Lecturer 2

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mycobacaterium
Aerobic, non-spore, non-motile, positive to
acid fast stain,
M.bovis transmitted from milk of diseased
cow causes intestinal lesions
M.tuberculosis transmitted 2ru inhalation
of infected droplets
Unique xters;
Cord factor
Lipoarabinomanam
Complement activated on the sugar of
the mycobacterium

 Primary infection
Inhalation T-cell mediated immunity that leads to
type IV hypersensitivity phagocytosed by
macrophages multiplies in macrophages and
lymph nodes disseminates to other body parts
through the blood after a few weeks the immune
system develops positive purified protein derivative
test reactions develops

Secondary infection
This happens probably due to the host is susceptible
or the strain is particularly virulent
Specials features include gaseous necrosis and
cavities
The ultimate residue of the primary infection is the
Ghon complex

Can be cultured in Lowenstein-Jensen medium

Histoplasmosis
It is caused by the fungus Histoplasma
capsulatum
Infection is acquired by inhalation of
microconidia in dust
Clinical presentation
Self limited and often latent primary pulmonary
droplet
Chronic progressive localized lung disease which
causes fever, cough and night sweat
Localized lesion in extra pulmonary site
Widely disseminate

It causes delayed type of hypersensitivity

It is dimorphic

 Pathogenesis
Yeast bind to the beta chain of the Cr3 receptor of the
complement pathway
Phagocytized by the macrophages
Multiply within the phagolyzosome and lyse the host cell
Infection controlled by helper T-cells (secrets interferon
lambda and active macrophages)
The macrophages secrets TNF-alpha which stimulates other
macrophages to kill histoplasma
In otherwise healthy adult,
histoplasma infection produce epitheloid cell granuloma
It undergoes coagulative necrosis
Coalesce to produce large areas of consolidation
May liquefy to from cavity

Diagnosis
swab is taken from the sputum
The yeast is 2-5microns
Can be stained with methenamine silver

Coccidiodomycosis
Histoplasmosis and coccidiodomycosis are always
discussed together for the following reasons
Both are granulomatous disease of the lung that may resemble TB
Both are caused by fungi that are thermally dimorphic in that they grow as
hyphae that produce spores at environmental temperature but grow as yeast at
body temperature within the lung
Each are geographically located

Acquired by inhalation of spores of coccidiodes immitis

It develops delayed type hypersensitivity in the body
The infective form is arthroconidia
Prevents phagocytosis by blocking the fusion of the
phagosome and lyzosome and so resist intracellular
killing
Can be cultured in saboround agar

Cryptococcosis
Cryptococcus neoformans is encapsulated yeast that can
cause meningo encyphalitis especially in immunocompromised
individuals
Found among patients with AIDS
C.neoformans present in soil and in birds (esp pigeons)
droppings
The portal of entry is the respiratory tract
Virulence of C.neoformans
Capsular polysaccharide
Resistance to killing by alveolar macrophages
Production of phenol oxidase

C.neoformans infects the brain because the CSF lacks the

alternative pathway complement component that binds to the
carbohydrate capsule and phagocytize and killing by
polymorph nuclear cells

Hepatitis A

Structure and classification

Small non-enveloped, single stranded RNA virus

Resistant to ether, to heating at 60C for 1hour and
to pH <3
Inactivated by formalin

Pathogenesis

Food ingestion
Infects and multiplies in the intestinal epithelium
Spread through the blood stream to the liver
Beginning as early as 10-14days virus is shed
copiously in faeces
It ceases at about time jaundice develops

Epidemiology
Faecal-oral route
Epidemics are encouraged by conditions of
overcrowding and poor sanitation

Diagnosis
Serological tools are used such as immunoelectron

Hepatitis B
Structure and classification
Hepadnaviridae family
Has an envelope of an icosahedral core particles

3 serological marker are detectable in the blood of patient with HB

HB surface antigen (HBsAg)
HB core antigen (HBcAg)
Soluble core antigen (HBeAg)

There are atleast 10 subtypes

HBsAg carries a common group of specific determinant (a)
2 mutually exclusive sub determinant d or y and w or r
Adw, adr, ayw, ayr,

Transmitted parenterally and through various body fluid

Factors that correlate with chronic disease include anicteric, mild
infection, long incubation period, immunosupression, genetic
predisposition and infection early in childhood