Mycobacterium kansasii

Mycobacteria such as Mycobacterium tuberculosis, Mycobacterium avium, Myco-bac-terium leprae, Mycobacterium kansasii, Mycobacterium fortuitum-M, Mycobacterium chelonae, and a few others are pathogenic organisms that cause very serious diseases in humans. The characteristic feature of mycobacteria is their high content of lipids (about 40% of their mass), and they are primarily located on the outer bacterial membrane. 

Rifampicin is highly active against Mycobacterium tuberculosis. Among atypical mycobacteria, it is active against Mycobacterium kansasii, Mycobacterium marinum, and most types of Mycobacterium scrofulaceum and Mycobacterium xenopi. Sensitivity of other mycobacteria varies. Rifampicin also exhibits activity against Mycobacterium leprae. 

Capreomycin has a pronounced suppressive effect against Mycobacterium tuberculosis and Mycobacterium bovis. Most strains of Mycobacterium kansasii are also sensitive to kanamycin, while other, nontuberculous strains are not sensitive to it. It is often used upon necessity of using parentemal therapy through deep intramuscular injections. Capreomycin is less toxic than kanamycin and has somewhat more of a bacteriostatic effect. Synonyms of this drug are capromycin, capastat, ogostal, and others. 

Increasingly the existence of multiresistant strains is reported, especially in the United States but also elsewhere. Also the occurrence of infections with difficult to treat, so called atypical mycobacteria like Mycobacterium avium intracellulare and Mycobacterium kansasii is on the rise. These infections are especially seen in patients with a compromised immune system. In vitro these atypical mycobacteria often show resistance against first-choice drugs. However this in vitro lack of sensitivity does not always correspond with in vivo responses. 

The mechanism of action and other pharmacologic features of streptomycin are discussed in Chapter 45. The typical adult dose is 1 g/d (15 mg/kg/d). If the creatinine clearance is less than 30 mL/min or the patient is on hemodialysis, the dose is 15 mg/kg two or three times per week. Most tubercle bacilli are inhibited by streptomycin, 1-10 mcg/mL, in vitro. Nontuberculosis species of mycobacteria other than Mycobacterium avium complex (MAC) and Mycobacterium kansasii are... 

The derivatives 3-<9-methyl-D-olivose (D-oleandrose, 3-<9-methyl-2,6-dideoxy-D-arabino-hexose), and 3-0-methyl-D-oliose (3-<9-methyl-2,6-dideoxy-D-/yvo-hexose) are components of steroidal glycosides obtained from Cynanchum othophyllum Schneid, a traditional Chinese medicine.148 A derivative 4-O-me-thyl-D-olivose has been identified as the terminal sugar of the tetrasaccharide moiety in the phenolic glycolipid of Mycobacterium kansasii.149... 

M. Gilleron, A. Venisse, J. J. Foumie, M. Riviere, M. A. Dupont, N. Gas, and G. Puzo, Structural and immunological properties of the phenolic glycolipids from Mycobacterium gastri and Mycobacterium kansasii, Eur. J. Biochem., 189 (1990) 167-173. 

Peyron P, Bordier C, N Diaye EN et al. Nonopsonic phagocytosis of Mycobacterium kansasii by human neutrophils depends on cholesterol and is mediated by CR3 associated with glycosylphosphatidylinositol-anchored proteins.) Immunol 2000 165(9) 5186-5191. 

A 35-year old Caucasian man with AIDS and multiple opportunistic infections, including Mycobacterium kansasii and Mycobacterium avium complex (MAC) disease developed moderate to severe primary sensorineural hearing loss after 4—5 months of therapy with oral azithromycin 500 mg/day. Other medications included ethambutol, isoniazid, rifabutin, ciprofloxacin, co-trimoxazole, fluconazole, zidovudine (later switched to stavudine), lamivudine, indinavir, methadone, mod-ified-release oral morphine, pseudoephedrine, diphenhydramine, megestrol acetate, trazodone, sorbitol, salbutamol by metered-dose inhaler and nebulizer, ipratropium, and oral morphine solution as needed. Significant improvement of the hearing impairment was documented 3 weeks after drug withdrawal. 

Ethambutol is tuberculostatic and acts against Mycobacterium tuberculosis and Mycobacterium kansasii as well as some strains of Mycobacterium avium complex. It has no effect on other bacteria. The sensitivities of non-tuberculous mycobacteria are variable. Ethambutol suppresses the growth of most isoniazid-resistant and streptomycin-resistant tubercle bacilli (1). 

Isoniazid is the hydrazide of isonicotinic acid. It is a first-line drug for therapy and prophylaxis of tuberculosis. It is bactericidal for rapidly dividing mycobacteria, but bacteriostatic for resting bacilli . Among non-tuberculous mycobacteria, only a few strains, such as Mycobacterium kansasii, are susceptible. As a rule, sensitivity should always be tested in vitro, since the minimum inhibitory concentration varies greatly. 

Wallace, P.A., andD.E. Minnikin, Synthesis of Racemic 2,4-Dimethyltetradecanoic Acid from. Mycobacterium kansasii, Chem. Phys. Lipids 82 141—146 (1996). 

Both were powerful a-mannosidase and B-gluco-A novel aminosugar, N-acyl-kanoscunine, has been Isolated from the antigenic llpo-oligosaccharlde of Mycobacterium kansasii and proposed to be, 6-dldeoxy-2-0-methyl-... 

Residue present in lipooligopolysacchar-ides of Mycobacterium kansasii. 

Present in the tetrasaccharide group of Mycobacterium kansasii glycolipid. 

A 75-year-old woman developed progressively worse peripheral vision in both eyes after taking ethambutol 1200 mg/day for almost 1 year, plus clarithromycin and rifampicin for infection with Mycobacterium avium complex and Mycobacterium kansasii. Best corrected visual acuity was 20/80— in the right eye and 20/60-1-in the left eye. Eye movements were full. Slit lamp exam showed -1-1 nuclear sclerosis in both eyes. On fundoscopy the optic discs were not swollen or pale. A 30-2 Humphrey visual field showed bitemporal hemianopia. An MRI scan of the brain was normal, as was optical coherence tomography. 

Malkin J, Shiimpton A, Wiselka M, Barer MR, Duddridge M, Pereta N. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behget s disease. J Med Microbiol 2009 58(3) 371-3. 

Another synthesis of methyl 2,6-dideoxy 4-Q-methyl-a-D-arabino-hexopvranoside (17) fc.f.. ref. 17), this time from di-Q-acetyl-6-deoxy-D-glucal (45) (Scheme 9), confirmed the identity of the sugar at the non-reducing terminus of the tetrasaccharide moiety in the major phenol glycolipid of Mycobacterium kansasii. 

Hunter, S.W., T. Fujiwara, R.C. Murphy, and P.J. Brennan N-Acyl Kansosamine. A Novel Acylamino Sugar from the Trehalose-Containing Lipooligosaccharide Antigens of Mycobacterium Kansasii. J. Biol. Chem. 259, 9729 (1984). 

Crespo et a/. [18]. Mycobacterium avium and Mycobacterium kansasii, and a non-pathogenic fast growing species, Mycobacterium smegmatis, in Middlebrook M7H9 culturing media were followed online. To aid in the identification volatiles were collected in Tenax tubes and analysed with a gas chromatograph equipped with a flame photometric detector. Identification of VOCs was also based on isotopic ratios and CID results. 

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