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Mycobacterium is a genus of Actinobacteria, given its own family, the Mycobacteriaceae. The genus includes pathogens known to cause serious diseases in mammals, including tuberculosis (Mycobacterium tuberculosis) and the classic Hansen's strain of leprosy (Mycobacterium leprae).^[1] The Greek prefix myco- means "fungus," alluding to the way mycobacteria have been observed to grow in a mold-like fashion on the surface of liquids when cultured.^[2]

1 Microbiologic characteristics
- 1.1 Pigmentation
- 1.2 Staining characteristics
2 Ecology
3 Pathogenicity
- 3.1 Medical classification
4 Mycosides
5 Genomics
6 Species
- 6.1 Slowly growing
  - 6.1.1 Mycobacterium tuberculosis complex
  - 6.1.2 Mycobacterium avium complex
  - 6.1.3 Mycobacterium gordonae clade
  - 6.1.4 Mycobacterium kansasii clade
  - 6.1.5 Mycobacterium nonchromogenicum/terrae clade
  - 6.1.6 Mycolactone-producing mycobacteria
  - 6.1.7 Mycobacterium simiae clade
  - 6.1.8 Ungrouped
- 6.2 Intermediate growth rate
- 6.3 Rapidly growing
  - 6.3.1 Mycobacterium chelonae clade
  - 6.3.2 Mycobacterium fortuitum clade
  - 6.3.3 Mycobacterium parafortuitum clade
  - 6.3.4 Mycobacterium vaccae clade
  - 6.3.5 CF
  - 6.3.6 Ungrouped
- 6.4 Ungrouped
7 Mycobacteriophage
8 References
9 Further reading
10 External links

Microbiologic characteristics

Mycobacterial cell wall: 1-outer lipids, 2-mycolic acid, 3-polysaccharides (arabinogalactan), 4-peptidoglycan, 5-plasma membrane, 6-lipoarabinomannan (LAM), 7-phosphatidylinositol mannoside, 8-cell wall skeleton

Mycobacteria are aerobic and nonmotile bacteria (except for the species Mycobacterium marinum, which has been shown to be motile within macrophages) that are characteristically acid fast.^[1] Mycobacteria have an outer membrane.^[3] They do not have capsules, and most do not form endospores. Mycobacterium marinum and perhaps M. bovis have been shown to sporulate;^[4] however, this has been contested by further research.^[5] The distinguishing characteristic of all Mycobacterium species is that the cell wall is thicker than in many other bacteria, which is hydrophobic, waxy, and rich in mycolic acids/mycolates. The cell wall consists of the hydrophobic mycolate layer and a peptidoglycan layer held together by a polysaccharide, arabinogalactan. The cell wall makes a substantial contribution to the hardiness of this genus. The biosynthetic pathways of cell wall components are potential targets for new drugs for tuberculosis.^[6]

Many Mycobacterium species adapt readily to growth on very simple substrates, using ammonia or amino acids as nitrogen sources and glycerol as a carbon source in the presence of mineral salts. Optimum growth temperatures vary widely according to the species and range from 25 °C to over 50 °C.

Some species can be very difficult to culture (i.e. they are fastidious), sometimes taking over two years to develop in culture.^{[citation needed]} Further, some species also have extremely long reproductive cycles — M. leprae, may take more than 20 days to proceed through one division cycle (for comparison, some E. coli strains take only 20 minutes), making laboratory culture a slow process.^[1] In addition, the availability of genetic manipulation techniques still lags far behind that of other bacterial species.^[7]

A natural division occurs between slowly– and rapidly–growing species. Mycobacteria that form colonies clearly visible to the naked eye within seven days on subculture are termed rapid growers, while those requiring longer periods are termed slow growers. Mycobacteria cells are straight or slightly curved rods between 0.2 and 0.6 µm wide by 1.0 and 10 µm long.

Pigmentation

Some mycobacteria produce carotenoid pigments without light. Others require photoactivation for pigment production.

Photochromogens (Group I)

Produce nonpigmented colonies when grown in the dark and pigmented colonies only after exposure to light and reincubation.

Ex: M. kansasii, M. marinum, M. simiae.

Scotochromogens (Group II)

Produce deep yellow to orange colonies when grown in the presence of either the light or the dark.

Ex: M. scrofulaceum, M. gordonae, M. xenopi, M. szulgai.

Non-chromogens (Groups III & IV)

Nonpigmented in the light and dark or have only a pale yellow, buff or tan pigment that does not intensify after light exposure.

Ex: M. tuberculosis, M. avium-intra-cellulare, M. bovis, M. ulcerans
Ex: M. fortuitum, M. chelonae

Staining characteristics

Mycobacteria are classical acid-fast organisms.^[8] Stains used in evaluation of tissue specimens or microbiological specimens include Fite's stain, Ziehl-Neelsen stain, and Kinyoun stain.

Mycobacteria appear phenotypically most closely related to members of Nocardia, Rhodococcus and Corynebacterium.

Ecology

Mycobacteria are widespread organisms, typically living in water (including tap water treated with chlorine) and food sources. Some, however, including the tuberculosis and the leprosy organisms, appear to be obligate parasites and are not found as free-living members of the genus.

Pathogenicity

Mycobacteria can colonize their hosts without the hosts showing any adverse signs. For example, billions of people around the world have asymptomatic infections of M. tuberculosis.

Mycobacterial infections are notoriously difficult to treat. The organisms are hardy due to their cell wall, which is neither truly Gram negative nor positive. In addition, they are naturally resistant to a number of antibiotics that disrupt cell-wall biosynthesis, such as penicillin. Due to their unique cell wall, they can survive long exposure to acids, alkalis, detergents, oxidative bursts, lysis by complement, and many antibiotics. Most mycobacteria are susceptible to the antibiotics clarithromycin and rifamycin, but antibiotic-resistant strains have emerged.

As with other bacterial pathogens, surface and secreted proteins of M. tuberculosis contribute significantly to the virulence of this organism. There is an increasing list of extracytoplasmic proteins proven to have a function in the virulence of M. tuberculosis.^[9]

Medical classification

Mycobacteria can be classified into several major groups for purpose of diagnosis and treatment: M. tuberculosis complex, which can cause tuberculosis: M. tuberculosis, M. bovis, M. africanum, and M. microti; M. leprae, which causes Hansen's disease or leprosy; Nontuberculous mycobacteria (NTM) are all the other mycobacteria, which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease, or disseminated disease.

Mycosides

Mycosides are phenolic alcohols (such as phenolphthiocerol) that were shown to be components of Mycobacterium glycolipids that are termed glycosides of phenolphthiocerol dimycocerosate.^[10] There are 18 and 20 carbon atoms in mycosides A, and B, respectively.^[11]

Genomics

Comparison of protein orthology in M. tuberculosis, M. leprae, and M. smegmatis, three major model systems in Mycobacterium research^[12]

Comparative analyses of mycobacterial genomes have identified several conserved indels and signature proteins that are uniquely found in all sequenced species from the genus Mycobacterium.^[13]^[14] Additionally, 14 proteins are found only in the species from the genera Mycobacterium and Nocardia, suggesting that these two genera are closely related.^[14]

Species

Phylogenetic Position of the Tubercle Bacilli within the Genus Mycobacterium.

The blue triangle corresponds to tubercle bacilli sequences that are identical or differing by a single nucleotide. The sequences of the genus Mycobacterium that matched most closely to those of M. tuberculosis were retrieved from the BIBI database (http://pbil.univ-lyon.fr/bibi/) and aligned with those obtained for 17 smooth and MTBC strains. The unrooted neighbor-joining tree is based on 1,325 aligned nucleotide positions of the 16S rRNA gene. The scale gives the pairwise distances after Jukes-Cantor correction. Bootstrap support values higher than 90% are indicated at the nodes.

Phenotypic tests can be used to identify and distinguish different Mycobacteria species and strains. In older systems, mycobacteria are grouped based upon their appearance and rate of growth. However, these are symplesiomorphies, and more recent classification is based upon cladistics.

Slowly growing

Mycobacterium tuberculosis complex

Mycobacterium tuberculosis complex (MTBC) members are causative agents of human and animal tuberculosis. Species in this complex include:

M. tuberculosis, the major cause of human tuberculosis

M. bovis

M. bovis BCG

M. africanum

M. canetti

M. caprae

M. microti

M. pinnipedii

Mycobacterium avium complex

Mycobacterium avium complex (MAC) is a group of species that, in a disseminated infection but not lung infection, used to be a significant cause of death in AIDS patients. The species M. indicus pranii appears to be basal in this complex.^[15] Species in this complex include:

M. avium

M. avium paratuberculosis, which has been implicated in Crohn's disease in humans and is the causative agent of Johne's disease in cattle and sheep

M. avium silvaticum

M. avium "hominissuis"

M. colombiense

M. indicus pranii

Mycobacterium gordonae clade

M. asiaticum
M. gordonae

Mycobacterium kansasii clade

M. gastri
M. kansasii

Mycobacterium nonchromogenicum/terrae clade

M. hiberniae
M. nonchromogenicum
M. terrae
M. triviale

Mycolactone-producing mycobacteria

M. ulcerans, which causes the "Buruli", or "Bairnsdale" ulcer
M. pseudoshottsii
M. shottsii

Mycobacterium simiae clade

M. triplex
M. genavense
M. florentinum
M. lentiflavum
M. palustre
M. kubicae
M. parascrofulaceum
M. heidelbergense
M. interjectum
M. simiae

Ungrouped

M. bohemicum
M. botniense
M. branderi
M. celatum
M. chimaera
M. conspicuum
M. cookii
M. doricum
M. farcinogenes
M. haemophilum
M. heckeshornense
M. intracellulare
M. lacus
M. leprae, which causes leprosy
M. lepraemurium
M. lepromatosis, another (less significant) cause of leprosy, described in 2008
M. malmoense
M. marinum, causes a rare disease called Aquarium granuloma.
M. monacense
M. montefiorense
M. murale
M. nebraskense
M. saskatchewanense
M. scrofulaceum
M. shimoidei
M. szulgai
M. tusciae
M. xenopi
M. yongonense

Intermediate growth rate

M. intermedium

Rapidly growing

Mycobacterium chelonae clade

M. abscessus
M. chelonae
M. bolletii

Mycobacterium fortuitum clade

M. fortuitum
M. fortuitum subsp. acetamidolyticum
M. boenickei
M. peregrinum
M. porcinum
M. senegalense
M. septicum
M. neworleansense
M. houstonense
M. mucogenicum
M. mageritense
M. brisbanense
M. cosmeticum

Mycobacterium parafortuitum clade

M. parafortuitum
M. austroafricanum
M. diernhoferi
M. hodleri
M. neoaurum
M. frederiksbergense

Mycobacterium vaccae clade

M. aurum
M. vaccae

CF

M. chitae
M. fallax

Ungrouped

M. confluentis
M. flavescens
M. madagascariense
M. phlei
M. smegmatis
- M. goodii
- M. wolinskyi
M. thermoresistibile
M. gadium
M. komossense
M. obuense
M. sphagni
M. agri
M. aichiense
M. alvei
M. arupense
M. brumae
M. canariasense
M. chubuense
M. conceptionense
M. duvalii
M. elephantis
M. gilvum
M. hassiacum
M. holsaticum
M. immunogenum
M. massiliense
M. moriokaense
M. psychrotolerans
M. pyrenivorans
M. vanbaalenii
M. pulveris

Ungrouped

M. arosiense
M. aubagnense
M. caprae
M. chlorophenolicum
M. fluoroanthenivorans
M. kumamotonense
M. novocastrense
M. parmense
M. phocaicum
M. poriferae
M. rhodesiae
M. seoulense
M. tokaiense

Mycobacteriophage

Mycobacteria can be infected by Mycobacteriophage, bacterial viruses that may be used in the future to treat tuberculosis and related diseases by phage therapy.

References

^ ^a ^b ^c Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.
^ James H. Kerr and Terry L. Barrett, "Atypical Mycobacterial Diseases", Military Dermatology Textbook, p. 401.
^ Niederweis M, Danilchanka O, Huff J, Hoffmann C, Engelhardt H (2010). "Mycobacterial outer membranes: in search of proteins". Trends in Microbiology 18 (3): 109–16. doi:10.1016/j.tim.2009.12.005. PMC 2931330. PMID 20060722.
^ Ghosh, Jaydip; Larsson, Pontus; Singh, Bhupender; Pettersson, B M Fredrik; Islam, Nurul M; Nath Sarkar, Sailendra; Dasgupta, Santanu; Kirsebom, Leif A (2009). "Sporulation in mycobacteria". Proceedings of the National Academy of Sciences of the United States of America 106 (26): 10781–10786. doi:10.1073/pnas.0904104106. PMID 19541637.
^ Traag, BA; Driks, A; Stragier, P; Bitter, W; Broussard, G; Hatfull, G; Chu, F; Adams, KN; Ramakrishnan, L; Losick, R (Jan 2010). "Do mycobacteria produce endospores?". Proc Natl Acad Sci U S A 107 (2): 878–81.
^ Bhamidi S (2009). "Mycobacterial Cell Wall Arabinogalactan". Bacterial Polysaccharides: Current Innovations and Future Trends. Caister Academic Press. ISBN 978-1-904455-45-5.
^ Parish T, Brown A (editors) (2009). Mycobacterium: Genomics and Molecular Biology. Caister Academic Press. ISBN 978-1-904455-40-0.
^ McMurray DN (1996). "Mycobacteria and Nocardia". In Baron S et al. (eds.). Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.
^ McCann et al. (2009). "Secreted and Exported Proteins Important to Mycobacterium tuberculosis Pathogenesis". Bacterial Secreted Proteins: Secretory Mechanisms and Role in Pathogenesis. Caister Academic Press. ISBN 978-1-904455-42-4.
^ Smith, D.W., et al., Nature 1960, 186, 887
^ fatty alcohols and aldehydes
^ Akinola R. et al. 2013 A Systems Level Comparison of Mycobacterium tuberculosis, Mycobacterium leprae and Mycobacterium smegmatis Based on Functional Interaction. J Bacteriol Parasitol 2013, 4:4
^ Gao, B.; Paramanathan, R.; Gupta, R. S. (2006). "Signature proteins that are distinctive characteristics of Actinobacteria and their subgroups". Antonie van Leeuwenhoek 90 (1): 69–91. doi:10.1007/s10482-006-9061-2. PMID 16670965.
^ ^a ^b Gao, B.; Gupta, R. S. (2012). "Phylogenetic Framework and Molecular Signatures for the Main Clades of the Phylum Actinobacteria". Microbiology and Molecular Biology Reviews 76 (1): 66–112. doi:10.1128/MMBR.05011-11. PMC 3294427. PMID 22390973.
^ Rahman, SA; Singh, Y; Kohli, S; Ahmad, J; Ehtesham, NZ; Tyagi, AK; Hasnain, SE (2014). "Comparative analyses of nonpathogenic, opportunistic, and totally pathogenic Mycobacteria reveal genomic and biochemical variabilities and highlight the survival attributes of Mycobacterium tuberculosis". MBio 5 (6). doi:10.1128/mBio.02020-14.

External links

Tuberculist: Genome annotation database
MTB Sysborg: Genome annotation database from the Institute of Genomics and Integrative Biology
TB Structural Genomics Consortium: Structures of Mycobacterium tuberculosis proteins
MycDB: Mycobacterium database
TBDB: Tuberculosis database
Mycobacterium genomes and related information at PATRIC, a Bioinformatics Resource Center funded by NIAID
Frequently Asked Questions about NTM Lung Disease
PRASITE: Identification of mycobacteria

UpToDate Contents

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1. Clinical manifestations and evaluation of pulmonary tuberculosis
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3. HIV陰性患者における肺結核の治療 treatment of pulmonary tuberculosis in hiv negative patients
4. 小児における結核 tuberculosis disease in children
5. HIV陰性成人における潜伏結核感染の診断 diagnosis of latent tuberculosis infection in hiv negative adults

English Journal

A rapid amplification/detection assay for analysis of Mycobacterium tuberculosis using an isothermal and silicon bio-photonic sensor complex.

Shin Y1, Perera AP1, Tang WY2, Fu DL1, Liu Q1, Sheng JK1, Gu Z1, Lee TY1, Barkham T2, Kyoung Park M1.
Biosensors & bioelectronics.Biosens Bioelectron.2015 Jun 15;68:390-6. doi: 10.1016/j.bios.2015.01.030. Epub 2015 Jan 14.
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Barreda-García S1, González-Álvarez MJ1, de-Los-Santos-Álvarez N1, Palacios-Gutiérrez JJ2, Miranda-Ordieres AJ1, Lobo-Castañón MJ3.
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A highly sensitive and robust method for the quantification of specific DNA sequences based on coupling asymmetric helicase-dependent DNA amplification to electrochemical detection is described. This method relies on the entrapment of the amplified ssDNA sequences on magnetic beads followed by a pos
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Shape-based virtual screening, docking, and molecular dynamics simulations to identify Mtb-ASADH inhibitors.

Kumar R1, Garg P, Bharatam PV.
Journal of biomolecular structure & dynamics.J Biomol Struct Dyn.2015 May;33(5):1082-93. doi: 10.1080/07391102.2014.929535. Epub 2014 Jun 23.
Aspartate β-semialdehyde dehydrogenase (ASADH) is a key enzyme for the biosynthesis of essential amino acids and several important metabolites in microbes. Inhibition of ASADH enzyme is a promising drug target strategy against Mycobacterium tuberculosis (Mtb). In this work, in silico approach was u
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Japanese Journal

Molecular characterization of rifampicin- and isoniazid-resistant Mycobacterium tuberculosis strains isolated in Kazakhstan

Kozhamkulov Ulan,Akhmetova Ainur,Rakhimova Saule [他]
Japanese Journal of Infectious Diseases 64(3), 253-255, 2011-05
NAID 40018820944

FTA card utility for PCR detection of Mycobacterium leprae

Khin Saw Aye,Matsuoka Masanori,Kai Masanori [他]
Japanese Journal of Infectious Diseases 64(3), 246-248, 2011-05
NAID 40018820942

Related Pictures

★リンクテーブル★

リンク元	「100Cases 33」「細菌の鑑別」「細胞内寄生菌」「耳前リンパ節」「抗酸菌」
拡張検索	「Mycobacterium avium complex」「atypical Mycobacterium infection」「Mycobacterium phlei」「hot water extract of Mycobacterium tuberculosis」「Mycobacterium leprae infection」

「100Cases 33」

Mycobacterium
	TEM micrograph of M. tuberculosis.
Scientific classification
Kingdom:	Bacteria
Phylum:	Actinobacteria
Order:	Actinomycetales
Suborder:	Corynebacterineae
Family:	Mycobacteriaceae
Genus:	Mycobacterium; Lehmann & Neumann 1896
Species
	See below.

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)

According to the US CDC definition, one has AIDS if he/she is infected with HIV and present with one of the following:

A CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

or he/she has one of the following defining illnesses:

01. Candidiasis of bronchi, trachea, or lungs
02. Candidiasis esophageal
03. Cervical cancer (invasive)
04. Coccidioidomycosis, disseminated or extrapulmonary
05. Cryptococcosis, extrapulmonary
06. Cryptosporidiosis, chronic intestinal for longer than 1 month
07. Cytomegalovirus disease (other than liver, spleen or lymph nodes)
08. Encephalopathy (HIV-related)
09. Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
10. Histoplasmosis, disseminated or extrapulmonary
11. Isosporiasis, chronic intestinal (for more than 1 month)
12. Kaposi's sarcoma
13. Lymphoma Burkitt's, immunoblastic or primary brain
14. Mycobacterium avium complex
15. Mycobacterium, other species, disseminated or extrapulmonary
16. Pneumocystis carinii pneumonia
17. Pneumonia (recurrent)
18. Progressive multifocal leukoencephalopathy
19. Salmonella septicemia (recurrent)
20. Toxoplasmosis of the brain
21. Tuberculosis
22. Wasting syndrome due to HIV

People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:

undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia

AND

the individual has had Pneumocystis carinii pneumonia
OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

□AIDSのステージング

Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)

http://en.wikipedia.org/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「細菌の鑑別」

　　[★]

関: 細菌

グラム陽性菌の鑑別 LAB.994

菌種	形態	抗酸性	芽胞	運動性	空気中での発育	嫌気条件下での発育	カタラーゼ	オキシダーゼ	ブドウ糖分解	OF試験
Micrococcus	C	－	－	－	＋	－	＋	－	D	O/－
Staphylococcus	C	－	－	－	＋	＋	＋	－	＋	F
Aerococcus	C	－	－	－	＋	W	W/－	－	＋	F
Streptococcus	C	－	－	＋/－	＋	＋	－	－	＋	F
Pediococcus	C.	－	－	－	＋	＋	－	－	＋	F
Gemella	C.	－	－	－	＋	＋	－	－	＋	F
嫌気性球菌*1	C	－	－	－	－	＋	－	－	＋/－	F/－
Kurthia	R	－	－	＋	＋	＋	＋	－	－	－
Corynebacterium	R	－	－	－	＋	＋	＋	－	＋/－	F/－
Listeria	R	－	－	＋	＋	＋	＋	－	＋	F
Erysipelothnx	R		－	－	＋	＋			＋	F
Lactobacillus
Arachnia*2
Rothia	R	－	－	－	＋	－	＋	●	＋	F
Propiombacterium	R	－	－	－	－	＋	＋	.	＋	F
Achnomyces	R	－	－	－	－	＋	－	●	＋	F
Bifidobacterium
Eubacterium	R	－	－	－	－	＋	－	.	＋/－	F/－
Clostridium	R	－	<＋>	D	－	＋	－	●	D	F/－
Bacillus	R	－	<＋>	D	＋	D	＋	d	D	F/O/－
Nocardia	R	W	－	－	＋	－	＋	－	＋	O
Mycobacterium	R	＋	－	－	＋	.	＋	－	＋	O/NT
1:Peptococcus, Peptostreptococus(あるいは Leuconostoc) 2:あるいはActinomyces odontolyticus D:その属の菌種によって反応が異なる。　d: 菌種によって反応が異なる。 F:発酵 O:酸化 W:弱反応・:不明 NT:テストできない <＋>:芽胞非形成筋もある C:球菌 R:桿菌

グラム陰性菌の鑑別 LAB.995

(再編集の時に－*に注意)

菌種	形態	運動性	空気中での発育	嫌気条件下での発育	カタラーゼ	オキシダーゼ	ブドウ糖(酸)	OF試験
Bacteroides	R	－	－	＋	d	－	D	F/－
Veillonella	C	－	－	＋	D	・	－	－
Neissena	C	－	＋	－	＋	＋	＋	O
Branhamella	C	－	＋	－	＋	＋	－	－
Acinetobacter	C/R	－	＋	－	＋	－	＋	O
Moraxella	R	－	＋		＋	＋	－
Brucella
Bordetella
Chromobacterium lividum	R	＋	＋	－	＋	＋	＋	O
Alcahsenes	R	＋	＋	－	＋	＋	－	－
Flavobacterium	R	－	＋	－	＋	＋	＋	O
Pseudomonas	R	＋	＋	＋	＋	＋	＋	O
Actinobacillus	R	－	＋	＋	＋	＋	＋	F
Pasteurella
Necromonas
Cardiobacterium	R	－	＋	＋	－	＋	＋	F
Chromobacterium violaceum
Beneckea	R	＋	＋	＋	＋	＋	＋	F
Vibrio
Plesiomonas
Aeromonas
腸内細菌	R	D	＋	＋	＋	－	＋	F
Haemophilus	R	－	＋	＋	D	－	D	NT
Eikenella	R	－	－*	＋	－	＋	－	－
Campylobacter	R	＋	－+1	－	D	＋	－	－
Streptobacillus+2	R	－	＋	＋	－	－	＋	F
マイコプラズマ	R	－	＋	＋	－	－	＋	F
1:Peptococcus, Peptostreptococus(あるいは Leuconostoc) 2:あるいはActinomyces odontolyticus D:その属の菌種によって反応が異なる。　d: 菌種によって反応が異なる。 F:発酵 O:酸化 W:弱反応・:不明 NT:テストできない <＋>:芽胞非形成筋もある C:球菌 R:桿菌・: 不明 *: 空気中では発育せず。空気CO2で発育。+1: 好気的または嫌気的には発育せず。5-6%O2中で発育。+2: あるいはShigella dysenteriae 1

「細胞内寄生菌」

　　[★]

英: intracellular organism, intracellular epiphyte
同: 細胞内寄生、細胞外寄生菌

宿主細胞内環境で増殖する細菌の総称

マクロファージ内で生存、増殖することができる。

ファゴソームとリソソームの融合阻止などによりマクロファージの細胞内で増殖できることが特徴であり、細胞外で増殖できないと言うことではない。

分類

通性細胞内寄生菌：細胞内でも細胞外でも増殖できる。
偏性細胞内寄生菌：細胞内でしか増殖できない

	細胞内寄生菌	細胞外寄生菌
生体防御反応	肉芽腫形成	膿瘍を形成

偏性細胞内寄生菌と通性細胞内寄生菌

偏性細胞内寄生菌	リケッチア、クラミジア、らい菌？
通性細胞内寄生菌	結核菌, リステリア属菌, サルモネラ属菌(チフス菌、パラチフス菌、サルモネラ症を起こす菌), ブルセラ属菌, 梅毒トレポネーマ, レジオネラ属菌

表：細胞内増殖：SMB. 111

ファゴソーム内で増殖(リソソームの融合を起こさせない)

ファゴソームを破砕し細胞質内に逃げ込む

Nocardia
Shigella
Rickettsia
Trypanosoma

リソソームの融合が起きる、あるいはファゴソームを修飾する

「耳前リンパ節」

　　[★]

英: anterior auricular lymph node, preauricular lymph node, preauricular node
同: 耳介前リンパ節、耳介前部リンパ節

[show details]

耳前リンパ節 : 約 16,300 件
耳介前リンパ節 : 51 件

解剖

参考.1

耳介前リンパ節(通常1-3個)は耳介の前方に位置する。耳介後リンパ節と耳介前リンパ節、浅耳介リンパ節には、外耳、涙腺や周辺の頭皮や顔面からのリンパが流入し、深頸リンパ節に注ぐ。

腫脹

IRE.383

結膜炎

外耳炎

参考

1. 解剖シェーマ

http://www.oralstudio.net/stepup/jisho//1.img/words/img153.gif

「抗酸菌」

　　[★]

fast
英: acid-fast bacterium, acid-fast bacteria, acid-fast bacillus, acid-fast bacilli
同: マイコバクテリウム Mycobacterium

グラム陽性桿菌
GゲノムはCリッチ
細胞質は脂質に富み通常の染色では難染性であり、抗酸菌染色(チール-ネールゼン染色や蛍光染色など)で陽性に染色される。
アニリン色素に難船色性、グラム染色陽性。いったん染色されると酸アルコールに脱色されにくい

"抗酸性"を示す細菌(Mycobacterium属、Nocardia属、Corynebacterium属、Actinomyces属、Rhodococcus属)

「Mycobacterium avium complex」

　　[★] マイコバクテリウム・アビウムコンプレックス MAC

「atypical Mycobacterium infection」

　　[★]

非定型抗酸菌症

関: atypical mycobacterial infection

「Mycobacterium phlei」

　　[★]

マイコバクテリウム・フレイ

関: M. phlei

「hot water extract of Mycobacterium tuberculosis」

　　[★] Z-100。結核菌熱水抽出物

「Mycobacterium leprae infection」

　　[★]

関: leprosy、癩菌感染症

[Sherris-1] Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.

[2] James H. Kerr and Terry L. Barrett, "Atypical Mycobacterial Diseases", Military Dermatology Textbook, p. 401.

[Niederweis2010-3] Niederweis M, Danilchanka O, Huff J, Hoffmann C, Engelhardt H (2010). "Mycobacterial outer membranes: in search of proteins". Trends in Microbiology 18 (3): 109–16. doi:10.1016/j.tim.2009.12.005. PMC 2931330. PMID 20060722.

[4] Ghosh, Jaydip; Larsson, Pontus; Singh, Bhupender; Pettersson, B M Fredrik; Islam, Nurul M; Nath Sarkar, Sailendra; Dasgupta, Santanu; Kirsebom, Leif A (2009). "Sporulation in mycobacteria". Proceedings of the National Academy of Sciences of the United States of America 106 (26): 10781–10786. doi:10.1073/pnas.0904104106. PMID 19541637.

[5] Traag, BA; Driks, A; Stragier, P; Bitter, W; Broussard, G; Hatfull, G; Chu, F; Adams, KN; Ramakrishnan, L; Losick, R (Jan 2010). "Do mycobacteria produce endospores?". Proc Natl Acad Sci U S A 107 (2): 878–81.

[BhamidiS-6] Bhamidi S (2009). "Mycobacterial Cell Wall Arabinogalactan". Bacterial Polysaccharides: Current Innovations and Future Trends. Caister Academic Press. ISBN 978-1-904455-45-5.

[ParishBrown-7] Parish T, Brown A (editors) (2009). Mycobacterium: Genomics and Molecular Biology. Caister Academic Press. ISBN 978-1-904455-40-0.

[Baron-8] McMurray DN (1996). "Mycobacteria and Nocardia". In Baron S et al. (eds.). Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.

[McCann-9] McCann et al. (2009). "Secreted and Exported Proteins Important to Mycobacterium tuberculosis Pathogenesis". Bacterial Secreted Proteins: Secretory Mechanisms and Role in Pathogenesis. Caister Academic Press. ISBN 978-1-904455-42-4.

[10] Smith, D.W., et al., Nature 1960, 186, 887

[11] tty alcohols and aldehydes

[12] Akinola R. et al. 2013 A Systems Level Comparison of Mycobacterium tuberculosis, Mycobacterium leprae and Mycobacterium smegmatis Based on Functional Interaction. J Bacteriol Parasitol 2013, 4:4

[13] Gao, B.; Paramanathan, R.; Gupta, R. S. (2006). "Signature proteins that are distinctive characteristics of Actinobacteria and their subgroups". Antonie van Leeuwenhoek 90 (1): 69–91. doi:10.1007/s10482-006-9061-2. PMID 16670965.

[Gao-14] Gao, B.; Gupta, R. S. (2012). "Phylogenetic Framework and Molecular Signatures for the Main Clades of the Phylum Actinobacteria". Microbiology and Molecular Biology Reviews 76 (1): 66–112. doi:10.1128/MMBR.05011-11. PMC 3294427. PMID 22390973.

[Rahman2014-15] Rahman, SA; Singh, Y; Kohli, S; Ahmad, J; Ehtesham, NZ; Tyagi, AK; Hasnain, SE (2014). "Comparative analyses of nonpathogenic, opportunistic, and totally pathogenic Mycobacteria reveal genomic and biochemical variabilities and highlight the survival attributes of Mycobacterium tuberculosis". MBio 5 (6). doi:10.1128/mBio.02020-14.

Mycobacterium

TEM micrograph of M. tuberculosis.
Scientific classification
Kingdom:	Bacteria
Phylum:	Actinobacteria
Order:	Actinomycetales
Suborder:	Corynebacterineae
Family:	Mycobacteriaceae
Genus:	Mycobacterium Lehmann & Neumann 1896
Species
See below.

匿名

検索

案内

Mycobacterium

Wikipedia preview

wiki en

Contents

Microbiologic characteristics

Pigmentation

Staining characteristics

Ecology

Pathogenicity

Medical classification

Mycosides

Genomics

Species

Slowly growing

Mycobacterium tuberculosis complex

Mycobacterium avium complex

Mycobacterium gordonae clade

Mycobacterium kansasii clade

Mycobacterium nonchromogenicum/terrae clade

Mycolactone-producing mycobacteria

Mycobacterium simiae clade

Ungrouped

Intermediate growth rate

Rapidly growing

Mycobacterium chelonae clade

Mycobacterium fortuitum clade

Mycobacterium parafortuitum clade

Mycobacterium vaccae clade

CF

Ungrouped

Ungrouped

Mycobacteriophage

References

Further reading

External links

UpToDate Contents

English Journal

Japanese Journal

Related Links

Related Pictures

★リンクテーブル★

「100Cases 33」

「細菌の鑑別」

グラム陽性菌の鑑別 LAB.994

グラム陰性菌の鑑別 LAB.995

「細胞内寄生菌」

分類

偏性細胞内寄生菌と通性細胞内寄生菌

表：細胞内増殖：SMB. 111

「耳前リンパ節」

解剖

腫脹

参考

「抗酸菌」

「Mycobacterium avium complex」

「atypical Mycobacterium infection」

「Mycobacterium phlei」

「hot water extract of Mycobacterium tuberculosis」

「Mycobacterium leprae infection」