Chapter 12 : Mycobacteria

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In general terms, the mycobacteria are divided into the complex (MTBC) and the nontuberculous mycobacteria (NTM). NTM immune reconstitution syndrome (IRS), in contrast, may be seen in HIV-infected patients with no previous history of mycobacterial disease, apparently representing an unmasking of subclinical disease in these cases. The most frequently isolated pathogens were rapidly growing mycobacteria, followed by and , for kidney transplant recipients; , complex (MAC), and for heart recipients; MAC, M, and for lung recipients; and MAC for liver transplant recipients. Historically, mycobacteria have been detected and identified by using the conventional methods of acid-fast bacilli (AFB) smear and culture. Specimens are digested and decontaminated using a sodium hydroxide and N-acetyl-L-cysteine method to prepare a concentrated sediment. This sediment can then be used to prepare smears for microscopy and to inoculate media for recovery of mycobacterial growth. The niacin test is one that provides information to separate from other mycobacteria: produces detectable amounts of niacin, while most NTM and do not. Fluorochrome stains are more sensitive than carbol-fuchsin stains, and broth-based culture systems are more sensitive than solid media for isolation of mycobacteria. Clinical equipment (e.g., bronchoscopes) may become contaminated by mycobacteria and then inadequately high-level disinfected or sterilized, causing contamination of specimens from subsequent patients examined with the same instrument or transmission of tuberculosis.

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12
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Figure 1.

Algorithm for AFB testing.

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12
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Table 1.

Phenotypic characteristics of selected mycobacteria

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12
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Table 2.

Phenotypic groupings of mycobacteria

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12
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Table 3.

Comparison of conventional and newer mycobacterial test methods

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12
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Table 4.

Suggested turnaround times for mycobacteriology laboratory tests

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12
Generic image for table
Table 5.

Primary and secondary drugs for susceptibility testing of mycobacteria

Citation: Warren N, Woods G. 2009. Mycobacteria, p 253-267. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch12

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