Presence of Mycobacterium avium subsp. paratuberculosis (MAP) in Brazilian patients with inflammatory bowel diseases and in controls / Presença de Mycobacterium avium subsp. paratuberculosis (MAP) em pacientes brasileiros com doença inflamatória intestinal e em controles

CONTEXT AND OBJECTIVE: Mycobacterium avium subsp. paratuberculosis (MAP) has attracted the interest of researchers because of similarities between paratuberculosis and Crohn's disease (CD). The aim of this study was to evaluate the frequency of MAP through cultures, histology and polymerase chain reaction (PCR) on intestinal biopsies from Brazilian CD patients. Quantitative real time PCR (qRT-PCR) was performed on positive samples. DESIGN AND SETTING: Analytical cross-sectional study with control group at two federal universities. METHODS: Fresh samples were collected from 25 patients; five with CD, eight with ulcerative colitis (UC) and 12 controls with non-inflammatory bowel disease (nIBD). Formalin-fixed paraffin-embedded (FFPE) samples from 143 patients were also collected: 44 CD, 49 UC and 56 nIBD. RESULTS: None of the fresh samples was positive for MAP. Five FFPE samples (one CD, two UC and two nIBD) and three fresh samples (one in each group) were positive through IS900-PCR. qRT-PCR was performed on these eight samples. Among the FFPE samples, there were 192.12 copies/μl in the CD group, 72.28 copies/μl in UC and 81.43 copies/μl in nIBD. Among the fresh samples, there were 432.99 copies/μl, 167.92 copies/μl and 249.73 copies/μl in the CD, UC and nIBD groups, respectively. The highest bacterial load was in the CD group. CONCLUSION: This study does not provide evidence for a role of MAP in the etiology of CD, although MAP DNA was detected in all three patient groups. This is the first report of MAP presence in human intestinal biopsies in Brazil.

CONTEXTO E OBJETIVO: Mycobaterium avium subsp. paratuberculosis (MAP) tem atraído o interesse de pesquisadores devido às semelhanças entre a paratuberculose e a doença de Crohn (CD). Este estudo objetivou avaliar a frequência de MAP por meio de cultura, histologia e reação da polimerase em cadeia (PCR), em biópsias intestinais de pacientes brasileiros com CD. PCR quantitativa em tempo real (qRT-PCR) foi realizada nas amostras positivas. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com grupo controle realizado em duas universidades federais. MÉTODOS: Amostras frescas foram coletadas de 25 pacientes; cinco com CD, oito com colite ulcerativa (UC) e 12 controles sem doença inflamatória intestinal (nIBD). Também foram coletadas 149 amostras fixadas em parafina (FFPE): 44 CD, 49 UC e 56 nIBD. RESULTADOS: Nenhuma das amostras frescas foi positiva para MAP. Cinco amostras FFPE (uma CD, duas UC e duas nIBD) e três amostras frescas (uma de cada grupo) foram positivas por IS900-PCR. qRT-PCR foi realizada nessas oito amostras. Nas amostras FFPE, havia 192,12 cópias/μl no grupo CD, 72,28 cópias/μl no UC e 81,43 cópias/μl no nIBD. Nas amostras frescas, havia 432,99 cópias/μl, 167,92 cópias/μl e 249,73 cópias/μl nos grupos CD, UC e nIBD, respectivamente. A maior carga bacteriana foi encontrada no grupo CD. CONCLUSÃO: Este estudo não fornece evidências do papel de MAP na etiologia da CD, embora DNA de MAP tenha sido detectado em pacientes dos três grupos. Este é o primeiro relato da presença de MAP em biópsias intestinais humanas no Brasil.

Cytokine gene expression and molecular detection of Mycobacterium avium subspecies paratuberculosisin organs of experimentally infected mice / Expressão de citocinas e detecção molecular de Mycobacterium avium subspecies paratuberculosis em órgãos de camundongos infectados experimentalmente

Mycobacterium avium subspecies paratuberculosis (MAP) can infect ruminants and remain subclinical for long periods within herds. The identification of organs that are more susceptible to infection and the evaluation of cytokine expression at the site of infection are important to understand the pathogenesis of MAP. In this study, the probability of detection of MAP-DNA and the expression of cytokines in organs of C57BL/6 mice infected intraperitoneally for 120 days were evaluated. Among the evaluated organs, the spleen (85%), colon (75%) and liver (60%) had the highest frequency of positivity. When compared these frequencies between organs, it has been found that the spleen had 1.54 times as likely to be positive in relation to the ileum, and 2.0 times more likely in relation to the Peyer's patches. In addition, at 60 days post-infection, the spleen and the liver were responsible for upregulation of IFN-γ , and the ileum by TNF-α and IL-4. The results indicate that the spleen is the best organ for evaluating an experimental infection by MAP, especially in the initial stages of the infection. Moreover, it showed that the spleen, liver and ileum have a direct role in the inflammatory response in experimental models.

Mycobacterium avium subespécie paratuberculosis (MAP) pode infectar ruminantes e permanecer subclínica por longos períodos nos rebanhos. A identificação de órgãos mais susceptíveis à infecção e a avaliação da expressão das citocinas no local da infecção são importantes para compreender a patogênese de MAP. Neste estudo foi avaliada a probabilidade de detecção de DNA de MAP e a expressão de citocinas em órgãos de camundongos C57BL/6 infectados por via intraperitoneal durante 120 dias. Dentre os órgãos avaliados, o baço (85%), cólon (75%) e fígado (60%) tiveram as maiores frequências de positividade. Quando comparadas essas frequências entre os órgãos, verificou-se que o baço teve 1,54 vezes mais probabilidade de ser positivo em relação ao íleo, e 2,0 vezes mais probabilidade em relação às placas de Peyer. Além disso, aos 60 dias pós infecção, o baço e o fígado foram responsáveis pela maior expressão de IFN-γ e o íleo pela TNF-α e IL-4. Os resultados indicam que o baço é o melhor órgão para avaliar uma infecção experimental por MAP, principalmente nos períodos iniciais da infecção. Além disso, demonstrou que o baço, fígado e íleo têm importância direta na resposta inflamatória de modelos experimentais.

Mycobacterium avium subsp paratuberculosis y enfermedad de Crohn: evidencias de una zoonosis / Possible association between Mycobacterium avium subsp paratuberculosis infection and Crohn's disease

Paratuberculosis is a chronic intestinal disease of animals caused by Mycobacte-rium avium subsp. paratuberculosis (MAP), which has some pathological features similar to Crohn's disease (CD) in humans. The presence of MAP in food for human consumption and in affected tissues of patients with CD has been detected. Therefore, a causal association between this microorganism and the disease in humans, has been postulated. However, several related studies have failed to confirm this hypothesis and the scientific acceptance of MAP as a zoonotic agent remains controversial. This review presents the main findings related to this issue, contrasting evidences for and against an association between MAP and CD. The need to promote national studies focusing on this area is suggested.

A seroepidemiological survey of mycobacterium avium subsp. paratuberculosis in sheep from North of Portugal / Rastreio seroepidemiológico de mycobacterium avium subsp. paratuberculosis em ovinos no Norte de Portugal

The aim of this study was evaluate the risk factors for Mycobacterium avium subsp. paratuberculosis (Map) seroprevalence in sheep in the North of Portugal. The effects on seroprevalence of several variables such as individual characteristics, management practices, farm characteristics, animal health, and available veterinary services were evaluated. This information was then used in a multivariable logistic regression model in order to identify risk factors for Map seropositivity. Univariable analysis was used to screen the variables used in the logistic regression model. Variables that showed p values of <0.15 were retained for the multivariable analysis. Fifteen variables were associated with paratuberculosis in univariable analysis. The multivariable logistic regression model identified a number of variables as risk factors for seropositivity like sheep pure local and/or a cross of a local breed (OR=2.02), herd size with 31-60 head (OR=2.14), culling during the Spring-Summer season (OR=1.69) and the use of an anti-parasitic treatment such as Ivermectin as the only anti-parasitic medication (OR=5.60). Potential risk factors identified in this study support current recommendations for the control of paratuberculosis.

Neste trabalho efectuou-se o estudo dos factores associados à seroprevalência da infecção ovina por Mycobacterium avium subspecies paratuberculosis (Map). Foram investigadas variáveis como as características individuais, práticas de maneio, características da granja, saúde animal e intervenções de sanidade efectuadas no animal. A análise multivariada de regressão logística foi usada para identificar estes factores associados com a seroprevalência da infecção. De acordo com os resultados da análise univariada associaram-se, com o resultado positivo à infecção (p<0,15), 15 variáveis. Após a aplicação do modelo de análise multivariada encontraram-se quatro factores de risco com significância estatística: rebanhos de raças autóctones e seus cruzamentos (OR=2,02); tamanho do efectivo entre 31-60 animais (OR=2,14); época de abate na Primavera-Verão (OR=1,69); uso de ivermectina como único antiparasitário (OR=5,60). Os potenciais factores de risco identificados neste estudo suportam as recomendações currentes para o controlo da paratuberculose.

Infecciones en la patogenia de la enfermedad inflamatoria intestinal / Infections in the pathogeny of inflammatory bowel disease

La enfermedad inflamatoria intestinal (EII) es una entidad compleja. Su desarrollo requiere de la interacción entre factores ambientales y la flora gastrointestinal, en un individuo genéticamente susceptible. Nuestro aparato gastrointestinal es un extraordinario, complejo y dinámico modelo de simbiosis o mutualismo con la flora. Los factores ambientales como el tabaco, las infecciones gastrointestinales y los antiinflamatorios no esteroidales juegan probablemente un rol iniciador y/o modificador de la enfermedad. La mucosa intestinal tiene la difícil tarea de limitar la respuesta inflamatoria contra la flora y de mantener la habilidad de generar una respuesta inmune contra los microorganismos patógenos. Esto crea una relación de equilibrio dinámico y frágil que al alterarse cualquiera de sus componentes puede generar un proceso inflamatorio. Existe evidencia que las infecciones pueden tener un rol tanto en el inicio de la enfermedad como en las reagudizaciones de ésta. Es así como las infecciones bacterianas gastrointestinales agudas y la Escherichia coli adherente invasora confieren un riesgo para desarrollar una enfermedad inflamatoria intestinal. Para Mycobacterium avium subespecie paratuberculosis (MAP) sólo se ha establecido una asociación y no un rol patogénico. Por último ha aumentado la incidencia y morbimortalidad de la infección por Clostridium difficile en los pacientes con EII.

Infections in the pathogeny of inflammatory bowel disease Inflammatory bowel disease (IBD) is a complex entity. Its development requires the interaction between environmental factors and gastrointestinal flora in a genetically susceptible subject. Our gastrointestinal tract is an extraordinary, complex and dynamic model of symbiosis or mutualism with the flora. Environmental factors such as tobacco, gastrointestinal infections and non-steroidal anti-inflammatory drugs might play a role of starter and/or modifier of the disease. The intestinal mucosa has the difficult task of limiting the inflammatory response against the flora and of keeping the capability of generating an immune response against pathogenic microorganisms. This creates a dynamic equilibrium relation that is fragile, and that when any of its components is altered, it can cause an inflammatory process. There is evidence that infections can have a role both in the beginning and in the episodes of New-Rebounds of the disease. Therefore, acute gastrointestinal bacterial infections and adherent-invasive Escherichia coli pose a risk of developing an inflammatory bowel disease. In the case of Mycobacterium avium subspecies paratuberculosis (MAP) an association has been established, but not a pathogenic role. The incidence and morbimortality of Clostridium difficile infection has increased in patients with IBD.

Strain diversity within Mycobacterium avium subspecies paratuberculosis — A review.

Mycobacterium avium subspecies paratuberculosis (MAP), is the etiological agent of Johne’s disease (or paratuberculosis) in animals and has also been linked with Crohn’s disease of human beings. Extreme fastidious nature of the organism (MAP) has hampered studies on diversity within the organism. Studies based on phenotypic properties like growth rate, pigmentation, lipid profile etc., are unable to provide complete information on diversity of MAP organism in nature. However, with the advent of molecular assays (IS900 RFLP, PFGE, IS1311 PCR-REA, SSR typing, VNTR typing etc.) in last 2 decades, progress has been made to differentiate MAP strains. MAP isolates have been classified into various types and subtypes using these molecular tools. Optimization of these typing assays has led to generation of new information about MAP strains, subtypes, their comparative genomics, relative evolution, comparative virulence etc. Knowledge of strain diversity is important for better understanding of molecular and sero-epidemiology, infection and patho-biology, vaccine development and planning control strategies. The present review provides available information on MAP strains, host adaptations, their virulence, comparative genomics, relative genetic evolution and differentiation.

Infección por Mycobacterium avium subsp. paratuberculosis en un rebaño criollo limonero / Mycobacterium avium subsp. paratuberculosis infection in a criollo limonero herd

El objetivo de este estudio consistió en definir, analizar y evaluar la situación de un rebaño Criollo Limonero elite en relación a la paratuberculosis bovina. La investigación se llevó a cabo utilizando las variables epidemiológicas y el análisis de muestras (leche y suero) mediante inmunoensayo enzimático (ELISA) comercial. Posteriormente, se tomaron como base estos resultados y utilizando otras herramientas diagnósticas como la exploración clínica, tinción directa, cultivos, identificación mediante ensayo de reacción en cadena de la polimerasa (PCR) y estudio histomorfológico, todas ellas dirigidas a confirmar el estado de la infección. Los resultados permiten aseverar la existencia de infección por Mycobacterium avium subsp. paratuberculosis (MAsP) en tasas de positividad variable. La técnica de ELISA mostró alta capacidad en la identificación de animales subclinicamente afectados, lo que demuestra su potencial como prueba primaria de diagnóstico en el establecimiento de futuros programas de control. La técnica de amplificación por PCR reveló la presencia de genoma de subespecies de Mycobacterium avium, lo cual apoya fuertemente la presunción de infección en estos animales por MAsP, pese a la imposibilidad de lograr claras evidencias clínicas, clinicopatológicas, microbiológicas e histopatológicas que permitieran corroborar este dictamen. La estrecha correlación entre los resultados de ELISA y PCR, ratifica no sólo la confirmación diagnóstica, sino también validan los datos obtenidos a través de la prueba serológica.

The purpose of this research was to define, analyze and evaluate the situation of an elite Criollo Limonero herd related to bovine paratuberculosis. The investigation was carried out using the epidemiological variables and samples analysis (milk and serum) through a commercial enzyme immunoassay (ELISA). The results of the above test were taken as a foundation to use other diagnostic tools, such as clinical examination, direct staining, bacterial culture, identification through polymerase chain reaction (PCR) and histopathologic studies, to find out the status of the disease. The results allowed asserting the infection by the presence of Mycobacterium avium subsp. paratuberculosis (MAsP) in positive variable rates. The ELISA technique showed high capacity in identification of the sub clinical affected animal, which proved its potential as a diagnostic primary test in the establishment of future control programs. The PCR amplification revealed Mycobacterium avium subspecie genome presence, which lead to predict these animals infection by MAsP, in spice of the impossibility to accomplish clear clinical, clinic pathologic, microbiologic and histopathologic evidences that allowed corroborating the diagnosis. The narrow relation between ELISA and PCR results ratified not only the diagnostic confirmation, but also they validated the data collected through the serological test.

Paratuberculosis in a dairy Gyr herd in the State of Paraíba, Brazil / Paratuberculose em um rebanho Gir leiteiro no Estado da Paraíba Brasil

This paper describes the clinical, pathological, and microbiologic aspects of paratuberculosis (Johne's disease) in a dairy Gyr herd in the State of Para�ba, northeastern Brazil. An eight years old cow with chronic unresponsive diarrhea was clinically examined and euthanized for pathological evaluation. Fecal samples from all 160 animals over 12 months of age from the herd were collected for isolation of Mycobacterium avium subsp. paratuberculosis. Clinically, the index case cow was severely dehydrated, cachectic, with profuse mucous diarrhea. The main post-mortem findings were emaciation and thickened intestinal wall. Microscopically, the intestinal lamina propria and submucosa were infiltrated by macrophages, epithelioid cells, and Langhans giant cells with numerous alcohol-acid resistant bacilli in the cytoplasm. Two fecal samples displayed growth in slants of Herrold's egg-yolk agar supplemented with mycobactin J, 150 days after incubation. No growth was noticed in slants without mycobactin J. Microscopic examination of the isolated microorganisms stained by Ziehl-Neelsen revealed considerable amounts of alcohol-acid resistant bacilli, morphologically compatible with Mycobacterium spp. Based on the clinical signs, gross and histological lesions, growth time, bacterial morphology in Ziehl-Neelsen staining, and dependence of mycobactin J, the first diagnosis of paratuberculosis in Zebu cattle was made.

Objetivou-se descrever os aspectos clínicos, anátomo-histopatológicos e microbiológicos da paratuberculose em um rebanho Gir leiteiro no Estado da Paraíba. Uma vaca de oito anos que apresentava diarréia persistente, refratária a tratamento foi necropsiada para estudo anátamo-histopatológico. Também foram coletadas amostras de fezes de todos os 160 animais do plantel, com idade superior a 12 meses, para tentativa de isolamento de Mycobacterium avium subsp. paratuberculosis. Ao exame clínico, o animal caso índice apresentou caquexia, diarréia profusa e desidratação grave. À necropsia, o animal apresentou-se emaciado e, ao exame detalhado do trato digestivo, foi observado espessamento da parede e superfície mucosa do íleo e intestino grosso. À microscopia, verificou-se intensa infiltração de macrófagos espumosos associado a raras células epiteliódes e gigantes do tipo Langerhans na lâmina própria e submucosa. À coloração de Ziehl-Neelsen foram observadas miríade de bacilos álcool-ácido resistentes no citoplasma destas células. Houve crescimento de colônias bacterianas em duas das 160 amostras de fezes após 150 dias de incubação em tubos com meio Herrold's egg-yolk suplementados com micobactina J e ausência de crescimento nos tubos com mesmo meio, mas sem suplementação. Os microrganismos isolados foram corados pelo Ziehl-Neelsen observando-se presença de grande quantidade de bacilos álcool-ácido resistente, com morfologia compatível ao gênero Mycobacterium. Baseado na história clínica, achados anátomo-histopatológicos e histoquímicos (Ziehl-Neelsen), e microbiológicos, firmou-se o primeiro diagnóstico de paratuberculose em Zebu na Paraíba.