Audit of scope and culture techniques applied to samples for the diagnosis of Mycobacterium bovis by hospital laboratories in England and Wales

Review on Bovine Tuberculosis: An Emerging Disease Associated with Multidrug-Resistant Mycobacterium Species

Bovine tuberculosis is a serious infectious disease affecting a wide range of domesticated and wild animals, representing a worldwide economic and public health burden. The disease is caused by Mycobacteriumbovis and infrequently by other pathogenic mycobacteria. The problem of bovine tuberculosis is complicated when the infection is associated with multidrug and extensively drug resistant M. bovis. Many techniques are used for early diagnosis of bovine tuberculosis, either being antemortem or postmortem, each with its diagnostic merits as well as limitations. Antemortem techniques depend either on cellular or on humoral immune responses, while postmortem diagnosis depends on adequate visual inspection, palpation, and subsequent diagnostic procedures such as bacterial isolation, characteristic histopathology, and PCR to reach the final diagnosis. Recently, sequencing and bioinformatics tools have gained increasing importance for the diagnosis of bovine tuberculosis, including, but not limited to typing, detection of mutations, phylogenetic analysis, molecular epidemiology, and interactions occurring within the causative mycobacteria. Consequently, the current review includes consideration of bovine tuberculosis as a disease, conventional and recent diagnostic methods, and the emergence of MDR-Mycobacterium species.

Prevalence of Bovine Tuberculosis in Slaughtered Cattle in Sicily, Southern Italy

Simple Summary

Mycobacterium bovis is a Gram-positive, acid-fast bacterium responsible for disease in cattle and in several other domestic and wild animal species, also representing a prominent cause of morbidity and mortality in humans. In Italy, the incidence of bovine tuberculosis (bTB) in cattle has been progressively reduced throughout the years; however, the disease still remains widespread in Southern Italy, with the highest prevalence rates recorded in Sicily. Specific eradication programs have been established, with herd testing and post-mortem inspection at the slaughterhouse used as diagnostic procedures to obtain epidemiological data on bTB prevalence. The concomitant use of these procedures is essential in epidemiological surveillance programs, and although data on disease prevalence at herd level are systematically collected and used for epidemiological surveillance in Sicily, data from post-mortem inspection are scant. Therefore, the current survey aimed to investigate the prevalence of bTB in cattle in Sicily during two different three-year periods, using data from meat inspections and histopathological methods. Results obtained show that even though bTB occurrence in cattle was well reduced over the years, the disease still remains widespread in this region, posing severe implications for public health and a prominent economic impact on the livestock industry.

Abstract

Post-mortem inspection in slaughterhouses plays a key role in the epidemiological surveillance of infectious diseases, including bTB. This study assessed the prevalence of bTB in cattle in Sicily during two different three-year periods (2010–2012; 2017–2019), using data from meat inspections and histopathological methods. Out of 100,196 cattle, 5221 (5.21%) were diagnosed with tuberculous lesions. Higher prevalence of bTB was recorded during the triennium 2010–2012 (6.74%; n = 3692) compared to the triennium 2017–2019 (3.36%; n = 1529), with a decreasing trend in annual occurrence throughout the study period and a heterogenous proportion of infected cattle among the Sicilian provinces (p < 0.01). Lower rates of infection were recorded in animals aged <12 months and >84 months (p < 0.0001). Pearson’s chi square analysis revealed a higher localization of lesions in the thoracic cavity (p < 0.0001). Gathered findings show that even though bTB occurrence in cattle was greatly reduced over the years, the disease still remains widespread in Sicily, also posing severe implications for public health.

Antibacterial and Antimycobacterial Activity of Crude Extracts, Fractions, and Isolated Compounds From Leaves of Sneezewood, Ptaeroxylon obliquum (Rutaceae)

Ptaeroxylon obliquum (Thunb.) Radlk. (Rutaceae) is traditionally used to treat human and animal diseases in South Africa. In this study, the activity of leaf extracts, fractions, and isolated compounds was determined against nonpathogenic mycobacterial species and nosocomial bacterial pathogens. An acetone leaf extract was partitioned by liquid-liquid fractionation, and obliquumol, a mixture of lupeol and β-amyrin, and eranthin were isolated. Antimicrobial activity was determined using a serial microdilution assay against Mycobacterium smegmatis (American Type Culture Collection [ATCC] 1441), M. bovis (BCG P1172), M. aurum (NCTC 10437), M. fortuitum (ATCC 6841), Staphylococcus aureus (ATCC 29213), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 25922), and Escherichia coli (ATCC 27853). The n-hexane fraction had minimal inhibitory concentration (MIC) values as low as 20 and 40 µg/mL against M. fortuitum and S. aureus, respectively. The chloroform fraction also had promising activity with an MIC value of 80 µg/mL against both P. aeruginosa and M. fortuitum. Obliquumol had excellent activity (MIC 8 µg/mL) against M. fortuitum. Fractionation of the crude extract potentiated the antimicrobial activity of the nonpolar fractions. The isolated compound, obliquumol, had good antimicrobial and excellent antimycobacterial activities. The antimicrobial activity provides some scientific rationale for the use of P. obliquum against infectious diseases and related symptoms. This is the first report on the antibacterial activity of obliquumol.

Tuberculosis patients co-infected with Mycobacterium bovis and Mycobacterium tuberculosis in an urban area of Brazil

In this cross-sectional study, mycobacteria specimens from 189 tuberculosis (TB) patients living in an urban area in Brazil were characterised from 2008-2010 using phenotypic and molecular speciation methods (pncA gene and oxyR pseudogene analysis). Of these samples, 174 isolates simultaneously grew on Löwenstein-Jensen (LJ) and Stonebrink (SB)-containing media and presented phenotypic and molecular profiles of Mycobacterium tuberculosis, whereas 12 had molecular profiles of M. tuberculosis based on the DNA analysis of formalin-fixed paraffin wax-embedded tissue samples (paraffin blocks). One patient produced two sputum isolates, the first of which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, and the second of which only grew on SB media and presented phenotypic profiles of Mycobacterium bovis. One patient provided a bronchial lavage isolate, which simultaneously grew on LJ and SB media and presented phenotypic and molecular profiles of M. tuberculosis, but had molecular profiles of M. bovis from paraffin block DNA analysis, and one sample had molecular profiles of M. tuberculosis and M. bovis identified from two distinct paraffin blocks. Moreover, we found a low prevalence (1.6%) of M. bovis among these isolates, which suggests that local health service procedures likely underestimate its real frequency and that it deserves more attention from public health officials.

The potential of South African plants against Mycobacterium infections

ETHNOPHARMACOLOGICAL RELEVANCE

In South Africa, tuberculosis (TB) caused by Mycobacterium tuberculosis is the most commonly notified disease and the fifth largest cause of mortality, with one in ten cases of TB resistant to treatment in some areas. Many plants are used locally in traditional medicine to treat TB-related symptoms.

AIM OF THE STUDY

The aim was to summarize currently available knowledge on South African plants used to treat TB symptoms, and antimycobacterial efficacy of plant-derived extracts and compounds.

MATERIALS AND METHODS

The traditional uses of plants for respiratory ailments and TB were collated and tabulated. The antimycobacterial activity tests of extracts and chemical constituents of several of these plants and others using different methods and target organisms were summarized.

RESULTS

Almost 180 plants used for TB-related symptoms in South African traditional medicine were documented. About 30% of these have been tested for antimycobacterial efficacy, mostly against fast-growing, non-pathogenic Mycobacterium species.

CONCLUSIONS

Many plant species are used in traditional South African medicine to alleviate symptoms of TB, and several interesting leads have originated for further inquiry following in vitro antimycobacterial activity evaluation. However, much work remains to be done on the systematic assessment of anti-TB efficacy of local plants against pathogenic Mycobacterium species, both in vitro and in vivo.

Purified compounds and extracts from Euclea species with antimycobacterial activity against Mycobacterium bovis and fast-growing mycobacteria

Naphthoquinones and other compounds with antimycobacterial activity against Mycobacterium tuberculosis have previously been isolated from Euclea species. In this study, several constituents of Euclea natalensis and E. undulata, as well as organic extracts of the leaves, were assessed for efficacy against the zoonotic pathogen, Mycobacterium bovis. Also included in the battery of test organisms were M. bovis BCG and the fast-growing species M. smegmatis and M. fortuitum. The acetone extract of E. natalensis had potent activity against M. bovis (MIC=26 microg/ml). The naphthoquinone 7-methyljuglone was the most active compound, with an MIC as low as 1.55 microg/ml against pathogenic M. bovis. M. bovis BCG was not as susceptible to the test compounds as the pathogenic strain, but similar patterns of activity were observed between all the strains tested. M. smegmatis appeared to be a better predictor of antimycobacterial activity against pathogenic M. bovis (and M. tuberculosis), while MIC values obtained using M. fortuitum correlated well with those of M. bovis BCG.

Human Mycobacterium bovis infection in the United Kingdom: Incidence, risks, control measures and review of the zoonotic aspects of bovine tuberculosis

Amongst the members of the Mycobacterium tuberculosis complex (MTBC), M. tuberculosis is mainly a human pathogen, whereas M. bovis has a broad host range and is the principal agent responsible for tuberculosis (TB) in domestic and wild mammals. M. bovis also infects humans, causing zoonotic TB through ingestion, inhalation and, less frequently, by contact with mucous membranes and broken skin. Zoonotic TB is indistinguishable clinically or pathologically from TB caused by M. tuberculosis. Differentiation between the causative organisms may only be achieved by sophisticated laboratory methods involving bacteriological culture of clinical specimens, followed by typing of isolates according to growth characteristics, biochemical properties, routine resistance to pyrazinamide (PZA) and specific non-commercial nucleic acid techniques. All this makes it difficult to accurately estimate the proportion of human TB cases caused by M. bovis infection, particularly in developing countries. Distinguishing between the various members of the MTBC is essential for epidemiological investigation of human cases and, to a lesser degree, for adequate chemotherapy of the human TB patient. Zoonotic TB was formerly an endemic disease in the UK population, usually transmitted to man by consumption of raw cows' milk. Human infection with M. bovis in the UK has been largely controlled through pasteurization of cows' milk and systematic culling of cattle reacting to compulsory tuberculin tests. Nowadays the majority of the 7000 cases of human TB annually reported in the UK are due to M. tuberculosis acquired directly from an infectious person. In the period 1990-2003, between 17 and 50 new cases of human M. bovis infection were confirmed every year in the UK. This represented between 0.5% and 1.5% of all the culture-confirmed TB cases, a proportion similar to that of other industrialized countries. Most cases of zoonotic TB diagnosed in the UK are attributed to (i) reactivation of long-standing latent infections acquired before widespread adoption of milk pasteurization, or (ii) M. bovis infections contracted abroad. Since 1990, only one case has been documented in the UK of confirmed, indigenous human M. bovis infection recently acquired from an animal source. Therefore, for the overwhelming majority of the population, the risk of contracting M. bovis infection from animals appears to be extremely low. However, bovine TB is once again a major animal health problem in the UK. Given the increasing numbers of cattle herds being affected each year, physicians and other public health professionals must remember that zoonotic TB is not just a disease of the past. A significant risk of M. bovis infection remains in certain segments of the UK population in the form of (i) continuing on-farm consumption of unpasteurized cows' milk, (ii) retail sales by approved establishments of unpasteurized milk and dairy products and (iii) occupational exposure to infectious aerosols from tuberculous animals and their carcases.

The importance of Mycobacterium bovis as a zoonosis

Mycobacterium bovis and closely associated acid-fast bacilli cause disease in humans. Epidemiologic investigations reveal that the organism may be ingested or inhaled. Extra pulmonary lesions may occur associated to the consumption of infected milk, even though with the practice of boiling milk, and the growth of milk pasteurization plants all over the world, the digestive route of infection became less important. On the other hand, airborne infection continues to occur among meat industry and slaughterhouse workers, in regions where the infection is still prevalent in cattle. Evidence of person to person transmission is rare. Main causes of concern related to M. bovis in industrialized countries are: epizootics in domesticated and wild mammals and latent infection in immigrants. Although multidrug-resistant (MDR) strains of M. bovis have been identified, case reports reveal that anti-tuberculosis drugs routinely used to treat Mycobacterium tuberculosis-infected patients are effective when properly administered.