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Flashcards in Mycobacterium Pathogenesis Deck (83):
1

What is the mechanism underlying granuloma formation?

resistance to microbicidal effects of a type 1 response results in chronic low level infection that requires an ongoing Th1 response to prevent pathogen proliferation and spread.

2

What is the characteristic feature of granulomas?

fusion of several macrophages to form multinucleated giant cells

3

Where are multinucleated giant cells found in the granuloma?

border of the central focus of macrophages and lympphcytes which surround them

4

Waht are type 1 cells?

NK cells ICL1 and Th1 cells

5

What are teh 3 general strategies for intracellular suvirval?

blockade of phagosome-lysosome fusion; escape from the phagosome into the cytosol and resistance for killing mechanisms within thep hagolysosome

6

What is tuberculin?

complex extract of peptides and carbohydrates derived from M.tuberculosis

7

Who gets a positive mantoux test?

those who have had BCG or have been infected by M.tb

8

What response causes a reaction with the mantoux test?

Th1 effector response- delayed type hypersensitivty reaction

9

What species make up the M.tb complex?

M.tb; M.africanuum and M.cannetti; M.bovis and M.microti

10

What does M. microti target?

small vertebrates

11

Which continent has all strains of M.tb and how does this relate to theories abotu the history of TB?

Africa- lines up with theory that TB evolved and spread with huams n

12

What is a problem with M.tb strains and research?

mainly made of Euro-American strains which does not reflect the global strain prevalence

13

What are teh 2 tests for determining latent TB?

TST and IGRA (immunoglobulin gamma release assay)

14

How is TB transmitted?

airborne

15

What is thought to vast amount of people who are connected with TB?

eliminate using their innate immune repsonse- will be completely in all testing as no T cell priming

16

What is multidrug resistant TB defined as?

resistance to at least isoniazid and rifampicin

17

What is XDR-TB defined as?

resistance to isoniazid and rifampicin; fluoroquinolone and any of the 3 injectable second line aminoglycosides

18

When is latent TB defined as being subclinical?

once there is positive culture or sputum smear- can transmit

19

What region of the genome is different between TB and BCG?

RD1

20

What does RD1 encode?

ESX-1 secretion system

21

what is the function of ESX-1?

once the bacteria have eben internalised in a phagosome by the host macropahges, ESX-1 mediates the delivery of bacterial productsi n to hte macropahge cytoplasm

22

What are the 2 broad outcomes of exposure to M.tb?

elimination or persistence of the pathogen

23

Why does a positive TST or IGRA not automatically mean a patient will benefit from LTBI treatment?

some individuals who sliminate the infection via the adaptive immune repsonse may have a positive test depending on whether they primed their T cells responses

24

What are the dominant cell type that M.tb infects?

alveolar macrophages

25

How do alveolar macropahges internalise M.tb?

receptor-mediated phagocytosis

26

What is the effect of surfactant D in M.tb phagocytosis?

can prevent it

27

What happens if the alveolar macrophages are no able to eliminate the bacteria?

bacteria invades the lung interstital tissue by direct infection fo the epithelium or the alveolar macropahges infected with M.tb migrating the lung parenchyma

28

What is one reason that M.tb uses the ESX-1 secretion system to inject bacterial products into the cytosol?

activation of cytosolic surveillance pathway resulting in a type I IFN response can help promote grwoth of intracellular bacterial pathogens

29

How is there georgraphical segreation in a grnuloma?

centre contains pro-inflammatory components whilst the surrounding tissue has anti-inflammatory ones

30

What suggests that other T-cell independet immune responses are involved in susceptibility to TB in HIV?

some studies indicate the risk of active TB disease is enhanced during hte early stage of HIV infection- when the number of CD4 cells is normal

31

Why is it unclear whether enhanced T cell repsonses give better protection?

in mice, increasing the total CD4 T cell responses lead to reduced protectio nand enahnced mortality

32

What suggests that M.tb might benefit from antigen-specfici CD4 T cell activation?

genomic studies of genes involved in the production of immunodominant CD4 T cell antigens do not vary across strains and lineages

33

How does M.tb develop drug ressitance?

through genetic mutations- not natural transformation

34

What are the 2 main mechanisms of M.tb drug resistance?

target modification; defective enzyme that converts a pro-drug into an active drug

35

What are the 2 tests available for identification of LTBI?

TST and the IGRA

36

What is the benefit of IGRA over TST?

IGRA can distinguish between BCG-induced and M.tb infection induced postiive TST

37

How is TST perfomed?

intradermal infection of 5 tuberculin units of purified protein derivative

38

What are the disadvantages of TST?

specificity is compromised by BCG vaccination and exposure to non-tuberculous mycobacteria; limited predictive value- most individuals with positive TST do not progress to active TB

39

How is IGRA carried out?

in vitro blood test of cell-mediated immune response- measure T cell release of IFNy following stimulation by RD1-encoded antigens

40

Why are RD1 antigens more specigic for M.tb than PPD antigens?

they are not encoded in the genome of any BCG vaccine strains or most species of non-tuberculous mycobacteria

41

What are the 4 main technologies for detection of active TB disease?

imaging-CXR and PET-CT; microscopy of sputum; culture based methodsl moelcualr tests

42

What is LAM rapid test?

detection of lipoarabinomannan antigen in urine

43

When should LAM rapid test be used?

HIB positive adults with signs of active TB with <100 CD4 or very ill HIV patients (specificity and sensitivity is highest in these patients)

44

What does the Xpert TB/Rif assay detect?

detect mycobacterium tb complex and ressitance to rifampicin

45

How does Xpert MTB/RIF assay work?

nucelic acid amplification system test using sputum

46

Why is sputum smear microscopy difficult in children?

young children are unable to produce sputum; disease may be extrapulmonary and low numbers of bacilli in children with TB

47

What are the methods of detection of drug resistance?

phenotypic; culture-based (ability of bacteria to grow in presence of anti-TB drugs); moeclular based (detection of genetic mutations)

48

What is the efficacy of BCG vaccine against pulmonary TB in adults?

0-80%

49

What is the effect of BCG vaccine in children?

infants and 5 years protects from severe, extrapulmonary forms of active TB disease-- 50-80%

50

What is the most common drug to be resistant to in TB?

isoniazid

51

What is the lifetime risk of latent TB converting to active TB?

10%

52

What happens when bacteria are phagocytosed by alveolar macrophages?

pro-inflammatory response; recruit mononuclear cells; buidling blocks for granuloma

53

What is the caseum?

area rich in lipis and debris from necrotic macropahges

54

What is foudn between the macropahges and lymphocytes in the granuloma?

fibrotic region with ECM and fibroblasts

55

What happens when there is breakdown of the granuloma?

stimatulion of mycobacterial growth and then release of large numbers of bacteria

56

What is recruited to the phagosome to reduce the pH?

V-H ATPase

57

What are the features of live BCG phagosomes?

limited acidication-reduced V-ATPase; contain early endosome markers- Rab5 and 14 (blocking lysosome fusion)

58

What are the 3 strategies for mycobacterial arrest of phagosome maturation?

interactiosn with surface receptors; modification of phagosomal lumen; modification of phagosomal membrane

59

What is the effect of CR3 uptake of Mtb?

prevents respiratory burst; blocks phagosome maturation

60

What does uptake of Mtb by TLR2 stimualte?

IL-12 and iNOS

61

How does Mtb modify the phagosomal lumen?

secreted acid phosphatase; lipoarabinomannan; protein kinase G

62

What is the effect of secreted acid phosphatase?

cleaves PI 3-kinase and blocks phagosome-late endosome fusion (PIP3 is essential for phagolysosome biosynthesis)

63

What is the effect of lipoarabinomannan?

inactivates macrophages; scavenges oxidative radicals

64

What is the effect of protein kinase G
?

protein kinase G- blocks delivery of mycobacteria to lysosome

65

What happens when AX20017 is used to block protein kinase G?

M.tb are found in the lysosome

66

How does M.tb modify the phagosomal membrane?

mycobacterial lipids/proteins traffic out of immature phagosome

67

What proteins are invovled in trafficing mycobacterial lipids/proteins out of immature phagosome?

PDIM and PIM (pthiocerol dimycocerasat and phosphatidylinositol mannosides)

68

What do lipids released in to vacuole accumulate in?

multilamellar bodies which are released by exocytosis

69

What happens to the exosomes with lipids from M.tb?

internalised by neighbouring cells

70

Why is treatment difficult and prolonged?

cell wall; slow replication time; intra-cellular niche

71

Which TB drug is classed as bactericidal and target rapidly dividing bacilli?

isoniazid

72

Which TB drugs are considered sterilising drugs killing persistent, nonreplicating organisms?

rifampicin and pyrazinamide

73

What is antibiotic tolerance?

reduced susceptibility to killing by cell wall-active antibiotics- feature of persistent bacilli and LTBI- rate of bacterial killing is proportional to the rate of bacterial replication and metabolic activity

74

What is dormancy?

bacteria are viable but exhibit reduced metabolic activity

75

Waht is LTBI traditionally thought of?

population of nonreplicating, metabolically quiescent organisms that have entered a dormant state as an adaptive response to immune-based containment mechanisms

76

What suggests that the classical definition of LTBI of dormancy is incorrect?

isoniazid can prevent reactivation disease indicates that some portion of bacilli are sporadically multiplying

77

How is the population of LTBI considered?

heterogenous bacillary population with some more rapidly replicating and some which are metabolically quiescent

78

How do LTBI arise?

6-8 weeks after infection, granulomas undergo necrosis killing the majority of tubercle bacilli and destruction of host tissue with the small proportion of bacilli surviving in an altered state- LTBI

79

What suggests the importance of CD4 T cells in anti-TB immunity?

knock out mice have a much greater increase in bacillary numbers and death rate ; also prevent reactivation as depletion 6 months after infection results in rapid reactivation

80

What suggests that the role of CD4 cells in their protection is independent of IFNy and macropahge activation?

CD4 depletion did not result in diminshed expression of IFny or iNOS activity

81

What suggests that protein kinase G is important in Mycobacterial pathogenicitiyu?

it is the only soluble kinase maintained in all pathogenic mycobacteria including mycobacterium leprae- which is considered to have the minimal genes required for pathogenicity- without tey show attenuated phenotype, cannot resist lysosomal transfer and are rapidly degraded

82

How is protein kinase G thought to work?

phosphorylates a host molecule therby preventing the actiivty of the host factor in carrying out phagosome-lysosome fusion

83

Why is protein kinase G an attractive target for inhibition?

this wouldn't be interfering with mycoabcterial physiology but allowing macrophage to carry out its innate antimicrobail activity; its secreted so drug does not need to get through teh impermeable mycobacterial cell wall