Лечение

• Мультилекарственная терапия

•General Characteristics:

•Nonmotile, nonsporing and noncapsulated bacillus arranged singly or in group

•Has a complex peptidoglycan arabinogalactan mycolate cell wall that is approximately 60% lipid, resulting in acid-fastness, poor Gram staining (weakly gram positive), and resistance to drying and many chemicals

•Mycobacterium tuberculosis appears slender, straight or slightly curved rod with beaded or barred appearance in ZN stain while Mycobacterium bovis appears straighter, stouter and shorter with uniform staining.

•A slow grower (generation time 12-24 hours) because it has single copies of ribosomal genes.

•Obligate aerobe and Facultative intracellular

•Determinants of pathogenecity (Mycosides):

•Mycosides are glycolipid derivatives of mycolic acid. Following mycosides are pathogenic determinants:

•1. Cord factor (Trehalose mycolate):

•inhibits neutrophil migration and causes the organism to grow in a cord or serpentine fashion in culture

•elicits granuloma formation

•disrupts mitochondrial membranes, interfering with respiration and oxidative phosphorylation

•immunogenic

•release of TNF (cachectin) resulting in rapid weight loss in mice experiments

•2. Sulfatides (Sulfur containing glycolipid):

•potentiates action of Cord factor

•permits intracellular survival in macrophages by inhibiting phagolysosome formation and by suppressing superoxide formation

•3. Wax D (complex mycoside):

•activation of cell mediated immunity

•Slow growing mycobacteria (growth of isolated colonies in more than 7 days)

•Nonpigmented, rough, dry colonies on Löwenstein-Jensen medium

•Acid-fast (Ziehl-Neelsen or Kinyoun stain)

•Nonphotochromogenic

•The niacin test: positive

•The nitrate reduction test: positive

•Growth on TCH (thiophene-2-carboxylic acid hydrazide); 10µg/ml: positive, TCH resistant (unlike M.bovis)

•Growth on pyrazinamidase agar (PZA); 25µg/ml: negative

•The arylsulfatase test (3-Day test): negative