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Mycobacteria are aerobic, acid-fast bacilli (rods) (Figure 21–1). They are neither gram positive nor gram negative (i.e., they are stained poorly by the dyes used in Gram stain). They are virtually the only bacteria that are acid-fast. (One exception is Nocardia asteroides, the major cause of nocardiosis, which is also acid-fast.)


Mycobacterium tuberculosis—acid-fast stain. Long red rods of M. tuberculosis are seen on a blue background. (Used with permission from Dr. George Kubica, Public Health Image Library, Centers for Disease Control and Prevention.)

The term acid-fast refers to an organism’s ability to retain the carbol fuchsin stain despite subsequent treatment with an ethanol–hydrochloric acid mixture. The high lipid content (approximately 60%) of their cell wall makes mycobacteria acid-fast.

The major pathogens are Mycobacterium tuberculosis, the cause of tuberculosis, and Mycobacterium leprae, the cause of leprosy. Atypical mycobacteria, such as Mycobacterium avium-intracellulare complex (MAI, MAC) and Mycobacterium kansasii, can cause tuberculosis-like disease but are less frequent pathogens. Rapidly growing mycobacteria, such as Mycobacterium chelonae, occasionally cause human disease in immunocompromised patients or those in whom prosthetic devices have been implanted (Table 21–1). The clinical features of three important mycobacteria are described in Table 21–2.

TABLE 21–1Medically Important Mycobacteria
TABLE 21–2Clinical Features of Important Mycobacteria

Additional information regarding the clinical aspects of infections caused by the organisms in this chapter is provided in Part IX, entitled Infectious Diseases.



This organism causes tuberculosis. Worldwide, M. tuberculosis causes more deaths than any other single microbial agent. Approximately one-third of the world’s population is infected with this organism. Each year, it is estimated that 1.7 million people die of tuberculosis and that 9 million new cases occur. An estimated 500,000 people are infected with a multidrug-resistant strain of M. tuberculosis...

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