by invading body systems and organs, and
  in stage 2 and 3 causing Arthritis, CNS diseases
  encephalopathy and meningitis and nevre palsies-
  and Cardiac Abnormalities.
• 2- Borrelia Recurrentis is found Worldwide. They
  cause an Epidemic/Endemic Relapsing Fever by
  Biting Insects (Human Lice/ Animal Ticks) which
  may lead after reachin blood to Septicemia and
  associated with Low-High Fever, Chills, Severe
  Headache and symptoms are resolved in 3-6 days
  then developing similar features for another 3-6
  dadys and relapses will continue to occur with
  shorter and milder inervals, Common Relapses.
• 3- Leptospira which causes Liptospiral diseases
  Zoonosis infect humans and animals- ,and cause
  mild-severe fatal systemic disease which is
  Weilss disease(infection with jaundice), it
  involves renal failure, hepatits , mental status
  change and hemorrhage in many organs associated
  with high Fever, vasculitis , Bleeding.
• Diagnosis Serological Tests and Special fluid
  culture methods. Especially for CSF

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Lyme Disease/ TickErythematic lesions