section)
Table of contents :
Thousands of different commensal
microbial species populate Homo
sapiens outer and inner body surfaces :
108 bacteria/ mL
103-105 bacteria per gram or mL of luminal contents
in mice, consisting mainly of acid-tolerant species (e.g. Lactobacilli
spp., Streptococcus spp., Helicobacter
pylori) unless patient is treated with antiacids (H2
antagonists,
PPI),
a risk factor for aspiration
pneumonia
500-1,000 different species exist : their microbiome contains 100-fold
more genes than human genome. Gut is colonized ~ 40 hrs after birth.
108 bacteria / mL : Döderlein's bacillus
: one of the gram-positive rods commonly found in vaginal secretions that
may consist of mixtures of Lactobacillus acidophilus, L. casei,
L.
cellobiosisus, L. fermentum, or Leuconostoc mesenteroides.
Said by some to be identical with
L. acidophilus
microbiota is dominated by Corynebacterium
spp., Microbacterium spp., Rhodococcus
spp., Staphylococcus epidermidis,Staphylococcus
capitis, Staphylococcus hominis,Staphylococcus
haemolyticus,Staphylococcus
lugdunensis and Staphylococcus
warneri. Under special circumstances, single species, including
IgA1
protease-producing bacteria, may become predominant in a restricted area
of the nasal mucosaref.
commensals can be divided into,
being present on 31 % of physicians' hands (7.104 CFUs
/ hand) and 17 % of nurses' hands (4.104 CFUs / hand).Taxonomic units
);
strictly or facultative anaerobes => endogenous infections)
(chronic granuloma with draining fistulae from which sulfur granules
come out)
or mucosal injuries-using
females or after trauma,
caries,
gingivitis
with a rash that may look like scarlet fever, the spectrum of diseases
caused by A. haemolyticum has been expanded to include invasive
infections, including sepsis and osteomyelitis. The pathophysiology of
the rash is unknown;
)
at the pear-shaped end ; resist high [K2TeO3], reducing
it to Te (gray-black precipitates; Chinese ideograms-shaped colonies).
Core regions containing cell wall components contributing to pathogenicity
have been identified, including an arabinogalactan polymer involved in
adhesion.,
oropharyngitis
(oedema => "bull-neck") and/or
larynx (maximal vascularization => maximal toxin absorption => malignant
angina) or tracheitis (croup
: suffocating risk if detachment occurs !) with regional lymphadenitis.
Complications : after 2÷3 weeks 20÷30% undergo bacteraemia
=>
and ciliary nerve paralysis, which manifest as strabismus, blurred vision,
or difficulty with accommodation.
Paralysis of the diaphragm can ensue.
that don't undergo scaring
looking for tox gene
within 48 hours of onset (almost useless after day 4) after testing for
sensitivity to antitoxin;
G 600,000 units IM bid for 14 days (150,000 units/kg/day IV for 10 days
for pediatric patients) or erythromycin
500 mg parenterally or po qid,
toxoid
or heterologous
vaccine in newborns : diphteria is reemerging in countries which have stopped
vaccination programmes. Concentration of neutralizing Abs
may be evaluated by Schick test (1913):
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ref1,
ref2
result from chronic inflammationref;
cord
factor
of virulent mycobacteria that prevents fusion of lysosomes with endosomal
vacuoles and allows serpentine cord-like formation in vitro, while
in
vivo they occur as "swallow tail-shaped" ; produce exochelin-mycobactin
system for Fe2+ uptake; colonies will normally grow in 2-3 weeks,
but if a patient is on some kind of chemotherapy, then growth may take
up to 8 weeks. At 37 °C, cultures have been found viable and virulent
after 12 years of sctorage. After 2 hours of direct sunlight, organisms
from cultures will die. If the bacillus is contained within the sputum,
it will take 20 to 30 hours of direct sunlight before the organisms are
killed. Tubercle bacilli can survive for several months in sputum if protected
from direct sunlight.
(5), breast lift (4), breast reduction (4), and breast implant (1). Symptoms
of infection began a median of 5 weeks after surgery (range: 1-20 weeks)
and included subcutaneous or deep-tissue abscesses requiring incision,
drainage, and antibiotic therapy in all patients; 9 patients were hospitalized.
Molecular typing using PFGE and randomly amplified polymorphic DNA PCR
confirmed that M.abscessus isolates from 7 of 12 specimens were
indistinguishable. Organisms with this common genetic pattern were recovered
from patients who had surgery performed during Oct-Dec 2003 in the same
surgical center in Santo Domingo.
and crystalline keratopathy : therapeutic lamellar keratectomy with flap
removal can provide an effective treatment modality for the management
of post-LASIK keratitis
that is unresponsive to amikacin and ciprofoxacin given for 6 weeks
,
imipenem-cilastatin,
panipenem,
meropenem,
clarithromycin
and minocycline
in ruminants and other animals
: the involvement of MAP in Crohn's disease (CD) in humans has been uncertain
because of the substantial difficulties in detecting this pathogen : in
its Ziehl-Neelsen staining-negative form, MAP is highly resistant to chemical
and enzymatic lysis. By using optimized sample processing and DNA extraction
procedures, MAP is detected by nested PCR methodologies targeted at IS900
in 92% of fresh ileocolonic biopsy specimens from patients with CD vs.
26% of patients in a control group and by mycobacterial growth indicator
tube (MGIT) cultures in 42% CD patients (60% when incubated for > 38 weeks)
vs. 9% of controlsref.
Up to 55% of dairy herds in Western Europe and America are infected with
the bacteria, which can survive the normal flesh method of pasteurisation
(it involves heating milk to 72°C for 15", but to be sure of killing
MAP milk would need to be heated to that level for 30") and MAP bacteria
are present in 2% of retail pasteurised milk cartons : those individuals
with CD or their close relatives, who may feel particularly at risk, should
drink UHT milk. Water supplies
become infected as the droppings from herds seep into the soil, down into
natural aquifers. American studies have isolated MAP from the breast milk
of women with Crohn's disease but not in women who do not have the illness.
: MAP inflames the nerves of the gut in both animals and humans
are rarely infected by M. bovis but are commonly infected via environmental
contamination by the avian/intracellulare complex, which does not spread
between pigs.
=> opportunistic disseminated infection in patients with AIDS
=> rare pneumonia
(sometimes cavitating) in patients with COPD
or CF
=> carpal
tunnel syndrome (CTS)
(monolateral cervical
lymphadenitis)
in children from ingestion of milk, fresh milk derivatives or mollusks
=> fibrosis, ulcer
and fistulae
: at T > 84°F, where many tubs operate, chlorine loses its disinfectant
properties, and MAC can flourish. The bubbles and steam arising from the
tub create an aerosol through which MAC readily enters the lung by inhalation.
. Discontinuation of hot tub use, without antimycobacterial therapy, leads
to prompt improvement in symptoms, pulmonary function, and radiographic
abnormalities, strongly supporting a diagnosis of hypersensitivity pneumonitis.
,
bones (carpal
tunnel syndrome (CTS)),
CNS, prosthetic heart valves, skin and soft tissues, including localized
infections and abscesses at the site of puncture wounds
),
CNS, prosthetic heart valves, skin and soft tissues, including localized
infections and abscesses at the site of puncture wounds
,
painful swelling, ulcers
progressing into abscess), septic
arthritis,
osteomyelitis,
and pneumonitis in patients who are immunologically compromised and submandibular
lymphadenitisref1,
ref2,
ref3,
ref4,
ref5,
ref6
and draining fistulas in apparently immunocompetent children. Underlying
conditions in the compromised patients have included AIDS; renal, bone
marrow, and cardiac transplantation; lymphoma; rheumatoid arthritis; marrow
hypoplasia; and Crohn's disease
,
clarithromycin,
rifabutin,
and rifampin.
Timely diagnosis and therapy require communication between clinician and
the laboratoryref
),
a chronic pneumonia
involving the upper lobes, with evidence of scarring. Rare disseminated
infection in immunocompromised hosts.
(carpal
tunnel syndrome (CTS),
synovitis,
tendinitis,
osteomyelitis)
in young European children, while isolations from other sites (lung specimens
included) were described only in immunocompromised patientsref1,
ref2,
ref3,
ref4,
ref5,
ref6,
ref7
: anyway a chronic pulmonary M. lentiflavum infection in an elderly
immunocompetent woman has been reportedref
(prevalence : 7%; => lepromatous lepromatous leprosy), gibbons and Erinaceidae.
Transmission of leprosy remains poorly understood, with nasal droplet infection,
contact with infected soil and insect vectors thought to play a role. Not
culturable in vitro : propagated by injection into the footpads
of Mus musculus
or Rattus norvegicus
(lower T)
: infection of nasal epithelium (it exits from the phagosome before phagolysosome
formation) => incubation ranges from 3 months to 40 years (average 2-5
years for tuberculoid form and 8-12 years for lepromatous form !) => type
II hypersensitivity
due to cross-reactivity between bacterial and skin Ags presented on HLA-DRB1*15
(in HLA-DR2 haplotype)
in 25-50%. Serological status is controlled
after lepromin subcutaneous injection :
after 3÷4 weeks (primary immune response)
(side effects : diffuse
skin hyperpigmentation,
unaccepted by Hinduists), clofazamine
and rifampin
daily for at least 2-3 years until all biopsies are negative for acid-fast
bacilli. Patients with undeterminated or tuberculoid leprosy may be treated
with dapsone and rifampin as above for 6÷12 months, followed by
dapsone alone for > 2 years. Type III hypersensitivity is treated with
prednisone
or thalidomide.
=> wart => aquarium fish or swimming pool granuloma, usually of
the skin and soft tissues.
(carpal
tunnel syndrome (CTS)),
osteomyelitis,
chronic
laryngitis.
.
None of these cases was fatal. A fatal case rapidly progressive dementia
was reportedref
but aetiology was doubtfulref.
(causes false positivity for urinary
tuberculosis in urinalysis), sometimes involved in pulmonary, skin,
soft-tissues and bone infections.
similar to tubercular pneumonia
and Diplonychus spp.),
which were able to transmit M. ulcerans to mice by their bites,
suggesting a possible mechanism for human infectionref.
Another study reported a potential role for fish in transmissionref.
Fish were found positive for M. ulcerans DNA, and all appeared to
feed on insects or plankton and were believed to concentrate M. ulcerans
from this usual food source. Endemic foci exist throughout the world, predominantly
in tropical rain forest areas. The peak incidence of the disease coincides
with the rainfall pattern and farming season in endemic districts. This
lends credence to speculation that disease onset is related to farming
activities, which predispose to injury and pricks. Mycobacterium ulcerans
has also been found in snails, spiders and crayfish. Other insects said
to have been found infected are march flies, a confusing name that may
be used for flies in the family Bibionidae
or the large biting tabanid flies (2 common genera being Tabanus
spp.
and Chrysops spp.)
: at a guess, it would seem that tabanids would be a better vehicle for
transmission of M. ulcerans. A research topic for "M. ulcerans
in Victoria"ref
says that previous research has shown that M. ulcerans ingested
by mosquito larvae can be passed to adults. Clearly if -- as it seems from
the present post -- mosquitoes serve as vectors, it needs to be known whether
transmission is mechanical (such as by infected mosquito mouthparts and/or
by their feces being scratched into the skin or abrasions) or whether the
salivary glands are infected. If transmission is mechanical, or mainly
so, then it is likely that many mosquito species might be involved, as
well as other hematophagous insects. A useful reference is a 22-page abstract
(in English) of a PhD thesis of Timothy Stinear, which has 155 referencesref.
teeming with mycobacteria
that enlarges and becomes fluctuant) with secondary skin ulceration,
leaving an undermined edge. The 3 main clinical forms are
: localized necrotizing skin ulcers; contiguous dissemination over extensive
body surfaces; and metastatic spread of M. ulcerans to distant sites,
usually skin and bone. Minor forms heal spontaneously, ordinarily in 3-6
months by a delayed-type hypersensitivity response, followed by scarring.
Devastating sequelae (scarring or amputations) often ensue from tissue
destruction and osteomyelitis.
Untreated, massive areas of skin, and, sometimes bone, are
destroyed causing gross deformities. When lesions heal, scarring may cause
restricted movement of limbs and other permanent disabilities. One important
feature of Buruli ulcer is the minimally painful nature of the disease,
which may partly explain why those affected do not seek prompt treatment.
.
,
rifampin, and fluoroquinolones). Current research findings indicate that
a combination of an aminoglycoside (amikacin or streptomycin) and rifampicin
cures Buruli ulcer in mice.
in individuals with AIDS
==bacteraemia==>
meningitis,
acute
nephritis
and pleurisy
in individuals with AIDS