Tenosinovitis por Mycobacterium bovis / Tenosynovitis by Mycobacterium bovis / Tenossinovite por Mycobacterium bovis

Resumen Tenosinovitis es la inflamación o infección de un tendón y su vaina sinovial. Una de las causas puede ser bacteriana. Los gérmenes comunes son los más frecuentes, pero deben investigarse también las micobacterias. En la Argentina, la tuberculosis es un problema de salud pública. Mycobacterium bovis ocasiona zoonosis que afectan animales y humanos. La infección en el hombre se da por inhalación de aerosoles de ganado enfermo, por vía digestiva o cutánea. Las manifestaciones extrapulmonares pueden ser digestivas, ganglionares, cutáneas u osteoarticulares. La tenosinovitis tuberculosa de muñeca es infrecuente y, generalmente, es diagnosticada como tenosinovitis reumática o inespecífica. Se presenta el caso de una mujer de 48 años, residente de zona rural, que presentaba hipertrofia y edema en dedos de la mano izquierda. Se le realizó cirugía del túnel carpiano y se observaron cuerpos como granos de arroz. Del tejido sinovial se aisló M. bovis. Comenzó tratamiento tuberculostático más claritromicina. Evolucionó favorablemente.

Abstract Tenosynovitis is an inflammation or infection of a tendon and its synovial sheath. One cause of this illness may be bacterial, being common organisms more frequent, but mycobacteria should be also investigated. In Argentina, tuberculosis is a public health problem. Mycobacterium bovis causes zoonoses that affect animals and humans. Infection in man occurs by inhalation of aerosols from sick cattle, by digestive or cutaneous routes. Extrapulmonary manifestations can be digestive, nodal, cutaneous or osteoarticular. Tuberculous wrist tenosynovitis is uncommon, usually diagnosed as rheumatic or nonspecific tenosynovitis. The case of a 48-year-old woman, a resident of rural areas, presenting hypertrophy, and edema in the fingers of the left hand was introduced. Carpal tunnel surgery was performed, while rice grain bodies were noticed. Synovial tissue material was taken for mycobacterial culture, where M. bovis was isolated. She began tuberculostatic treatment plus clarithromycin. She evolved favourably.

Resumo A tenossinovite é a inflamação ou infecção de um tendão e sua bainha sinovial. A causa pode ser bacteriana, sendo os germes comuns os mais frequentes, mas as micobactérias devem ser investigadas. Na Argentina, a tuberculose é um problema de saúde pública. Mycobacterium bovis causa zoonose que afeta animais e humanos. A infecção no homem ocorre por inalação de aerossóis de gado doente, por via digestiva ou cutânea. As manifestações extrapulmonares podem ser digestivas, ganglionares, cutâneas, osteoarticulares. A tenossinovite tuberculosa do pulso é pouco frequente, geralmente diagnosticada como tenossinovite reumática ou inespecífica. Apresenta-se o caso de uma mulher de 48 anos, moradora de zona rural, com hipertrofia e edema nos dedos da mão esquerda. Foi realizada cirurgia do túnel do carpo, observando-se corpos como grãos de arroz. Do tecido sinovial foi isolado M. bovis. Iniciou-se tratamento tuberculostático mais claritromicina. Evoluiu favoravelmente.

Differences in responses to the intracellular macrophage environment between Mycobacterium bovis BCG vaccine strains Moreau and Pasteur

BACKGROUND The Bacille Calmette-Guérin (BCG) vaccine comprises a family of strains with variable protective efficacy against pulmonary tuberculosis (TB) and leprosy, partly due to genetic differences between strains. OBJECTIVES Previous data highlighting differences between the genomes and proteomic profiles of BCG strains Moreau and Pasteur led us to evaluate their behaviour in the macrophage microenvironment, capable of stimulating molecular responses that can impact the protective effect of the vaccine. METHODS Strain infectivity, viability, co-localisation with acidified vesicles, macrophage secretion of IL-1 and MCP-1 and lipid droplet biogenesis were evaluated after infection. FINDINGS We found that BCG Moreau is internalised more efficiently, with significantly better intracellular survival up to 96 h p.i., whereas more BCG Pasteur bacilli were found co-localised in acidified vesicles up to 6 h p.i. IL-1β and MCP-1 secretion and lipid droplet biogenesis by infected macrophages were more prominent in response to BCG Pasteur. MAIN CONCLUSION Overall, our results show that, compared to Pasteur, BCG Moreau has increased fitness and better endurance in the harsh intracellular environment, also regulating anti-microbial responses (lower IL-1b and MCP-1). These findings contribute to the understanding of the physiology of BCG Moreau and Pasteur in response to the intraphagosomal environment in a THP-1 macrophage model.

Geographic patterns and hotspots of pediatric tuberculosis: the role of socioeconomic determinants / Padrões geográficos e focos de tuberculose pediátrica: o papel de determinantes socioeconômicos

ABSTRACT Objective: Children are an important demographic group for understanding overall tuberculosis epidemiology, and monitoring of childhood tuberculosis is essential for appropriate prevention. The present study sought to characterize the spatial distribution of childhood tuberculosis notification rates in continental Portugal; identify high-risk areas; and evaluate the association between childhood tuberculosis notification rates and socioeconomic deprivation. Methods: Using hierarchical Bayesian spatial models, we analyzed the geographic distribution of pediatric tuberculosis notification rates across 278 municipalities between 2016 and 2020 and determined high-risk and low-risk areas. We used the Portuguese version of the European Deprivation Index to estimate the association between childhood tuberculosis and area-level socioeconomic deprivation. Results: Notification rates ranged from 1.8 to 13.15 per 100,000 children under 5 years of age. We identified seven high-risk areas, the relative risk of which was significantly above the study area average. All seven high-risk areas were located in the metropolitan area of Porto or Lisbon. There was a significant relationship between socioeconomic deprivation and pediatric tuberculosis notification rates (relative risk = 1.16; Bayesian credible interval, 1.05-1.29). Conclusions: Identified high-risk and socioeconomically deprived areas should constitute target areas for tuberculosis control, and these data should be integrated with other risk factors to define more precise criteria for BCG vaccination.

RESUMO Objetivo: As crianças são um grupo demográfico importante para a compreensão da epidemiologia da tuberculose em geral, e o monitoramento da tuberculose infantil é essencial para a prevenção adequada. O presente estudo procurou caracterizar a distribuição espacial das taxas de notificação de tuberculose infantil em Portugal continental; identificar áreas de alto risco e avaliar a associação entre taxas de notificação de tuberculose infantil e privação socioeconômica. Métodos: Por meio de modelos espaciais hierárquicos bayesianos, analisamos a distribuição geográfica das taxas de notificação de tuberculose pediátrica em 278 municípios entre 2016 e 2020 e determinamos as áreas de alto e baixo risco. Usamos a versão portuguesa do European Deprivation Index para calcular a associação entre a tuberculose infantil e a privação socioeconômica em cada área. Resultados: As taxas de notificação variaram de 1,8 a 13,15 por 100.000 crianças com idade < 5 anos. Identificamos sete áreas de alto risco, cujo risco relativo era significativamente maior que a média da área de estudo. Todas as sete áreas de alto risco situavam-se na área metropolitana do Porto e de Lisboa. Houve uma relação significativa entre a privação socioeconômica e as taxas de notificação de tuberculose pediátrica (risco relativo = 1,16; intervalo de credibilidade de 95%: 1,05-1,29). Conclusões: Áreas identificadas como sendo de alto risco e desfavorecidas socioeconomicamente devem constituir áreas-alvo para o controle da tuberculose, e esses dados devem ser integrados a outros fatores de risco para definir critérios mais precisos para a vacinação com BCG.

Mycobacterium bovis induced human tuberculosis in India: Current status, challenges & opportunities

Tuberculosis (TB) caused by Mycobacterium tuberculosis is a leading cause of human deaths due to any infectious disease worldwide. However, infection of Mycobacterium bovis, primarily an animal pathogen, also leads to the development of ‘human tuberculosis’. Infected animals have been considered the major source of M. bovis infection and humans get exposed to M. bovis through close contact with infected animals or consumption of contaminated milk, unpasteurized dairy products and improperly cooked contaminated meat. The information on the global distribution of bovine TB (bTB) is limited, but the disease has been reported from all the livestock-producing middle- and low-income countries of the world. In recent years, there is a renewed interest for the control of bTB to minimize human infection worldwide. In India, while the sporadic presence of M. bovis has been reported in domestic animals, animal-derived food products and human beings from different geographical regions of the country, the information on the national prevalence of bTB and transmission dynamics of zoonotic TB is, however, not available. The present article reviewed published information on the status of M. bovis-induced zoonotic TB to highlight the key challenges and opportunities for intervention to minimize the risk of M. bovis infection in humans and secure optimum animal productivity in India.

Infección por Mycobacterium bovis en una adolescente con síndrome febril prolongado / Mycobacterium bovis infection in an adolescent with prolonged febrile syndrome

La tuberculosis bovina es una zoonosis causada por Mycobacterium bovis. El bovino es el huésped primario. Otras especies pueden ser infectadas (cerdos, cabras y caballos, entre otras). En el ser humano, el contagio puede ser por vía aérea (enfermedad pulmonar), clínicamente indistinguible de la producida por Mycobacterium tuberculosis, o por vía oral o cutánea, (formas extrapulmonares: digestiva, ganglionar, cutánea). Su contagio se ha relacionado principalmente al contacto con el ganado y al consumo de lácteos sin pasteurizar. También se notificó el posible contagio interpersonal.Se describe el caso de una paciente adolescente, proveniente de la provincia de Buenos Aires, con síndrome febril prolongado y conglomerado ganglionar abdominal, con antecedente de ingestión de leche no pasteurizada. Es fundamental alertar acerca de la importancia del procesamiento correcto de los alimentos, sobre todo en esta época en la que las nuevas tendencias alimentarias (ingestión de lácteos caseros o comprados en ferias informales) pueden poner en riesgo la salud.

Bovine tuberculosis is an infectious, zoonotic disease, caused by Mycobacterium bovis. The bovine is the primary host. Other species can be infected (pigs, goats, horses, etc). Man can be infected by air (lung disease), clinically indistinguishable from that produced by Mycobacterium tuberculosis or by oral or cutaneous route (extrapulmonary forms: digestive, lymph node, skin). Contagion has been mainly related to contact with livestock and the consumption of unpasteurized dairy products. It was also reported the possible contagion between people. It is described the case of an adolescent patient, from the province of Buenos Aires, with prolonged febrile syndrome and abdominal lymph node conglomerate, with a history of ingestion of unpasteurized milk. We consider the importance of warning about the correct processing of food, especially at this time when new food trends (homemade dairy intake or bought at informal fairs) could put the health of the population at risk.

Detection of Mycobacterium sp. by multiplex PCR directly from suspicious granulomas from cold chambers in the state of Bahia, Brazil

The diagnosis of bovine tuberculosis (TB) by molecular techniques has been broadly studied. These methods allow accelerating the diagnosis, in addition to presenting high specificity and sensitivity in the identification of the pathogen, critical characteristic for public health, especially when it comes to the direct diagnosis of the biologic samples, which has been little explored. This paper has evaluated a multiplex polymerase chain reaction (mPCR) as a tool to diagnose TB, which was performed directly on the granulomatous material of suspicious lesions collected in a cold chamber under state inspection in the state of Bahia, Brazil. Of the 74 samples evaluated, 14.86% were positive, with 10.81% positive for mPCR and culture, 4.05% negative for cultivation and positive for mPCR. The correlation between the cultivation and the mPCR presented agreeance higher than 61.54% of the cases. The results have indicated that the protocol proved itself effective, fast and very promising in the surveillance in slaughterhouses for the diagnosis of tuberculosis directly from the granuloma.(AU)

Spoligotyping, genotyping, and spatial distribution of Mycobacterium bovis in cattle in the state of Bahia, Brazil / Genotipagem por spoligotyping e distribuição espacial de Mycobacterium bovis em bovinos no estado da Bahia, Brasil

Mycobacterium bovis is responsible for bovine and buffalo tuberculosis, an important zoonotic disease with global distribution. The knowledge of the distribution and the precise identification of this disease, including advanced diagnoses such as spoligotyping, allows choosing the best strategies to fight the disease's progress. The present work aimed to investigate mycobacteria's presence, genotype their strains, and evaluate tuberculosis cases' spatial distribution from suggestive lesions in carcasses of bovine and buffalo inspected in slaughterhouses under an official inspection regime in the state of Bahia, Brazil. The study investigated 453,417 animals. Among these, 31 (0.007%) from 17 municipalities were suspected of tuberculosis. Among the culture medium growth, 95% of these were categorized as alcohol-acid resistant bacilli (BAAR). All isolates were subjected to spoligotyping and 95% were confirmed as M. bovis (SB0120, SB0121, SB0852, SB0828, SB0295, SB0881, SB1648, SB6119, SB0140, SB1055). The strain SB0120 was the most prevalent, and this profile has been described in cases of human tuberculosis by M. bovis, highlighting the zoonotic potential of this profile. This study also identified strains never reported in Bahia, highlighting a distinctive pattern from other parts of Brazil, besides mixed infections. Besides, to identify strains never before described in the state, highlighting a distinctive pattern in Brazil (SB6119 and SB0852, respectively). An unpublished profile was identified and inserted in the international database (Mbovis.org), named SB2715.(AU)

O Mycobacterium bovis é o responsável pela tuberculose bovina e bubalina, doença zoonótica importante e com distribuição global. O conhecimento da distribuição e a identificação precisa dessa enfermidade, incluindo diagnósticos mais avançados como o spoligotyping, permite escolher as melhores estratégias de combate ao avanço da doença. O presente trabalho objetivou investigar a presença de micobactérias, genotipar suas estirpes e avaliar a distribuição espacial dos casos de tuberculose a partir de lesões sugestivas nas carcaças de bovinos e bubalinos inspecionadas em frigoríficos sob regime de inspeção oficial no estado da Bahia. Foram investigados 453.417 animais dentre os quais 31 (0,007%) foram suspeitos de doença e provenientes de 17 municípios. Após o crescimento em meio de cultura, 95% foram categorizados como bacilos álcool-ácido resistentes (BAAR). Todos os isolados foram submetidos à spoligotyping e 95% foram confirmados M. bovis (SB0120, SB0121, SB0852, SB0828, SB0295, SB0881, SB1648, SB6119, SB0140, SB1055). A cepa SB0120 foi a mais prevalente e este perfil vem sendo descrito na literatura com casos de tuberculose humana por M. bovis ressaltando o potencial zoonótico deste perfil. Este estudo também identificou cepas nunca relatadas no estado da Bahia, destacando um padrão distinto de outras partes do Brasil, além da existência de infecções mistas. Permitiu ainda relatar linhagens nunca antes descritas no estado com destaque para um padrão novo no Brasil (SB6119 e SB0852 respectivamente). Um perfil inédito identificado foi identificado e inserido no banco de dados internacional (Mbovis.org), nomeado SB2715.(AU)

Spoligotyping, genotyping, and spatial distribution of Mycobacterium bovis in cattle in the state of Bahia, Brazil

ABSTRACT: Mycobacterium bovis is responsible for bovine and buffalo tuberculosis, an important zoonotic disease with global distribution. The knowledge of the distribution and the precise identification of this disease, including advanced diagnoses such as spoligotyping, allows choosing the best strategies to fight the diseases progress. The present work aimed to investigate mycobacterias presence, genotype their strains, and evaluate tuberculosis cases spatial distribution from suggestive lesions in carcasses of bovine and buffalo inspected in slaughterhouses under an official inspection regime in the state of Bahia, Brazil. The study investigated 453,417 animals. Among these, 31 (0.007%) from 17 municipalities were suspected of tuberculosis. Among the culture medium growth, 95% of these were categorized as alcohol-acid resistant bacilli (BAAR). All isolates were subjected to spoligotyping and 95% were confirmed as M. bovis (SB0120, SB0121, SB0852, SB0828, SB0295, SB0881, SB1648, SB6119, SB0140, SB1055). The strain SB0120 was the most prevalent, and this profile has been described in cases of human tuberculosis by M. bovis, highlighting the zoonotic potential of this profile. This study also identified strains never reported in Bahia, highlighting a distinctive pattern from other parts of Brazil, besides mixed infections. Besides, to identify strains never before described in the state, highlighting a distinctive pattern in Brazil (SB6119 and SB0852, respectively). An unpublished profile was identified and inserted in the international database (Mbovis.org), named SB2715.

RESUMO: O Mycobacterium bovis é o responsável pela tuberculose bovina e bubalina, doença zoonótica importante e com distribuição global. O conhecimento da distribuição e a identificação precisa dessa enfermidade, incluindo diagnósticos mais avançados como o spoligotyping, permite escolher as melhores estratégias de combate ao avanço da doença. O presente trabalho objetivou investigar a presença de micobactérias, genotipar suas estirpes e avaliar a distribuição espacial dos casos de tuberculose a partir de lesões sugestivas nas carcaças de bovinos e bubalinos inspecionadas em frigoríficos sob regime de inspeção oficial no estado da Bahia. Foram investigados 453.417 animais dentre os quais 31 (0,007%) foram suspeitos de doença e provenientes de 17 municípios. Após o crescimento em meio de cultura, 95% foram categorizados como bacilos álcool-ácido resistentes (BAAR). Todos os isolados foram submetidos à spoligotyping e 95% foram confirmados M. bovis (SB0120, SB0121, SB0852, SB0828, SB0295, SB0881, SB1648, SB6119, SB0140, SB1055). A cepa SB0120 foi a mais prevalente e este perfil vem sendo descrito na literatura com casos de tuberculose humana por M. bovis ressaltando o potencial zoonótico deste perfil. Este estudo também identificou cepas nunca relatadas no estado da Bahia, destacando um padrão distinto de outras partes do Brasil, além da existência de infecções mistas. Permitiu ainda relatar linhagens nunca antes descritas no estado com destaque para um padrão novo no Brasil (SB6119 e SB0852 respectivamente). Um perfil inédito identificado foi identificado e inserido no banco de dados internacional (Mbovis.org), nomeado SB2715.

Bovine tuberculosis in safari park in Brazil

ABSTRACT: Bovine tuberculosis (bTB) is an infectious disease caused by Mycobacterium bovis, affecting domestic animals, wild animals and humans. In captivity, for wild animals, bTB represents a risk to animal keepers and zoo visitors, in addition to the possibility of spreading the infection to domestic animals or through the trade of infected wild animals. Sambar (Cervus unicolor), red deer (Cervus elaphus) and fallow deer (Dama dama) from a safari park in the State of Rio Grande do Sul, Brazil, showed a clinical condition of dyspnea and weight loss. Some animals died and showed lesions suggestive of tuberculosis (LST), which were confirmed by histopathology. After the interdiction of the safari park by the state veterinary authorities, 281 deer were euthanized with the authorization of the Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA). Retropharyngeal and submandibular lymph nodes and viscera were collected from 21 animals, which were grown in Stonebrink medium for up to 90 days. After DNA extraction from the bacterial colonies, PCR was performed for targets flanking the region of differentiation 4 (RD4). Of the 21 samples, 14 (66.7%) presented LST with a granulomatous appearance, a whitish coloration, and caseous or calcified consistency, and seven samples (33.3%), showed no lesions. In the culture of 14 samples with LST, 13 (92.8%) presented bacterial growth compatible with M. bovis. In the cultivation of the seven samples without LST, four (57.1%) presented colonies compatible with M. bovis. PCR and DNA sequencing of the PCR amplicons detected as positive all the 17 (100%) bacteriological cultures suggestive of M. bovis, thus confirming the outbreak of bTB in deer. Decisions about positive tested and suspicious animals should be taken based on the evaluation of the risk of transmission to the rest of the zoological animals, animal welfare, conservation considerations and, the zoonotic potential of this pathogen.

RESUMO: A tuberculose bovina (bTB) é uma doença infecciosa causada por Mycobacterium bovis, afetando animais domésticos, animais selvagens e humanos. Para animais selvagens em cativeiro, a bTB representa um risco para os tratadores de animais e visitantes do zoológico, além da possibilidade de espalhar a infecção para animais domésticos ou por meio do comércio de animais silvestres infectados. Cervídeos sambar (Cervus unicolor), veado-vermelho (Cervus elaphus) e gamo (Dama dama) de um parque safári no Estado do Rio Grande do Sul, Brasil, mostraram uma condição clínica de dispneia e perda de peso. Alguns animais morreram e apresentaram lesões sugestivas de tuberculose (LST), as quais foram confirmadas por histopatologia. Após a interdição do parque safári pelas autoridades veterinárias estaduais, 281 veados sofreram eutanásia com a autorização do Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA). Os linfonodos retrofaríngeos e submandibulares e vísceras foram coletados de 21 animais, que foram cultivados em meio Stonebrink por até 90 dias. Após extração de DNA das colônias bacterianas, foi realizada PCR para alvos que flanqueavam a região de diferenciação 4 (RD4). Das 21 amostras, 14 (66,7%) apresentaram LST com aspecto granulomatoso, coloração esbranquiçada e consistência caseosa ou calcificada, e sete amostras (33,3%) não apresentaram lesões. Na cultura de 14 amostras com LST, 13 (92,8%) apresentaram crescimento bacteriano compatível com M. bovis. No cultivo das sete amostras sem LST, quatro (57,1%) apresentaram colônias compatíveis com M. bovis. A PCR e o sequenciamento de DNA dos fragmentos de PCR detectaram como positivo todas as 17 (100%) culturas bacteriológicas sugestivas de M. bovis, confirmando assim o surto de bTB em cervídeos. As decisões sobre animais positivos testados e suspeitos devem ser tomadas com base na avaliação do risco de transmissão para o restante dos animais zoológicos, bem-estar animal, considerações de conservação e no potencial zoonótico desse patógeno.

Tuberculosis outbreak in intensive swine farming from southern Brazil / Surto de tuberculose em suínos de criação intensiva no Sul do Brasil

ABSTRACT: Mycobacterium tuberculosis var. bovis is the etiologic agent of animal tuberculosis (aTB), a neglected zoonotic disease. Animal tuberculosis can affect many species, including swine. aTB-consistent granulomas in these animals lead to carcass disposal, generating economic losses and posing risks to human health. In the present study, an aTB outbreak was identified at an intensive swine farming operation in Southern Brazil. Inspection during swine slaughter revealed aTB-suspected lesions, which were collected for diagnosis by histology, PCR, and bacterial isolation. The animals had no clinical signs of tuberculosis. Granulomatous lesions were identified in 0.73% (59/8,071) of the slaughtered swine, and were confirmed by histology. Nine samples were further examined by PCR and bacterial isolation, with 44.4% and 55.5% positive results, respectively. Data from abattoirs subjected to federal surveillance show an aTB prevalence in Brazil of <0.001%. The present data thus indicate a swine aTB outbreak in intensive breeding. Swine infection can be related to exposure to infected animals or to contaminated food or environment. Biosecurity measures must be taken to avoid aTB transmission. Although certified swine breeding farms adopt such measures, this report indicates that constant monitoring is crucial, and greater control in swine breeding and finishing units is required to prevent outbreaks and spread of tuberculosis.

RESUMO: Mycobacterium bovis é o agente etiológico da tuberculose animal (aTB), uma doença zoonótica negligenciada. A tuberculose animal pode afetar muitas espécies, incluindo suínos. Os granulomas compatíveis com a aTB nesses animais levam ao descarte de carcaças, gerando perdas econômicas e trazendo riscos à saúde humana. No presente estudo, um surto de aTB foi identificado em um sistema de criação intensiva de suínos na região Sul do Brasil. A inspeção durante um abate de suínos revelou lesões suspeitas de tuberculose, as quais foram coletadas para diagnóstico por histologia, PCR e isolamento bacteriano. Os animais não apresentavam sinais clínicos de tuberculose. Lesões granulomatosas foram identificadas em 0,73% (59/8.071) dos suínos abatidos, e foram confirmadas pela histologia. Nove amostras foram posteriormente examinadas por PCR e isolamento bacteriano, com 44,4% e 55,5% de resultados positivos, respectivamente. Dados de frigoríficos submetidos à vigilância federal demostram prevalência da aTB de < 0,001% no Brasil. Os dados presentes indicam, portanto, um surto de aTB em suínos de criação intensiva. A infecção em suínos pode estar relacionada à exposição a animais infectados, alimentos ou ambientes contaminados. Medidas de biossegurança devem ser tomadas para evitar a transmissão da aTB. Embora as granjas suinícolas certificadas adotem tais medidas, este relato indica que o monitoramento constante é crucial, e maior controle nas unidades de criação e terminação de suínos é necessário para prevenir surtos e disseminação da tuberculose.

Bovine tuberculosis in safari park in Brazil / Tuberculose bovina em parque safári no Brasil

Bovine tuberculosis (bTB) is an infectious disease caused by Mycobacterium bovis, affecting domestic animals, wild animals and humans. In captivity, for wild animals, bTB represents a risk to animal keepers and zoo visitors, in addition to the possibility of spreading the infection to domestic animals or through the trade of infected wild animals. Sambar (Cervus unicolor), red deer (Cervus elaphus) and fallow deer (Dama dama) from a safari park in the State of Rio Grande do Sul, Brazil, showed a clinical condition of dyspnea and weight loss. Some animals died and showed lesions suggestive of tuberculosis (LST), which were confirmed by histopathology. After the interdiction of the safari park by the state veterinary authorities, 281 deer were euthanized with the authorization of the "Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis" (IBAMA). Retropharyngeal and submandibular lymph nodes and viscera were collected from 21 animals, which were grown in Stonebrink medium for up to 90 days. After DNA extraction from the bacterial colonies, PCR was performed for targets flanking the region of differentiation 4 (RD4). Of the 21 samples, 14 (66.7%) presented LST with a granulomatous appearance, a whitish coloration, and caseous or calcified consistency, and seven samples (33.3%), showed no lesions. In the culture of 14 samples with LST, 13 (92.8%) presented bacterial growth compatible with M. bovis. In the cultivation of the seven samples without LST, four (57.1%) presented colonies compatible with M. bovis. PCR and DNA sequencing of the PCR amplicons detected as positive all the 17 (100%) bacteriological cultures suggestive of M. bovis, thus confirming the outbreak of bTB in deer. Decisions about positive tested and suspicious animals should be taken based on the evaluation of the risk of transmission to the rest of the zoological animals, animal welfare, conservation considerations and, the zoonotic potential of this pathogen.(AU)

A tuberculose bovina (bTB) é uma doença infecciosa causada por Mycobacterium bovis, afetando animais domésticos, animais selvagens e humanos. Para animais selvagens em cativeiro, a bTB representa um risco para os tratadores de animais e visitantes do zoológico, além da possibilidade de espalhar a infecção para animais domésticos ou por meio do comércio de animais silvestres infectados. Cervídeos sambar (Cervus unicolor), veado-vermelho (Cervus elaphus) e gamo (Dama dama) de um parque safári no Estado do Rio Grande do Sul, Brasil, mostraram uma condição clínica de dispneia e perda de peso. Alguns animais morreram e apresentaram lesões sugestivas de tuberculose (LST), as quais foram confirmadas por histopatologia. Após a interdição do parque safári pelas autoridades veterinárias estaduais, 281 veados sofreram eutanásia com a autorização do Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA). Os linfonodos retrofaríngeos e submandibulares e vísceras foram coletados de 21 animais, que foram cultivados em meio Stonebrink por até 90 dias. Após extração de DNA das colônias bacterianas, foi realizada PCR para alvos que flanqueavam a região de diferenciação 4 (RD4). Das 21 amostras, 14 (66,7%) apresentaram LST com aspecto granulomatoso, coloração esbranquiçada e consistência caseosa ou calcificada, e sete amostras (33,3%) não apresentaram lesões. Na cultura de 14 amostras com LST, 13 (92,8%) apresentaram crescimento bacteriano compatível com M. bovis. No cultivo das sete amostras sem LST, quatro (57,1%) apresentaram colônias compatíveis com M. bovis. A PCR e o sequenciamento de DNA dos fragmentos de PCR detectaram como positivo todas as 17 (100%) culturas bacteriológicas sugestivas de M. bovis, confirmando assim o surto de bTB em cervídeos. As decisões sobre animais positivos testados e suspeitos devem ser tomadas com base na avaliação do risco de transmissão para o restante dos animais zoológicos, bem-estar animal, considerações de conservação e no potencial zoonótico desse patógeno.(AU)

Tuberculosis cutánea: casuística del Servicio de Dermatología del Hospital Nacional / Cutaneous tuberculosis: casuistry of the Dermatology Service of the Hospital Nacional

RESUMEN Introducción: la tuberculosis cutánea no es frecuente y el diagnóstico es difícil por presentar varias formas clínicas, ninguna especifica de la enfermedad, y pueden requerir varios estudios laboratoriales para confirmarlo. Objetivos: realizar una revisión de los casos de tuberculosis cutánea observados en el Servicio de Dermatología del Hospital Nacional en el periodo 1990 - 2019; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Metodología: estudio retrospectivo, descriptivo y observacional. Resultados: se diagnosticaron 7 casos; 5 hombres y 2 mujeres; con edades que oscilaban de 4 meses a 74 años y 3 eran nativos. Las formas clínicas fueron escrofuloderma y gomosa en 3 casos; verrugosa en 1. Todos tenían compromiso sistémico (pulmonar en 3 casos, óseo en 2 y ganglionar en 4) y también factores de inmunodepresión, predominando la desnutrición. En 3 casos el diagnóstico se confirmó con el cultivo de lesiones de piel que reportó Mycobacterium tuberculosis en 2 y M. bovis en 1. Los otros casos se diagnosticaron por hallazgos de bacilos ácido - alcohol resistentes en piel u otros órganos, anatomía patológica compatible y respuesta al tratamiento. Todos recibieron el tratamiento específico de la enfermedad con buena respuesta a excepción de un caso con inmunodeficiencia severa que falleció. Conclusiones: la tuberculosis cutánea es rara también en nuestro Servicio, pero su diagnóstico representa un desafío importante y además acompaña a afectación sistémica, por lo que el tratamiento debe ser oportuno.

ABSTRACT Introduction: cutaneous tuberculosis is not frequent and the diagnosis is difficult because it presents several clinical forms, none specific of the disease, and may require several laboratory studies to confirm it. Objectives: to carry out a review of the cases of cutaneous tuberculosis observed in the Dermatology Service of Hospital Nacional in the period 1990 - 2019; determining their demographic, clinical, laboratory and evolutionary characteristics. Methodology: retrospective, descriptive and observational study. Results: 7 cases were diagnosed; 5 men and 2 women; with ages ranging from 4 months to 74 years and 3 were native. The clinical forms were scrofuloderma and gummy in 3 cases; warty in 1. All had systemic involvement (lung in 3 cases, bone in 2 and lymph node in 4) and also immunosuppressive factors, predominantly malnutrition. In 3 cases, the diagnosis was confirmed by the culture of skin lesions that reported Mycobacterium tuberculosis in 2 and M. bovis in 1. The other cases were diagnosed by findings of acid-fast bacilli in skin or other organs, compatible pathological anatomy and response to treatment. All received specific treatment for the disease with a good response, except for one case with severe immunodeficiency that died. Conclusions: cutaneous tuberculosis is also rare in our Department, but its diagnosis represents a significant challenge and also accompanies systemic involvement, so treatment must be timely.

Isolation and genotyping of Mycobacterium bovis in suggestive lesions of tuberculosis in cattle slaughtered in the state of Ceará, Brazil / Isolamento e tipificação genética de Mycobacterium bovis em lesões sugestivas de tuberculose em bovinos abatidos no estado do Ceará

Bovine tuberculosis (BTB) is a zoonosis caused by the bacterium Mycobacterium bovis, which induces the development of nodular and granulomatous lesions in various animal tissues. The recognition of these suggestive gross lesions during postmortem sanitary inspection in slaughterhouses provides a presumptive diagnosis, which requires the use of complementary tests to confirm the disease. This study aimed to verify the occurrence of BTB in cattle slaughtered in slaughterhouses in the state of Ceará, Brazil, using bacteriological and molecular methods. To this end, suggestive lesions were analyzed on carcasses condemned by the "Serviço de Inspeção Estadual" (SIE). The samples were submitted to microbiological analysis using culture media and specific staining followed by spoligotyping molecular technique for identification and genotyping of the mycobacteria. Occurrence of lesions suggestive of BTB was verified in bovine carcasses (0.071%) from different municipalities of the state. These lesions were located mainly in the lung (95.12%), lymph nodes (58.53%), and liver (36.58%). Microbiological culture showed bacterial isolation (17.94%), with the growth of colonies showing morphological and tannic characteristics belonging to genus Mycobacterium spp. Genetic polymorphism analysis identified M. bovis in all isolates, which were discriminated into six spoligotypes (SB0121, SB0295, SB1064, SB0120, SB0870, and SB0852). These profiles have been described in Brazil and several areas of the world, except for profiles SB1064 and SB0852, which were described in the country for the first time. The results show that the association of the diagnostic methods used was the basis for the first study on identification of mycobacteria found in the state, which may provide a database for the epidemiological study of BTB in the state of Ceará.(AU)

A tuberculose bovina (TB) é uma zoonose causada pelo Mycobacterium bovis, o qual induz ao desenvolvimento de lesões nodulares e granulomatosas em vários tecidos do animal. O reconhecimento dessas lesões macroscópicas sugestivas durante a inspeção sanitária post mortem em matadouros fornece um diagnóstico presuntivo, sendo necessário a utilização de testes complementares para confirmação da doença. O objetivo deste trabalho foi verificar a ocorrência da TB em animais abatidos em matadouros-frigoríficos no estado do Ceará através da utilização de métodos bacteriológicos e moleculares. Para tanto, foram analisadas lesões sugestivas de TB em carcaças condenadas pelo Serviço de Inspeção Estadual (SIE). As amostras foram submetidas à análise microbiológica, utilizando meios de cultivo e de coloração específicos, seguida pela técnica molecular spoligotyping para identificação e tipificação genética da micobactéria. Verificou-se a ocorrência de lesões sugestivas de TB em carcaças bovinas (0,071%) oriundas de diferentes municípios do estado do Ceará. Essas lesões estavam localizadas principalmente no pulmão (95,12%), linfonodos (58,53%) e fígado (36,58%). O cultivo microbiológico obteve isolamento bacteriano (17,94%), com o crescimento de colônias apresentando características morfológicas e tintoriais pertencentes ao gênero Mycobacterium spp. A análise do polimorfismo genético identificou a presença de M. bovis em todos os isolados, que foram discriminados em seis espoligotipos (SB0121, SB0295, SB1064, SB0120, SB0870 e SB0852), descritos no Brasil e em diversas áreas do mundo, exceto os perfis SB1064 e SB0852 que foram descritos pela primeira vez no país. Os resultados obtidos demonstram que a associação dos métodos diagnósticos utilizados foram a base do primeiro estudo de identificação das micobactérias encontradas no estado do Ceará, o que pode contribuir para a criação de um banco de dados para o estudo epidemiológico da TB no estado.(AU)

Detection and Identification of Mycobacterium tuberculosis and Mycobacterium bovis from Blood and Milk of Bovines

Bovine tuberculosis, a chronic disease of animals is caused by species of Mycobacterium tuberculosis complex (MTC) and it remains a potential threat to animals as well as humans. Differentiation of the species of MTC is required for epidemiological and diagnostic purpose. The present study evaluated the presence of different species of MTC in bovines using gyrB-restriction fragment length polymorphism analysis. In this study, blood and milk samples from 50 milch animals which were positive reactors of comparative intradermal tuberculin test were collected. Screening of MTC was done by IS6110-PCR using primers INS1/INS2 specific for MTC. The positive samples were further identified using gyrB- Restriction fragment length polymorphism analysis. Out of 50 positive reactors to CITT, only 4 (8%) animal were positive for MTC by IS6110-PCR. And gyrB-RFLP analysis using RsaI and SacII showed two positive for M. bovis and two animals for M. tuberculosis. Thus, gyrB-RFLP could be used as an additional tool in differential diagnosis of mycobacterial diseases thereby able to differentiate species of MTC

Suppurative BCG Lymphadenitis and the Importance of Microbiology Investigations – A Case Report

@#Suppurative BCG lymphadenitis can easily be overlooked, as it mimics other diseases such as tuberculous lymphadenitis. A case of a three-month old female infant who received the BCG vaccination at birth presented with isolated left axillary mass at two months of age. She was initially treated as lymph node abscess but was referred to the hospital due to the increasing size of the swelling. Needle aspiration was done and the microbiology analysis came out positive for acid-fast bacilli. She was planned for syrup isoniazid; however, the management team withheld treatment until they were certain of the identity of the bacteria. The bacteria was confirmed by the molecular method to be Mycobacterium bovis BCG strain. The case report highlights the importance of the microbiology investigations for appropriate management in this case.

Tuberculosis por Mycobacterium bovis en un niño de la Comuna N° 8, Ciudad Autónoma de Buenos Aires / Mycobacterium bovis Tuberculosis in a child in the Commune n° 8, Buenos Aires City

La tuberculosis bovina es una enfermedad infectocontagiosa producida por Mycobacterium bovis, que, junto con otras micobacterias, compone el complejo Mycobacterium tuberculosis. Su prevención radica en detectar la infección en el ganado bovino y pasteurizar la leche. El hombre, clásicamente, ha adquirido la enfermedad por contacto con el ganado, en el contexto de una zoonosis laboral, o por consumo de productos lácteos no pasteurizados. Se describe el caso de un paciente de 10 años, sin actividades relacionadas con animales, que presenta una forma de tuberculosis pulmonar por M. bovis, indistinguible clínica y radiológicamente de la tuberculosis humana. Se destaca la importancia de la detección de la enfermedad, del control sanitario de los alimentos y del primer nivel de atención en lo que respecta al reconocimiento de la enfermedad y a su prevención en la población.

Bovine tuberculosis is a contagious infectious disease produced by Mycobacterium bovis, which together with other mycobacteria makes up the Mycobacterium tuberculosis complex. Its prevention lies in detection of the infection in cattle and milk pasteurization. Man has traditionally acquired the disease through contact with livestock, in the context of an occupational zoonosis, or through consumption of unpasteurized dairy products. We describe the case of a 10-year-old male patient, without activities related to animals, that presents a form of pulmonary tuberculosis due to M. bovis, clinically and radiologically indistinguishable from human tuberculosis. The importance of the disease detection, the food sanitary control, and the first level of attention, with respect to the recognition of the disease and its prevention in the population, is highlighted.

La importancia de investigar Mycobacterium bovis en muestras clínicas de procedencia humana / Importance of investigating Mycobacterium bovis in clinical samples of human origin

Resumen Introducción. La tuberculosis es una enfermedad infectocontagiosa que continúa siendo un problema mundial de salud pública. Es la principal causa de mortalidad en personas con HIV. Objetivo. Identificar la presencia de Mycobacterium bovis como agente etiológico de tuberculosis humana en muestras de esputo con baciloscopia positiva, mediante la prueba Genotype MTBC™. Materiales y métodos. Se llevó a cabo un estudio descriptivo de 88 muestras de esputo remitidas al Grupo de Micobacterias del Instituto Nacional de Salud entre enero y noviembre de 2015. Se hizo el análisis microbiológico convencional y se empleó la prueba molecular de Genotype MTBC™ para diferenciar las especies del complejo M. tuberculosis. Resultados. Sesenta y dos casos (70,5 %) correspondían a pacientes de sexo masculino; los grupos más afectados fueron el de 24 a 34 años, el de residentes en las cabeceras municipales, y el de afiliados al régimen subsidiado. En el 50 % (44) de las muestras con resultados en la prueba de identificación de la especie, se detectó el complejo M. tuberculosis. Conclusiones. La mayor carga de la enfermedad se registró en la población masculina y en edad productiva. La prueba de identificación para especies del complejo, solo demostró la presencia de M. tuberculosis. Sin embargo, con estos datos no es posible descartar M. bovis en humanos con tuberculosis en Colombia. La identificación diferencial de la especie debería implementarse de forma rutinaria en los casos de tuberculosis en los grupos de riesgo y en las zonas donde se conoce la circulación de esta micobacteria en bovinos.

Abstract Introduction: Tuberculosis is an infectious disease that still represents a major public health problem worldwide. It is one of the main causes of mortality in people with HIV. Objective: To identify the presence of M. bovis as an etiological agent of human tuberculosis in sputum smear positive samples using the test Genotype MTBC™. Materials and methods: We conducted a descriptive study, 88 sputum samples were submitted to the Grupo de Micobacterias of the Instituto Nacional de Salud between January and November, 2015. We used the conventional microbiological analysis and the molecular test Genotype MTBC™ to identify the M. tuberculosis complex species. Results: Sixty two (70.5%) were males; the most affected groups were those between 24 and 34 years old, those residing in the municipal seats and those affiliated to the subsidized health plans. In 50.0% (44) of the samples with a result in the species identification test, we detected M. tuberculosis. Conclusion: The highest burden of the disease was recorded among the male population in productive ages. The identification test for species of the complex showed all were M. tuberculosis. However, it is not possible to discard the presence of M. bovis in humans in Colombia. The differential identification of species should be done in risk groups and in areas where the circulation of this mycobacterium in cattle is known.

Infección diseminada por Bacilo Calmette-Guérin en un lactante con inmunodeficiencia: reporte de caso / Disseminated infection by Bacillus Calmette-Guérin in an immunodeficient infant: case report

RESUMEN La vacuna Bacillus Calmette-Guerin (BCG) que se administra a los recién nacidos de países con alta incidencia de tuberculosis puede ocasionar reacciones locales hasta infección diseminada en pacientes inmunocomprometidos. Reportamos el caso de un lactante varón de seis meses con antecedente de haber recibido vacuna BCG al nacer, y presentar cuadros infecciosos a repetición, nódulos violáceos blandos en tronco y extremidades con presencia de bacilos ácido alcohol resistentes (BARR) en la histopatología y en cultivo de piel; el estudio molecular reportó la presencia de Micobacterium bovis BCG. En la tomografía se observó opacidades intersticiales en pulmones y en el lavado gástrico se identificó BAAR. El estudio genético del paciente y de la madre reveló la presencia de mutación en el gen IL2RG confirmando el diagnóstico de inmunodeficiencia combinada severa, recibe tratamiento con inmunoglubolina humana y esquema antituberculosis con isoniacida, rifampicina y etambutol. Presentamos el caso por la implicancia en el pronóstico de vida de estos pacientes y por la necesidad de un diagnóstico preciso y oportuno.

ABSTRACT The Bacillus Calmette-Guerin (BCG) vaccine given to newborns in countries with a high incidence of tuberculosis may cause local reactions up to disseminated infection in immunocompromised patients. We report the case of a six-monthold male infant with a history of having received the BCG vaccine at birth, and presenting repeated infectious, soft violet nodules in the trunk and extremities with the presence of acid-alcohol-resistant bacilli (BAAR) in histopathology and skin culture; the molecular study reported the presence of Mycobacterium bovis BCG. In the tomography, interstitial opacities were observed in the lungs and in the gastric lavage BAAR was identified. The genetic study of the patient and the mother revealed the presence of a mutation in the IL2RG gene confirming the diagnosis of severe combined immunodeficiency. Received treatment with human immunoglobulin and anti-tuberculosis scheme with isoniazid, rifampicin, and ethambutol. We present the case because of the implication in the life prognosis of these patients and because of the need for an accurate and timely diagnosis

Mycobacterium bovis Osteitis Following Immunization with Bacille Calmette-Guérin (BCG) in Korea

BACKGROUND: Mycobacterium bovis Bacille Calmette-Guérin (BCG) osteitis, a rare complication of BCG vaccination, has not been well investigated in Korea. This study aimed to evaluate the clinical characteristics of BCG osteitis during the recent 10 years in Korea. METHODS: Children diagnosed with BCG osteitis at the Seoul National University Children's Hospital from January 2007 to March 2018 were included. M. bovis BCG was confirmed by multiplex polymerase chain reaction (PCR) in the affected bone. BCG immunization status and clinical information were reviewed retrospectively. RESULTS: Twenty-one patients were diagnosed with BCG osteitis and their median symptom onset from BCG vaccination was 13.8 months (range, 6.0–32.5). Sixteen children (76.2%) received Tokyo-172 vaccine by percutaneous multiple puncture method, while four (19.0%) and one (4.8%) received intradermal Tokyo-172 and Danish strain, respectively. Common presenting symptoms were swelling (76.2%), limited movement of the affected site (63.2%), and pain (61.9%) while fever was only accompanied in 19.0%. Femur (33.3%) and the tarsal bones (23.8%) were the most frequently involved sites; and demarcated osteolytic lesions (63.1%) and cortical breakages (42.1%) were observed on plain radiographs. Surgical drainage was performed in 90.5%, and 33.3% of them required repeated surgical interventions due to persistent symptoms. Antituberculosis medications were administered for a median duration of 12 months (range, 12–31). Most patients recovered without evident sequelae. CONCLUSION: Highly suspecting BCG osteitis based on clinical manifestations is important for prompt management. A comprehensive national surveillance system is needed to understand the exact incidence of serious adverse reactions following BCG vaccination and establish safe vaccination policy in Korea.

Mycobacteria in Minas cheese commercialized in open fairs in São Paulo, Brazil / Mycobacteria em queijos tipo Minas comercializados em feiras-livres de São Paulo, Brasil

Mycobacterium bovis is the causative agent of bovine tuberculosis, a disease that affects dairy herds throughout the Brazilian territory, constituting a neglected zoonosis transmitted by raw milk and its derivatives. In this study, we evaluated the presence of M. bovis and other mycobacteria in Minas cheese obtained from open fairs in the city of São Paulo between 2012 and 2013. Samples (n = 133) were decontaminated using hexa-cetylpyridinium chloride and seeded on Stonebrink­Leslie medium. The isolates were submitted to molecular identification by TB Multiplex PCR targeting the 16S rRNA gene and amplicon nucleotide sequencing. From 16 cheese samples (12%), we obtained 26 putative colonies of Mycobacterium spp, none of which belonged to any of the Mycobacterium tuberculosis, Mycobacterium avium, or Mycobacterium intracellulare complexes. Phylogenetic analysis showed that sample sequences were grouped in a clade that includes only non-tuberculous mycobacteria with proximity to sequences obtained from Mycobacterium novocastrense (3 sequences), Mycobacterium holsaticum (1 sequence), and Mycobacterium elephantis (2 sequences). Although no epidemiological evidence was found regarding the importance of oral transmission of mycobacteria in healthy people, their importance in the immunosuppressed population remains uncertain.(AU)

Mycobacterium bovis é o agente da tuberculose bovina, doença que acomete o rebanho em todo território brasileiro e é uma negligenciada zoonose transmitida pelo leite e seus derivados. Este trabalho avaliou a presença de M. bovise outras micobactérias, em queijo minas meia-cura, obtidos em feiras-livres na cidade de São Paulo, entre os anos de 2012 e 2013. As amostras (n = 133) foram descontaminadas pelo método HPC (hexa-cetyl-pyridinium chloride) e semeadas em meio Stonebrink Leslie. Os isolados foram submetidos à identificação molecular por PCR TB multiplex, pesquisando-se o gene 16S rRNA, e ao sequenciamento nucleotídico. Dezesseis amostras (12%) possuiam 26 colônias sugestivas de Mycobacterium spp, mas nenhuma delas pertencia aos complexos Mycobacterium tuberculosis, Mycobacterium avium e Mycobacterium intracellulare. A análise filogenética mostrou que todas as amostras estavam agrupadas em clados que incluem apenas micobactérias não tuberculosas (MNT), sendo que algumas possuiam proximidade com sequências obtidas de Mycobacterium novocastrense (3 sequências), Mycobacterium hosaticum(1 sequência) e Mycobacterium elephantis (2 sequências). Embora no momento não haja evidência epidemiológica da importância da transmissão oral das micobactérias pra indivíduos saudáveis, sua importância na população imunossuprimida ainda é incerta.(AU)