See below.
Mycobacterium is a genus In biology, a genus is a low-level taxonomic rank (a taxon) used in the classification of living and fossil organisms, which is an example of definition by genus and differentia. The term comes from Latin genus "descent, family, type, gender", cognate with Greek: γένος – genos, "race, stock, kin" of Actinobacteria Actinobacteria are a group of Gram-positive bacteria with high G+C ratio. They can be terrestrial or aquatic, given its own family, the Mycobacteriaceae. The genus includes pathogens A pathogen, (from Greek πάθος pathos "suffering, passion", and γἰγνομαι gignomai (gen-) "I give birth to") an infectious agent, or more commonly germ, is a biological agent that causes disease to its host. There are several substrates and pathways whereby pathogens can invade a host; the principal pathways have known to cause serious diseases in mammals, including tuberculosis Tuberculosis or TB is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in(Tuberculae Basillus/Mycobacterium Tuberculae) and leprosy Leprosy or Hansen's disease , named after physician Gerhard Armauer Hansen, is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external sign. Left untreated, (Leprae Basillus/Mycobacterium Leprae).[1] The Latin Latin or sometimes Roman is an Italic language originally spoken in Latium and Ancient Rome. Although often considered a dead language, in view of the fact that it has no native, fluent speakers, Latin continues to be taught in schools and has been, and currently is, used in the process of new word production in modern languages from many prefix "myco—" means both fungus and wax; its use here could be related to the "waxy" compounds that compose parts of the cell wall A cell wall is a tough, usually flexible but sometimes fairly rigid layer that surrounds some types of cells. It is located outside the cell membrane and provides these cells with structural support and protection, and also acts as a filtering mechanism. A major function of the cell wall is to act as a pressure vessel, preventing over-expansion (see Discussion for details)'.
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Microbiologic characteristics
Mycobacterial cell wall A cell wall is a tough, usually flexible but sometimes fairly rigid layer that surrounds some types of cells. It is located outside the cell membrane and provides these cells with structural support and protection, and also acts as a filtering mechanism. A major function of the cell wall is to act as a pressure vessel, preventing over-expansion: 1-outer lipids, 2-mycolic acid Mycolic acids are long fatty acids found in the cell walls of the mycolata taxon, a group of bacteria that includes Mycobacterium tuberculosis, the causative agent of the disease tuberculosis. They form the major component of the cell wall of mycolata species. Despite their name, mycolic acids have no biological link to fungi; the name arises from, 3-polysaccharides Polysaccharides are polymeric carbohydrate structures, formed of repeating units joined together by glycosidic bonds. These structures are often linear, but may contain various degrees of branching. Polysaccharides are often quite heterogeneous, containing slight modifications of the repeating unit. Depending on the structure, these macromolecules (arabinogalactan), 4-peptidoglycan Peptidoglycan, also known as murein, is a polymer consisting of sugars and amino acids that forms a mesh-like layer outside the plasma membrane of bacteria , forming the cell wall. The sugar component consists of alternating residues of β-(1,4) linked N-acetylglucosamine and N-acetylmuramic acid. Attached to the N-acetylmuramic acid is a peptide, 5-plasma membrane The cell membrane is one biological membrane separating the interior of a cell from the outside environment, 6-lipoarabinomannan (LAM), 7-phosphatidylinositol mannoside, 8-cell wall skeletonMycobacteria are aerobic A good example would be the oxidation of glucose in aerobic respiration and nonmotile bacteria (except for the species Mycobacterium marinum, which has been shown to be motile within macrophages Macrophages are white blood cells within tissues, produced by the differentiation of monocytes. Human macrophages are about 21 micrometres (0.00083 in) in diameter. Monocytes and macrophages are phagocytes, acting in both non-specific defense (innate immunity) as well as to help initiate specific defense mechanisms (adaptive immunity) of) that are characteristically acid-alcohol fast Acid-fastness is a physical property of some bacteria referring to their resistance to decolorization by acids during staining procedures.[1] Mycobacteria do not contain endospores An endospore is a dormant, tough, and non-reproductive structure produced by certain bacteria from the Firmicute phylum. The name "endospore" is suggestive of a spore or seedlike form , but it's not a true spore (not an offspring). It's a kind of stripped-down, dormancy form that the bacterium can reduce itself to. The endospore becomes or capsules The cell capsule is a very large structure of some prokaryotic cells, such as bacterial cells. It is a layer that lies outside the cell wall of bacteria. It is a well organized layer, not easily washed off, and it can be the cause of various diseases and are usually considered Gram-positive Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain and appearing red or pink. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of. A recent paper in PNAS showed sporulation in Mycobacterium marinum and perhaps in M. bovis [2]. However, this has been strongly argued by other scientists [3]. While mycobacteria do not seem to fit the Gram-positive category from an empirical The word empirical denotes information gained by means of observation, experience, or experiment. A central concept in science and the scientific method is that all evidence must be empirical, or empirically based, that is, dependent on evidence or consequences that are observable by the senses. It is usually differentiated from the philosophic standpoint (i.e. they generally do not retain the crystal violet Methyl violet is the name given to a group of similar chemicals used as pH indicators and dyes. Depending on the amount of attached methyl groups, the color of the dye can be altered. Its main use is as a purple dye for textiles and to give deep violet colors in paint and ink stain well), they are classified as an acid-fast Gram-positive bacterium due to their lack of an outer cell membrane The cell membrane is one biological membrane separating the interior of a cell from the outside environment. All Mycobacterium species share a characteristic cell wall A cell wall is a tough, usually flexible but sometimes fairly rigid layer that surrounds some types of cells. It is located outside the cell membrane and provides these cells with structural support and protection, and also acts as a filtering mechanism. A major function of the cell wall is to act as a pressure vessel, preventing over-expansion, thicker than in many other bacteria, which is hydrophobic In chemistry, hydrophobicity is the physical property of a molecule (known as a hydrophobe) that is repelled from a mass of water, waxy, and rich in mycolic acids/mycolates. The cell wall consists of the hydrophobic mycolate layer and a peptidoglycan Peptidoglycan, also known as murein, is a polymer consisting of sugars and amino acids that forms a mesh-like layer outside the plasma membrane of bacteria , forming the cell wall. The sugar component consists of alternating residues of β-(1,4) linked N-acetylglucosamine and N-acetylmuramic acid. Attached to the N-acetylmuramic acid is a peptide layer held together by a polysaccharide, arabinogalactan. The cell wall makes a substantial contribution to the hardiness of this genus. The biosynthetic pathways of cell wall components are potential targets for new drugs for tuberculosis.[4]
Many Mycobacterium species adapt readily to growth on very simple substrates In biology a substrate is the surface a plant or animal lives upon. The substrate can include biotic or abiotic materials. For example, encrusting algae that lives on a rock can be substrate for another animal that lives on top of the algae. See also substrate, using ammonia Ammonia is a compound of nitrogen and hydrogen with the formula NH3. It is a colourless gas with a characteristic pungent odour. Ammonia contributes significantly to the nutritional needs of terrestrial organisms by serving as a precursor to food and fertilizers. Ammonia, either directly or indirectly, is also a building block for the synthesis of or amino acids Amino acids are molecules containing an amine group, a carboxylic acid group and a side chain that varies between different amino acids. These molecules contain the key elements of carbon, hydrogen, oxygen, and nitrogen. These molecules are particularly important in biochemistry, where this term refers to alpha-amino acids with the general formula as nitrogen sources and glycerol Glycerol is an organic compound, also called glycerin or glycerine. It is a colorless, odorless, viscous liquid that is widely used in pharmaceutical formulations. Glycerol has three hydrophilic hydroxyl groups that are responsible for its solubility in water and its hygroscopic nature. The glycerol substructure is a central component of many as a carbon source in the presence of mineral salts. Optimum growth temperatures vary widely according to the species and range from 25 °C to over 50 °C.
Some species can be very difficult to culture A microbiological culture, or microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory conditions. Microbial cultures are used to determine the type of organism, its abundance in the sample being tested, or both. It is one of the primary diagnostic (i.e. they are fastidious), sometimes taking over two years to develop in culture.[citation needed] Further, some species also have extremely long reproductive cycles — M. leprae, may take more than 20 days to proceed through one division cycle (for comparison, some E. coli Escherichia coli is a Gram negative rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms (endotherms). Most E. coli strains are harmless, but some, such as serotype O157:H7, can cause serious food poisoning in humans, and are occasionally responsible for product recalls. The harmless strains are part of the strains take only 20 minutes), making laboratory culture a slow process.[1] In addition, the availability of genetic manipulation techniques still lags far behind that of other bacterial species.[5]
A natural division occurs between slowly– and rapidly–growing species. Mycobacteria that form colonies clearly visible to the naked eye within seven days on subculture are termed rapid growers, while those requiring longer periods are termed slow growers. Mycobacteria cells are straight or slightly curved rods between 0.2-0.6 µm wide by 1.0-10 µm long.
Pigmentation
Some mycobacteria produce carotenoid Carotenoids are tetraterpenoid organic pigments that are naturally occurring in the chloroplasts and chromoplasts of plants and some other photosynthetic organisms like algae, some types of fungus some bacteria and at least one species of aphid. Carotenoids are generally not manufactured by species in the animal kingdom, although one species of pigments without light. Others require photoactivation for pigment production.
- Photochromogens (Group I)
- Produce nonpigmented colonies when grown in the dark and pigmented colonies only after exposure to light and reincubation.
- Ex: M. kansasii, M. marinum, M. simiae.
- Scotochromogens (Group II)
- Produce deep yellow to orange colonies when grown in the presence of either the light or dark.
- Ex: M. scrofulaceum, M. gordonae, M. xenopi, M. szulgai.
- Non-chromogens (Groups III & IV)
- Nonpigmented in the light and dark or have only a pale yellow, buff or tan pigment that does not intensify after light exposure.
- Ex: M. tuberculosis, M. avium-intra-cellulare, M. bovis, M. ulcerans
- Ex: M. fortuitum, M. chelonae
Staining characteristics
Mycobacteria are classical acid-fast Acid-fastness is a physical property of some bacteria referring to their resistance to decolorization by acids during staining procedures organisms.[6] Stains used in evaluation of tissue specimens or microbiological specimens include Fite's stain, Ziehl-Neelsen stain The Ziehl-Neelsen stain, also known as the acid-fast stain, was first described by two German doctors; Franz Ziehl , a bacteriologist and Friedrich Neelsen (1854 to 1894), a pathologist. It is a special bacteriological stain used to identify acid-fast organisms, mainly Mycobacteria. Mycobacterium tuberculosis is the most important of this group,, and Kinyoun stain.
Mycobacteria appear phenotypically most closely related to members of Nocardia Nocardia is a genus of weakly-staining Gram-positive, catalase-positive, rod-shaped bacteria. It forms partially acid-fast beaded branching filaments . It has total 85 species. Some species are non pathogenic; some species are pathogenic (nocardiosis). Nocardia are found worldwide in soil that is rich with organic matter. Most Nocardia infections, Rhodococcus and Corynebacterium Corynebacterium is a genus of Gram-positive rod-shaped bacteria. They are widely distributed in nature and are mostly innocuous. Some are useful in industrial settings such as C. glutamicum. Others can cause human disease. C. diphtheriae, for example, is the pathogen responsible for diphtheria.
Ecological characteristics
Mycobacteria are widespread organisms, typically living in water (including tap water Tap water is part of indoor plumbing, which became available in the developed world in the late 19th century and common in the mid-20th century.[dubious – discuss] treated Water purification is the process of removing undesirable chemicals, materials, and biological contaminants from raw water. The goal is to produce water fit for a specific purpose. Most water is purified for human consumption but water purification may also be designed for a variety of other purposes, including meeting the requirements of medical, with chlorine Chlorine (pronounced /ˈklɔəriːn/ KLOR-een, from the Greek word 'χλωρóς' , is the chemical element with atomic number 17 and symbol Cl. It is a halogen, found in the periodic table in group 17 (formerly VII, VIIa, or VIIb). As the chloride ion, which is part of common salt and other compounds, it is abundant in nature and necessary to) and food sources. Some, however, including the tuberculosis and the leprosy organisms, appear to be obligate parasites An obligate parasite is a parasitic organism that cannot live independently of its host and are not found as free-living members of the genus.
Pathogenicity
Mycobacteria can colonize their hosts without the hosts showing any adverse signs. For example, billions of people around the world have asymptomatic infections of M. tuberculosis.
Mycobacterial infections are notoriously difficult to treat. The organisms are hardy due to their cell wall, which is neither truly Gram negative Gram-negative bacteria are those bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color. The test itself is useful in classifying two distinct types of bacteria based on the structural nor positive Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain and appearing red or pink. Gram-positive organisms are able to retain the crystal violet stain because of the high amount of. Additionally, they are naturally resistant to a number of antibiotics In common usage, an antibiotic is a substance or compound that kills bacteria or inhibits their growth. Antibiotics belong to the broader group of antimicrobial compounds, used to treat infections caused by microorganisms, including fungi and protozoa that disrupt cell-wall biosynthesis, such as penicillin Penicillin is a group of antibiotics derived from Penicillium fungi. Penicillin antibiotics are historically significant because they are the first drugs that were effective against many previously serious diseases such as syphilis and Staphylococcus infections. Penicillins are still widely used today, though many types of bacteria are now. Due to their unique cell wall, they can survive long exposure to acids, alkalis, detergents, oxidative bursts, lysis by complement The complement system is a biochemical cascade that helps, or “complements”, the ability of antibodies to clear pathogens from an organism. It is part of the immune system called the innate immune system that is not adaptable and does not change over the course of an individual's lifetime. However, it can be recruited and brought into action, and many antibiotics In common usage, an antibiotic is a substance or compound that kills bacteria or inhibits their growth. Antibiotics belong to the broader group of antimicrobial compounds, used to treat infections caused by microorganisms, including fungi and protozoa. Most mycobacteria are susceptible to the antibiotics clarithromycin Clarithromycin is a macrolide antibiotic used to treat pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia , skin and skin structure infections. In addition, it is sometimes used to treat Legionellosis, Helicobacter pylori, and lyme disease and rifamycin, but antibiotic-resistant strains have emerged.
As with other bacterial pathogens, surface and secreted proteins of M. tuberculosis contribute significantly to the virulence of this organism. There is an increasing list of extracytoplasmic proteins proven to have a function in the virulence of M. tuberculosis.[7]
Medical classification
Mycobacteria can be classified into several major groups for purpose of diagnosis and treatment: M. tuberculosis complex, which can cause tuberculosis Tuberculosis or TB is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in: M. tuberculosis, M. bovis, M. africanum, and M. microti; M. leprae, which causes Hansen's disease Leprosy or Hansen's disease , named after physician Gerhard Armauer Hansen, is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external sign. Left untreated, or leprosy; Nontuberculous mycobacteria Nontuberculous mycobacteria , also known as environmental mycobacteria, atypical mycobacteria and mycobacteria other than tuberculosis (MOTT), are mycobacteria which do not cause tuberculosis or Hansen's disease (also known as leprosy) (NTM) are all the other mycobacteria, which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease, or disseminated disease.
Phenotypic testing
Various phenotypic tests can be used to identify and distinguish different Mycobacteria species and strains.
Phenotypic testing of Mycobacteria
Mycosides
Mycosides are phenolic alcohols (such as phenolphthiocerol) that were shown to be components of mycobacterium glycolipids Glycolipids are carbohydrate-attached lipids. Their role is to provide energy and also serve as markers for cellular recognition that are termed glycosides of phenolphthiocerol dimycocerosate (Smith DW et al., Nature 1960, 186, 887) There are 18 and 20 carbon atoms in mycosides A, and B, respectively.[8]
Species
Phylogenetic Position of the Tubercle Bacilli within the Genus Mycobacterium The blue triangle corresponds to tubercle bacilli sequences that are identical or differing by a single nucleotide. The sequences of the genus Mycobacterium that matched most closely to those of M. tuberculosis were retrieved from the BIBI database (http://pbil.univ-lyon.fr/bibi/) and aligned with those obtained for 17 smooth and MTBC strains. The unrooted neighbor-joining tree is based on 1,325 aligned nucleotide positions of the 16S rRNA gene. The scale gives the pairwise distances after Jukes-Cantor correction. Bootstrap support values higher than 90% are indicated at the nodes.In older systems, mycobacteria are grouped based upon their appearance and rate of growth. However, these are symplesiomorphies, and more recent classification is based upon cladistics.
Slowly growing
Mycobacterium tuberculosis complex
- Mycobacterium tuberculosis complex (MTBC) members are causative agents of human and animal tuberculosis. Species in this complex include:
- M. tuberculosis, the major cause of human tuberculosis
- M. bovis
- M. bovis BCG
- M. africanum
- M. canetti
- M. caprae
- M. microti
- M. pinnipedii
Mycobacterium avium complex
- Mycobacterium avium complex (MAC), is a group of species that, in a disseminated infection but not lung infection, used to be a significant cause of death in AIDS patients. Species in this complex include:
- M. avium
- M. avium paratuberculosis, which has been implicated in Crohn's disease in humans and Johne's disease in cattle and sheep
- M. avium silvaticum
- M. avium "hominissuis"
- M. colombiense
Mycobacterium gordonae clade
Mycobacterium kansasii clade
Mycobacterium nonchromogenicum/terrae clade
Mycolactone-producing mycobacteria
- M. ulcerans, which causes the "Buruli", or "Bairnsdale, ulcer"
- M. pseudoshottsii
- M. shottsii
Mycobacterium simiae clade
- M. triplex
- M. genavense
- M. florentinum
- M. lentiflavum
- M. palustre
- M. kubicae
- M. parascrofulaceum
- M. heidelbergense
- M. interjectum
- M. simiae
Ungrouped
- M. branderi
- M. cookii
- M. celatum
- M. bohemicum
- M. haemophilum
- M. malmoense
- M. szulgai
- M. leprae, which causes leprosy
- M. lepraemurium
- M. lepromatosis, another (less significant) cause of leprosy, described in 2008
- M. africanum
- M. botniense
- M. chimaera
- M. conspicuum
- M. doricum
- M. farcinogenes
- M. heckeshornense
- M. intracellulare
- M. lacus
- M. marinum
- M. monacense
- M. montefiorense
- M. murale
- M. nebraskense
- M. saskatchewanense
- M. scrofulaceum
- M. shimoidei
- M. tusciae
- M. xenopi
Intermediate growth rate
Rapidly growing
Mycobacterium chelonae clade
Mycobacterium fortuitum clade
- M. fortuitum
- M. fortuitum subsp. acetamidolyticum
- M. boenickei
- M. peregrinum
- M. porcinum
- M. senegalense
- M. septicum
- M. neworleansense
- M. houstonense
- M. mucogenicum
- M. mageritense
- M. brisbanense
- M. cosmeticum
Mycobacterium parafortuitum clade
Mycobacterium vaccae clade
CF
Ungrouped
- M. confluentis
- M. flavescens
- M. madagascariense
- M. phlei
- M. smegmatis
- M. thermoresistibile
- M. gadium
- M. komossense
- M. obuense
- M. sphagni
- M. agri
- M. aichiense
- M. alvei
- M. arupense
- M. brumae
- M. canariasense
- M. chubuense
- M. conceptionense
- M. duvalii
- M. elephantis
- M. gilvum
- M. hassiacum
- M. holsaticum
- M. immunogenum
- M. massiliense
- M. moriokaense
- M. psychrotolerans
- M. pyrenivorans
- M. vanbaalenii
- M. pulveris
Ungrouped
- M. arosiense
- M. aubagnense
- M. caprae
- M. chlorophenolicum
- M. fluoroanthenivorans
- M. kumamotonense
- M. novocastrense
- M. parmense
- M. phocaicum
- M. poriferae
- M. rhodesiae
- M. seoulense
- M. tokaiense
References
- ^ a b c Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 0-8385-8529-9.
- ^ Ghosh, Jaydip, Pontus Larsson, Bhupender Singh, B M Fredrik Pettersson, Nurul M Islam, Sailendra Nath Sarkar, Santanu Dasgupta, y Leif A Kirsebom. 2009. Sporulation in mycobacteria. Proceedings of the National Academy of Sciences of the United States of America 106, no. 26 (Junio 30): 10781-10786. http://www.ncbi.nlm.nih.gov/pubmed/19541637
- ^ Traag BA, Driks A, Stragier P, Bitter W, Broussard G, Hatfull G, Chu F, Adams KN, Ramakrishnan L, Losick R.2010. Do mycobacteria produce endospores? Proc Natl Acad Sci U S A. 2010 Jan 12;107(2):878-81.
- ^ Bhamidi S (2009). "Mycobacterial Cell Wall Arabinogalactan". Bacterial Polysaccharides: Current Innovations and Future Trends. Caister Academic Press. ISBN 978-1-904455-45-5.
- ^ Parish T, Brown A (editors) (2009). Mycobacterium: Genomics and Molecular Biology. Caister Academic Press. ISBN 978-1-904455-40-0.
- ^ McMurray DN (1996). "Mycobacteria and Nocardia". in Baron S et al. (eds.). Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1772.
- ^ McCann et al. (2009). "Secreted and Exported Proteins Important to Mycobacterium tuberculosis Pathogenesis". Bacterial Secreted Proteins: Secretory Mechanisms and Role in Pathogenesis. Caister Academic Press. ISBN 978-1-904455-42-4.
- ^ fatty alcohols and aldehydes
Further reading
- Diagnosis and Treatment of Disease Caused by Nontuberculous Mycobacteria (PDF). American Thoracic Society. Am J Respiratory and Critical Care Medicine. Aug 1997 156(2) Part 2 Supplement
- RIDOM: Ribosomal Differentiation of Medical Microorganisms
- J.P. Euzéby: List of Prokaryotic Names with Standing in Nomenclature - Genus Mycobacterium
External links
- Tuberculist: Genome annotation database
- MTB Sysborg: Genome annotation database from the Institute of Genomics and Integrative Biology
- TB Structural Genomics Consortium: Structures of Mycobacterium tuberculosis proteins
- MycDB: Mycobacterium database
- TBDB: Tuberculosis database
- Mycobacterium genomes and related information at PATRIC, a Bioinformatics Resource Center funded by NIAID
- Frequently Asked Questions about NTM Lung Disease
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Categories: Acid fast bacilli | Corynebacterineae | Tuberculosis | Bacteriology | Bacterial diseases | Microbiology
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Tue, 08 Jun 2010 15:14:21 GMT+00:00
tuberculosis antigen ... 7thSpace Interactive (press release) Tuberculosis is a highly infectious disease that is spread from person to person by infected aerosols emitted by patients with respiratory forms of the ...
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Nat Genet. 2010 Jun; 42(6):498-503. Comas I, Chakravartti J, Small PM, Galagan J, Niemann S, Kremer K, Ernst JD, Gagneux S.
Q. What are the signs & symptoms of Mycobacterium leprae?
Asked by sassygirl - Wed Mar 22 20:44:04 2006 - - 1 Answers - 0 Comments
A. articles: symptoms--
Answered by fungusbrains1 - Wed Mar 22 20:44:36 2006
