Tuberculosis Mycobacterium tuberculosis

1. TuberculosisMycobacterium tuberculosis Stavros Giannoukos Ben Altland

2. Taxonomy Kingdom: Bacteria Phylum: Actinobacteria Order: Actinobacteridae Family: Actinomycetales Genus: Mycobacterium Species: tuberculosis

3. General Information about M.TB. • Aerobic • Rod shaped • Non-motile • Neither Gram-negative nor Gram-positive. • Stains weakly Gram-positive. • Genome was mapped in its entirety in 1998. • The main cause of Tuberculosis, however other species of mycobacterium can also cause the disease.

4. Pathogenicity • Highly pathogenic • Long generation time (15-20 hours) prevents recognition of the immune system. • Low permeability membrane allows survival inside macrophages. • Only susceptible to a select few antibiotics. • Over 20% are resistant to primary treatment. And 2% are resistant to secondary treatment. • Byproducts of the infection inhibit oxygen transfer from • Causes extreme necrosis of Lung tissue, leading to emphysema and eventual death by asphyxiation.

5. Ecology • M.TB. is found exclusively in the human body. • Complexes primarily form in the lungs. • If infection is not contained by granuloma formation, infection can spread to other tissues of the body. • No other reservoirs for the bacteria exist in the world. • Believed to have been created from the mutation of Mycobacterium leprosy within the human body.

6. Target Tissues • Lungs (Pulmonary alveoli) • Ghon focus • Central Nervous System • Circulatory System • Lymphatic System • Joints • Skin Photo of the rare event of an M.TB infection of the skin. Cross sections of an alveoli infected with M.TB. The blue spheres are granulomas, the immune response to contain the infection.

7. Symptoms • Only 10% of infected patients are symptomatic. • Active symptoms include chest pain, coughing up blood, or white mucosa and necrotic tissue, and a productive, persistent cough for more than three weeks. • Systemic symptoms of wide spread infection are, weight loss, loss of apatite, fever, chills, night sweats, paling (loss of skin color) and rapid fatigue.

8. Diagnostic Testing • Comprehensive review of medical history. • Chest X-ray • Physical exam • Skin test of an active TB skin infection site.

9. Treatment • Complete treatment takes 6-9 months. • Multiple drugs are used in combination. • Isoniazid– Inhibits cells wall synthesis. • Ethambutol- Inhibits cell wall synthesis. • Pyrazinaide- Destroys plasma membrane and inhibits metabolic processes. Exact mechanism unknown. • Rifampin- Inhibits RNA synthesis.

10. Prevention • Prevention almost entirely consists of avoiding contact with great numbers of people potentially infected with M.TB. • M.TB is spread by the transmission of sneeze droplets from person to person, with only one droplet between .5 and 5 micro liters required to transmit an infections amount of bacteria. • 40,000 of these drops are released with every sneeze. • Infected persons are usually required to wear masks to prevent transmission through sneezing. • The vaccine BCG exists derived from attenuated M. bovine virus, but is not approved for use in the US. A child receiving a tuberculosis vaccine at school in Bulacan province, Philippines, c. 1952. UNICEF/ICEF-2539

11. Epidemiology • Is the most prevalent pathogen infection in the world, with an estimated 2,000,000,000 of the worlds population infected on some level. • Also referred to as the “White plague.” • Highest concentrations of infections occur in areas with higher HIV prevalence. (South Africa has 718/100,000 population infected.) • India has the single largest number of infections with over 1,800,000 cases. • Occurs less frequently (between 5<50/100,000 population) in more developed countries. World TB incidence. Cases per 100,000; Red > 300, orange = 200–300; yellow = 100–200; green 50–100 and grey <50. Data from WHO, 2006.

12. Morbidity and Mortality • Over 8,000,000 people become infected with tuberculosis annually. • 2,000,000 people die annually from tuberculosis. • In 2004, worldwide there were 14.6 million people with active TB disease, with 9 million new cases being presented that year. • The world’s greatest infectious killer of women of reproductive age, and the leading cause of death among people with HIV. • In 2006, there was a total of 13,767 deaths in the U.S. from TB (4.6/100,000 population) reported. This is a 3.2% decrease from 2005, and the lowest in U.S. history since tracking began in 1953.

13. Refrences • www.CDC.gov • http://library.med.utah.edu • http://www.textbookofbacteriology.net • http://www.microbiologybytes.com • National Institute of Allergy and Infectious Diseases (NIAID). Microbes in Sickness and in Health. 26 October 2005. Retrieved on 3 October 2006. • (1997) "Diagnosis and treatment of disease caused by nontuberculous mycobacterium. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association". Am J Respir Crit Care Med 156 (2 Pt 2): S1–25. PMID 9279284. • Nahid P, Pai M, Hopewell P (2006). "Advances in the diagnosis and treatment of tuberculosis". Proc Am Thorac Soc 3 (1): 103-10. PMID 16493157.