07 Mycobacterium

Mycobacterium Tuberculosis

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• Mycobacterium cowboy: acid-fast gunslinger

• Fuschin color: Carbol fuchin stain

• tassels: Mycolic acids

• lowenstein general store: TB grows on Lowenstein-Jenses medium

• air bellow: Obligate aerobe

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• latent

• miliary and systemic, multiorgan failure

• reactivation

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• Primary TB: infects middle or lower lobe of lung

• Primary TB: Hilar lymph node calcification

• cactus with holes in middle lobe and hilar involvement, gun complex: Ghon complex: Hilar lymphadenopathy + peripheral granulomatous lesion in middle or lower lung lobe

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• Proliferates in macrophages

• cord: cord factor (serpentine shaped) secreting TNF-a to activate macrophages and walled off in granuloma

• spur and clouds: Sulfatides (spurs), phagosome and lysosome unable to fuse

• broken down carts: Necrotic macrophages, caseating granulomas

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• sleeping kid: Latent infection common after primary infection kids

• sleeping kid with sac: Fibrosis

• shovel: Positive PPD test

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• BCG vaccine can cause a false positive skin test

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• Millet seeds everywhere: Miliary TB

• cow skull: Miliary TB can be lethal

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• TNF guy bound: neurtralized TNF > reactivation

• Reactivation with TNF alpha inhibitors

• guy coughing blood and sweating at night: Symptoms of reactivation: cough, hemoptysis, night sweats

• wasting from TNF alpha

• 2nd cactus: Reactivated TB: affects upper lung lobes

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• bullet in hat: CNS involvement with cavitary lesion or tuberculoma

• pots damaged: Pott's disease, multiple vertebrae affected, demineralization of bone, soft tissue swelling

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• RIPE: Rifampin, isoniozid, pyrazinamide, ethambutol

• Rifampin and isoniazid for prophylaxis

Mycobacterium Leprosy

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aka Hansen's disease.,

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• tassles: Mycolic acids

• Mycobacterium cowboy: Acid-fast gunslinger

• gun: Carbol fuchsin stain

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• armadillo jail and armadillo: Armadillo is main reservoir in United States

• Winter scene: Thrives in cool temperatures: predilection for extremities

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• tuberculoid

• lepromatous

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• Jail cell 1: Tuberculoid leprosy: Th1 response with cell mediated immunity

• Jail: Tuberculoid leprosy: able to contain bacteria within macrophages

• bald head: Tuberculoid leprosy: well-demarcated, hairless, hypoesthetic skin lesion

• rifle and deputy: Treatment: Rifampin/dapsone

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• shovel in dirt: Tuberculoid leprosy: positive Lepromin skin test, good cell mediated response

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• Jail 2: Lepromatous leprosy: bacteria unable to be contained by macrophages

• prisoner laughing: Lepromatous leprosy: Th2 mediated humoral response

• touching hands: lepromatous human to human transmission

• lion's face mask: Lepromatous leprosy: leonine facies

• gloves: Lepromatous leprosy: symmetric glove and stocking neuropathy

• skin lesions on arm/legs: Lepromatous leprosy: poorly demarcated raised lesions on extensor surfaces of extremities

• clothe: Treatment: Clofazimine along with rifampin/dapsone