MycoplasmasMycoplasmas and and ActinomycetesActinomycetes
Presented byPresented by
فطاني. مان جي محمد احمد آصف فطاني. د مان جي محمد احمد آصف د) عبدالعزيز ) الملك جامعة والجراحة الطب (بكاالوريوس عبدالعزيز ) الملك جامعة والجراحة الطب بكاالوريوس
) مانشستر ) جامعة والجزيئية الطبية الدقيقة الكائنات (ماجستير مانشستر ) جامعة والجزيئية الطبية الدقيقة الكائنات ماجستير) بريطانيا ) – مانشستر جامعة الطبية الدقيقة الكائنات (دكتوراه بريطانيا ) – مانشستر جامعة الطبية الدقيقة الكائنات دكتوراه
Dr Asif Jiman-Fatani, MB ChB, MSc, PhD (UK)Dr Asif Jiman-Fatani, MB ChB, MSc, PhD (UK)
Assistant Professor in Medical Microbiology,Assistant Professor in Medical Microbiology,Faculty of Medicine, King Abdulaziz UniversityFaculty of Medicine, King Abdulaziz University
Consultant MicrobiologistConsultant MicrobiologistHead, Clinical Microbiology LaboratoriesHead, Clinical Microbiology Laboratories
King Abdulaziz University HospitalKing Abdulaziz University Hospital
MYCOPLASMASMYCOPLASMASCharacteristicsCharacteristics
Lacking cell wallLacking cell wall Resistant to antibacterials that inhibit cell wall synthesisResistant to antibacterials that inhibit cell wall synthesis Gram’s stain : Not usefulGram’s stain : Not useful PleomorphicPleomorphic Cannot be classified as either cocci or bacilliCannot be classified as either cocci or bacilli
Enclosed in a plasma membraneEnclosed in a plasma membrane Lipid bilayer membrane containing sterolsLipid bilayer membrane containing sterols
Smallest free-living organismsSmallest free-living organisms Pass through bacteriologic filtersPass through bacteriologic filters
Can be cultured in vitro.Can be cultured in vitro.
MYCOPLASMASMYCOPLASMAS
Mycoplasma pneumoniaeMycoplasma pneumoniae →→ Atypical Pneumonia
Mycoplasma hominis → → STI: Non-gonococcal Urethritis, Cervicitis, PID
Ureaplasma urealyticum → → STI: Non-gonococcal Urethritis, Cervicitis, PID
Mycoplasma pneumoniae Mycoplasma pneumoniae )Eaton’s reagent()Eaton’s reagent(
Habitat and TransmissionHabitat and Transmission
Habitat is the human respiratory tract.Habitat is the human respiratory tract.
TransmissionTransmission : Respiratory droplets. : Respiratory droplets.
Mycoplasma pneumoniaeMycoplasma pneumoniaePathogenesisPathogenesis
P1 adhesion proteinP1 adhesion protein M. pneumoniaeM. pneumoniae binds to respiratory ciliated epithelium binds to respiratory ciliated epithelium Adherence results in ciliostasis & cell destruction Adherence results in ciliostasis & cell destruction →→ reduced reduced
ciliated clearanceciliated clearance Bacteria then gain access to the lower respiratory tractBacteria then gain access to the lower respiratory tract
Produces Produces hydrogen peroxidehydrogen peroxide : may damage the : may damage the respiratory tract.respiratory tract.
No exotoxins produced.No exotoxins produced. No endotoxin because there is no cell wall.No endotoxin because there is no cell wall.
Mycoplasma pneumoniaeMycoplasma pneumoniae
DiseasesDiseases
AtypicalAtypical pneumonia pneumonia :: Clinical Features: Fever – Clinical Features: Fever – DryDry cough “or scantily cough “or scantily
productive cough”productive cough” Walking pneumoniaWalking pneumonia Complications: Mild hemolytic anaemiaComplications: Mild hemolytic anaemia
Upper Respiratory Diseases :Upper Respiratory Diseases : Otitis MediaOtitis Media PharyngitisPharyngitis TracheobronchitisTracheobronchitis
Mycoplasma pneumoniaeMycoplasma pneumoniae
Laboratory DiagnosisLaboratory Diagnosis Specimens: but scanty sputumSpecimens: but scanty sputum Gram stain : not useful.Gram stain : not useful.
Culture: on Culture: on special bacteriologicspecial bacteriologic media. Takes at least 10 days to grow )too media. Takes at least 10 days to grow )too long to be clinically useful(.long to be clinically useful(. Colonie: Fried egg appearanceColonie: Fried egg appearance
SerologySerology A cold-agglutinin titer of 1:128 or higher is indicative of recent A cold-agglutinin titer of 1:128 or higher is indicative of recent
infectioninfection Cold agglutinin: IgM autoantibodies against red blood cells that Cold agglutinin: IgM autoantibodies against red blood cells that
agglutinate these cells at 4 °C but not at 37 °C agglutinate these cells at 4 °C but not at 37 °C
Complement fixation test for antibodies to Complement fixation test for antibodies to Mycoplasma pneumoniaeMycoplasma pneumoniae is more specific.is more specific.
PCRPCR
Note Note : Diagnosis relies on clinical findings: Diagnosis relies on clinical findings
Mycoplasma pneumoniaeMycoplasma pneumoniaeTreatmentTreatment Erythromycin or …Erythromycin or … Tetracycline.Tetracycline.
PreventionPrevention No vaccine or drug is availableNo vaccine or drug is available
Genital MycoplasmasGenital Mycoplasmas
Mycoplasma hominis → → STD: Non-gonococcal Urethritis, Cervicitis, PID
Ureaplasma urealyticum → → STD: Non-gonococcal Urethritis, Cervicitis, PID
ActinomycetesActinomycetes
ActinomycetesActinomycetes
Gram positive bacteriaGram positive bacteria
Filamentous branching bacilliFilamentous branching bacilli Superficially resemble fungi on morphologic groundsSuperficially resemble fungi on morphologic grounds
They are prokaryotesThey are prokaryotes
Has bacterial sizeHas bacterial size
ActinomycetesActinomycetes
Few are pathogenic to human, the most Few are pathogenic to human, the most important are :important are : Actinomyces israeliiActinomyces israelii Nocardia astroidesNocardia astroides
ACTINOMYCETESACTINOMYCETES
Actinomyces Actinomyces israeliiisraelii
Gram-positive filamentous branching bacilliGram-positive filamentous branching bacilli
AnaerobicAnaerobic
Grows slowlyGrows slowly
Actinomyces israeliiActinomyces israelii Habitat and TransmissionHabitat and Transmission
Habitat :Habitat : Found as scanty normal commensal in the: Found as scanty normal commensal in the: Mouth, especially anaerobic crevices around the teethMouth, especially anaerobic crevices around the teeth ColonColon VaginaVagina
Disease begins when these normal flora enter adjacent Disease begins when these normal flora enter adjacent sterile tissue e.g, by trauma, surgerysterile tissue e.g, by trauma, surgery
TransmissionTransmission into tissues occurs during : into tissues occurs during : Dental extraction - Poor dental hygieneDental extraction - Poor dental hygiene Trauma )mouth – uterus(Trauma )mouth – uterus( Organism also aspirated into lungs, causing thoracic actinomycosis.Organism also aspirated into lungs, causing thoracic actinomycosis.
Actinomyces israeliiActinomyces israeliiPathogenesisPathogenesis
Infections occur in both :Infections occur in both : Normal hostsNormal hosts Immunocompromised patientsImmunocompromised patients
No toxins or virulence factors known.No toxins or virulence factors known.
Organism forms sinus tracts that open onto skin and contain Organism forms sinus tracts that open onto skin and contain yellow “yellow “sulfur granulessulfur granules”” Sulfur granules : are made up of large masses of Sulfur granules : are made up of large masses of
organisms microcolonies of filamentous bacteriaorganisms microcolonies of filamentous bacteria
Actinomyces israeliiActinomyces israelii DiseaseDisease
Actinomycosis Actinomycosis )abscesses with draining sinus tracts()abscesses with draining sinus tracts(
Chronic suppurative abscessChronic suppurative abscess The lesion )Mycetoma( :The lesion )Mycetoma( :
Begins as a hard red swellingBegins as a hard red swelling Ddevelops slowly, becomes filled with pusDdevelops slowly, becomes filled with pus Draining with sinus formationDraining with sinus formation
Sites:Sites: Oral-facial abscesses )> 50% of cases(Oral-facial abscesses )> 50% of cases(
Often associated with trauma or dental extractionOften associated with trauma or dental extraction Abdominal infections:Abdominal infections:
Abscess. Many after appendicitisAbscess. Many after appendicitis Uterine infection :Uterine infection :
Associated with intrauterine contraceptive devicesAssociated with intrauterine contraceptive devices Chest infectionChest infection Invasive infections in immunocompromised patientsInvasive infections in immunocompromised patients
Actinomyces israeliiActinomyces israelii Laboratory DiagnosisLaboratory Diagnosis
Specimen:Specimen: Pus Pus Filaments may aggregate to form visible granules “Sulphur Filaments may aggregate to form visible granules “Sulphur
granules” in pus: Yellowish particlesgranules” in pus: Yellowish particles No sulphurNo sulphur
Microscopy:Microscopy: Sulfur Granules :Sulfur Granules : Gram-positive filamentous, branching rods Gram-positive filamentous, branching rods
Culture:Culture: AnaerobicAnaerobic culture on blood agar plate )10 days( culture on blood agar plate )10 days( Molar teeth coloniesMolar teeth colonies
No serologic tests.No serologic tests.
Actinomyces israeliiActinomyces israeliiTreatmentTreatment
PenicillinPenicillin For up to 3-12 monthsFor up to 3-12 months
Tetracyclin or ClindamycinTetracyclin or Clindamycin For penicillin-allergic patientsFor penicillin-allergic patients
Surgical drainageSurgical drainage
PreventionPrevention Good oral hygieneGood oral hygiene Prophylactic antibiotics in association with GIT or oral Prophylactic antibiotics in association with GIT or oral
trauma or surgerytrauma or surgery No vaccine is available.No vaccine is available.
ACTINOMYCETESACTINOMYCETES
Nocardia asteroidesNocardia asteroides
Nocardia asteroidesNocardia asteroidesDiseaseDisease
Nocardiosis (especially lung and brain abscesses).Nocardiosis (especially lung and brain abscesses).
Nocardia asteroidesNocardia asteroidesCharacteristicsCharacteristics
Gram positive filamentous, branching rods.Gram positive filamentous, branching rods.
AerobicAerobic
Acid-fast (weakly)Acid-fast (weakly)
Nocardia asteroidesNocardia asteroides Habitat and TransmissionHabitat and Transmission
Habitat is the soil.Habitat is the soil.
Transmission :Transmission : Airborne particles, which are inhaled into the lungsAirborne particles, which are inhaled into the lungs Implantation : by contamination of skin woundsImplantation : by contamination of skin wounds
Nocardia asteroidesNocardia asteroidesPathogenesisPathogenesis
Predisposing Factors:Predisposing Factors: ImmunosuppressionImmunosuppression HIVHIV CancerCancer
No toxins or virulence factors known.No toxins or virulence factors known.
Nocardia asteroidesNocardia asteroidesDiseasesDiseases
Diseases:Diseases: Abscesses in: Abscesses in: LungLung BrainBrain KidneyKidney
Nocardia asteroidesNocardia asteroidesLaboratory DiagnosisLaboratory Diagnosis
Specimen :Specimen : Pus Pus
Microscopy :Microscopy : Gram-stained smear : Gram positive filamentous, branching rodsGram-stained smear : Gram positive filamentous, branching rods Ziehl-Neelsen stain )modified( : weakly AFB )branching(Ziehl-Neelsen stain )modified( : weakly AFB )branching(
Culture :Culture : Aerobic culture on blood agar plate.Aerobic culture on blood agar plate.
No serologic tests.No serologic tests.
Nocardia asteroidesNocardia asteroidesTreatmentTreatment
SulfonamidesSulfonamides Long durationLong duration Nocardia is resistant to penicillinNocardia is resistant to penicillin
PreventionPrevention No vaccine is available.No vaccine is available.
Differences between Differences between Actinomyces israeliiActinomyces israelii & & Nocardia astroidesNocardia astroides
Actinomyces israeliiActinomyces israeliiNocardia astroidesNocardia astroides
Growth Growth AtmosphereAtmosphere
AnaerobicAnaerobicAerobicAerobic
HabitatHabitatMouth, Colon, VaginaMouth, Colon, VaginaSoilSoil
TransmissionTransmissionTrauma (Tooth Trauma (Tooth extraction, Jaw fracture, extraction, Jaw fracture, Intrauterine Contr. Dev.)Intrauterine Contr. Dev.)
InhalationInhalation or or implantationimplantation
Sulfur granulesSulfur granulesYesYesNoNo
Acid-FastnessAcid-FastnessNoNoYes (weakly acid-fastYes (weakly acid-fast((
DiseaseDiseaseActinomycosis Actinomycosis (abscess with draining (abscess with draining sinuses) Cervicofacial, sinuses) Cervicofacial, Thorasic, Abd, PelvicThorasic, Abd, Pelvic
Nocardiosis (abscess in Nocardiosis (abscess in brain & kidneys in brain & kidneys in immunodeficient patients immunodeficient patients – Pneumonia)– Pneumonia)
TreatmentTreatmentPenicillinPenicillinSulfonamidesSulfonamides