MYCOBATERIUM TUBERCULOSIS

INFECTIOUS AGENT:
Mycobacterium tuberculosis is a species of pathogenic bacteria in the
family Mycobacteriaceae and the causative agent of tuberculosis. Mycobacterium
tuberculosis is the second most common infectious cause of death in adults worldwide. The
physiology of M. tuberculosis is highly aerobic and requires high levels of oxygen. Primarily a
pathogen of the mammalian respiratory system, it infects the lungs. The most frequently used
diagnostic methods for tuberculosis are the tuberculin skin test, acid-fast stain, culture,
and polymerase chain reaction. Though TB typically attacks the lungs, it can also target the
kidney, spine and brain to a fatal degree. TB progresses very slowly to the extent that it can be
misdiagnosed

RESERVOIR
The only known reservoir for M. tuberculosis is humans. It is spread through the air from
person to person. Someone whose lungs are infected with active TB release it into the air when
coughing or sneezing. The ability of the organism to efficiently establish latent infection has
enabled it to spread to nearly one-third of individuals worldwide. No animal reservoir has been
confirmed, although some cases of bovine TB caused by MTB have been reported (Gidel et al.,
1969; Rey et al., 1986; A. Sanou , Z. Tarnagda, E. Kanyala, D. Zingue´, M. Nouctara, H. Hien, N.
Meda, P. Van de Perre, A. L. Ban˜uls & S. Godreuil)

PORTAL OF EXIT
This is where the microorganism leaves the reservoir. Mycobacterium tuberculosis portal
of exit is through the mouth and nose. When someone with tuberculosis sneezes or coughs, the
release large number of Mycobacterium tuberculosis. Therefore, for the majority of cases, M.
tuberculosis must exit the respiratory tract of the source case, survive the rigors of aerosolization
and desiccation in the outside environment, be inhaled into the lung of the new potential host,
and evade immune defenses to cause new infection

MODE OF TRANSMISSION

M. tuberculosis is carried in airborne particles, called droplet nuclei, of 1– 5 microns in

diameter. Infectious droplet nuclei are generated when persons who have pulmonary or
laryngeal TB disease cough, sneeze, shout, or sing. Depending on the environment, these tiny
particles can remain suspended in the air for several hours. M. tuberculosis is transmitted through
the air, not by surface contact. Transmission occurs when a person inhales droplet nuclei
containing M. tuberculosis, and the droplet nuclei traverse the mouth or nasal passages, upper
respiratory tract, and bronchi to reach the alveoli of the lungs.

Factors that Determine the Probability of M. tuberculosis Transmission There are four factors that
determine the probability of transmission of M. tuberculosis

FACTOR DESCRIPTION
SUSCEPTIBILITY Susceptibility (immune status) of the exposed
individual
 INFECTIOUSNESS Infectiousness of the person with TB disease is
directly related to the number of tubercle
bacilli that he or she expels into the air.
Persons who expel many tubercle bacilli are
more infectious than patients who expel few
or no bacilli
ENVIRONMENT Environmental factors that affect the
concentration of M. tuberculosis organisms
EXPOSURE Proximity, frequency, and duration of
exposure
CLINICAL  Presence of cough, especially lasting
3 weeks or longer
 Respiratory tract disease, especially
with involvement of the larynx (highly
infectious)
 Failure to cover the mouth and nose
when coughing
 Inappropriate or inadequate
treatment (drugs, duration)
PROCEDURE Undergoing cough-inducing or aerosol-
generating procedures (e.g., bronchoscopy,
sputum induction, administration of
aerosolized medications)
RADIOGRAPHC AND LABORATORY  Cavitation on chest radiograph
 Positive culture for M. tuberculosis
 Positive AFB sputum smear result

PORTAL OF ENTRY
Many portals of entry exists from microorganism including the breaks in the skin, mucous
membrane (nose and mouth) and orifices in the body. Tuberculosis’ portal of entry is also the
portal of exit – the human respiratory system. Just as the mycobacterium tuberculosis can be
expelled by sneezing, it can be inhaled through the nose and mouth.
SUSCEPTIBLE HOST
Higher inhaled doses of infectious particles probably more likely result in tuberculosis . A
determinant of inhaled dose is proximity of contact to the source case; individuals sharing a bed
with people with tuberculosis have the greatest risk of becoming infected.

People at high risk for Tuberculosis (TB) exposure and infection include:

 Close contacts of persons exposed to contagious cases of TB

 Foreign-born persons, including children, who have immigrated within the last 5 years from
areas that have a high TB incidence

 Residents and employees of high-risk congregate settings (prisons, nursing homes, homeless
shelters, drug treatment facilities, and healthcare facilities)

 Healthcare workers who serve high-risk clients

 Some medically under served, low-income populations as defined locally

 High-risk racial or ethnic minority populations defined locally as having an increased

prevalence of TB

 Infants, children, and adolescents exposed to adults in high-risk categories

 Persons who inject illicit drugs or any other locally identified high-risk substance users