ZoonoticTuberculosis in India p`aNaIjanya xayaroaga

ZoonoticTuberculosis in Indiap`aNaIjanya xayaroaga

Dr. Ashok Kale M.D.(Community Medicine )

Mob : 9406109410

[email protected]@gmail.com

1ABSENCE of Opportunity is CHARACTER

mailto:[email protected]

Yearwise Tuberculosis mortality and different interventions

ABSENCE of Opportunity is CHARACTER 2

Times of India ,Nov 8, 1996.Dr. Ashok Kale & Dr. S. V. Gore wrote:1.Tuberculin Test + vity has a special relevance in animals.2. In tub. animals majority (80 %) have lung tub.3.Only 1% of tub. Animals have lesions in milking part mastitis (udder)4.Animals shed tubercle bacilli through exhaled air and faeces (gober).5. In Indian rural household animals and human stay under one roof.6. South African study – INH cures Tub. Of Animals.


National Medicos Organisation’s resolution , Jan 1997- Tiru.

• Zoonotic aspect of pulmonary tuberculosis needs to be attended by controlling tuberculosis in animals, especially cattle to protect the rural people staying with animals under one roof.

• District Tuberculous Centres should coordinate with the Veterinary department.

• GOI should initiate necessary action in this regard.


TAI’s Nagpal’s letter 1997


Views of Vice-chairman of TAI(1997)

1.Report of RTC, TT testing etc is now history2.Invariable boiling of milk practice can not

cause Zoonotic Tub, even if there are tub.cows

3. Cross reaction due to non-tub mycobacteria4.Culture of samples did not yield M.bovis. I(Nagpal) know all this does not mean we

should ignore this (ZTB) issue.


Dr. Kale Ashok*, Dr. Deshpande Shailesh, Dr. Gore

• Medico Friends Circle Bulletin – Jan-Feb 2000

Can Human Tuberculosis be Controlled in India Without Control of TB in Domestic Animals ?


Understanding tubercle bacillus, some queries to the audience.

1. Why bovine bacillus was taken by Dr. Albert Calmette for human vaccine (BCG) development?

2. Why we cannot differentiate by observing Tuberculin reaction the type of causative organism ,i.e. human or animal (bovis) ?

3. Why there is cross immunity? 4. If M. bovis & M.tuber. are 2 species , how can

they have cross immunity ?5. Are they different species or variants of same

species?


Tubercle Bacillus Infection & Tuber . In Man & Animals- Dr.Calmette , 1923


Tuberculosis in Animals and Man- Francis, 1957


Bovine Tub control in Man & Animals- Dr. Steele & Myers, 1971 , USA


Steele and Myers from USA

• Tuberculin and it’s use :• Dr. Robert Koch– 1890• Russia – Guttman, Denmark- Bang• On postmortem they found– reacting animals

had TB in one or more organs.


Tuberculin Test studies

• Pearson’s study in 1891 (USA)• Tested 80 cattle – reacted 30 – PM showed TB

lesions• Russel, Europe, 1892-- 30 tested--26 +ve


Tuberculin Test in Human

• Ghon- 1908-12- PM of 183 children who during lifetime had no evidence of Tuberculosis except TT positivity.

• Children had died of Nontuberculous conditions.

• Except one ,all had tuberculous lesions.• He had done the study to test the specificity

of Pirquet’s belief.


Francis– What happens in cattle after infection of tub bacillus?

• Unlike human ,Primary tuberculous infection in cattle –

*Lesions do not heal, progressive TB.

* In man – large population reacts to the tuberculin test but does not spread infection.

*But in cattle – All T.T. positive are INFECTIOUS, verified by Bang, Pearson and other veterinarians.


Veterinary pathology

• Lesions in the dog – Three- quarters of natural cases of infection- Caused by human type of bacillus.• The disease runs a progressive course in the

dog.• One rarely encounters healed TB in PM

examinations.


True meaning of the term-- Bovine Tuberculosis

• Strictly ,this term should only be used to refer to tuberculosis in cattle , but is often used to denominate tuberculosis caused by bovine strains irrespective of the host.

• --- Bovine tubercle bacilli and disease in animals and man, Epidem Inf (1987), 92, 221-234. Grange & Collins.


Grange J.M. and Collins, Epidem Inf. (1987), 92, 221-- 234 , Bovine tubercle bacilli and disease in animals and man

• As in man, in animals ,the lung is the usual site of disease, and spread of infection occurs by the respiratory route. Although milk is the principal vector for transmission of infection to man, disease of the udder relatively uncommon, effecting only about 1% of tuberculous cows.


(BMJ,Oct.24,1908).Why TT +ve cattle are called infectious?

• Dr. E. C. Schroeder, of the Department of Agriculture, Washington, read a paper on his investigations,( International Congress on Tuberculosis held in Washington, September, 1908 )

• About 40 per cent of cattle apparently healthy, and known to be tuberculous only because they had reacted with tuberculin, intermittently passed tubercle bacilli with their faeces.

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When a number of such cattle were kept under continued observation, the

percentage that expelled tubercle bacilli per rectum was found to double in about eighteen months; and both the frequency

with which bacilli occurred and the number found in individual animals also

showed an increase. Among twelve cows, bacilli in the faeces were at first found in five, but before the end of two years the

number had risen to ten.ABSENCE of Opportunity is CHARACTER 20

Tople wilson Bacteriology

• Response of Bacteria to the Environment (Section B) :

Bacteria flourish in physical environments that differ widely.

Bacteria prove to be the most ADAPTABLE of the living organisms in their modes of

obtaining energy for growth.


Tople wilson Bacteriology

• May alter their phenotype in response to environment change while the genotype remains unchanged.

• Mutant cell with a temporary selective advantage can over grow a population of unaltered cells within a few hours.

• If cells are examined on times scales that permit many generations, what is in reality genotype variation may appear to be phenotypic variation.


The Bacteriology of Tuberculosis, Ergons Darzins,

Univ. of Minnesota, 1958, Chapter XXI, 273 – 286.

• Pathogenicity is the disease-producing property of microorganisms.

• Virulence expresses the degree of pathogenicity of bacilli.


Do Fixed Types of Tubercle Bacilli Exist?

Chapter XXI ,


Price’s (1932), study of the incidence of bovine tub infection in same region of Canada

Number Percentage Bovine infection

Children 286 14.1

Adult 168 3.5


Rich,1951- “very curious phenomenon”

Number Percentage bovine

Children 877 22.2

Adult 1330 2.2


Explanation of supporters of the theory of stable types of bacilli

• Generally children are more frequently exposed to bovine infection than adults, because milk is the chief food of children,

• That the resistance of adults to tuberculous infection is greater than that of children


But

• These hypotheses are insufficient to explain why the bacillus of bovine type disappears from the human body and why the bacillus of human type takes its place when the infected child develops into a tuberculous adult.


Another explanation?

• The theory of the superinfection with bacilli of human type cannot explain this phenomenon; *Consequently, it is necessary to seek a different answer to the problem.


Jensen and Frimodt-Moller (1936)-Change of types

• Described seven strains of tubercle bacilli, all of low virulence for rabbits, as bacilli of human type.

• In all seven cases the authors• were able to cultivate bacilli of the

bovine type from rabbits inoculated with these strains.


Interesting history of strain 1832

Jensen and Frimodt-Moller (1936b). This strain of human type was cultured from

urine and grew dysgonic, being virulent for guinea pigs and only slightly virulent for rabbits and calves. The passage of this strain through a rabbit produced a typical bovine type bacilli. This transformation of the original human type into a bovine type of bacilli was performed seven times.


Conclusion ofJensen and Frimodt-Moller

The appearance of bovine type of bacilli was the

result of the transformation of the original human type of bacilli into the bovine type within the rabbit organism.


Pinner (1935)

• by means of passages through guinea pigs succeeded in transforming two strains of nonpathogenic acid-fast bacilli, isolated from tuberculous patients, into bacilli producing typical tuberculosis in guinea pigs


Smithburn (1939)

• restored the virulence of attenuated bovine and human types of bacilli by serial transfer of these strains to rabbits and by serial brain-to-brain passages through guinea pigs.


RTC-(Griffith )

• tubercle bacilli derived from cases of human pulmonary tuberculosis, discovered cultures consisting of a mixture of both the human and bovine types of bacilli.

• out of 1,068 cases studied, 5 were mixtures of bovine and human types of bacilli.


Griffith gives two reasons

1. Transformation, within the human body, of one type of bacilli into another

OR

2. Later association of another type of bacilli with the already existing infection


British Medical Journal, March3, 1934,371, Walker

• Discussion :-• It has been suggested that mutation of type

occurs in the human body, so that an • infecting bovine organism after

many years in human tissues acquires the characteristics associated with human type bacilli, and becomes manifest as such in chronic pulmonary tuberculosis in adults.


British Medical Journal, Aug 15, 1936,pg 324-325.John Blacklock ,

Tuberculosis in Infancy and Childhood.

• The immunity from childhood infection – It seems certain, from my figures that tub

infection in the child under 3 years is serious, and should , if possible, be prevented.


British Medical Journal, Aug 15, 1936,pg 324-325.

John Blacklock

• Tuberculin-positive children more frequently develop fatal phthisis in later life than those who react negatively


British Medical Journal, Aug 15, 1936,pg 324-325.John Blacklock

• After many years' sojourn in the tissues it may mutate to a more pathogenic form or even to a human type. Calmette himself thought it possible that in naturally occurring bovine infections in man, mutation to the human type after a time was possible, and might be the cause of pulmonary tuberculosis.


Bovine and Human Tuberculosis– Prof.Orth, BMJ ,1913



Rabinowitsh, The transmission of Tuberculosis through Domestic animals, Amer Rev

Tuber,1927,v.15,419-428

Author believes that it is not impossible for the biological

properties of the various types of bacilli to alter while in the human

body- the bovine becoming converted into the human.


Book. --Tubercle Bacillus Infection AND Tuberculosis in

Man & Animals, Dr. Albert Calmette , 1923, page 294. • We are not justified in inferring the duality of

human and bovine tuberculous bacillus.• These types differ one from another only because

they have more or less adapted themselves, through a series of successive cultural generations to a human or bovine environment.

• And it cannot be conceived to constitute special types.

• In all of these we have to do with the same bacillus.


Book. --Tubercle Bacillus Infection AND Tuberculosis in

Man & Animals, Dr. Albert Calmette , 1923, page 294.

• Many efforts have been made in a variety of ways to convert what by agreement is called the human type into the bovine type, for example by inoculating successively the same virus from man to cattle, then from cattle to cattle or through an intermediate stage in the goat. It would seem that in a few cases partial success has been attained.


Zoonoses


Dung of Tuberculous animal

Milk Borne diseases, Douglas, BMJ, July 30 ,1932 , 198 – 200.

• Frequently such animals excrete large number of tubercle bacilli in the faeces.

• virulent bovine tubercle have been recovered from cow manure after one year, from a lump of cow dung for upwards of two years, and even from the effluent of a drainage system of the septic tank type

47

Mode of Infection from Cattle to Human

• Magnussen emphasizes the danger children run when they play in infected cowsheds.

• Infection between cattle generally occurs by the airborne route. The most infectious particle is a recently exhaled moist droplet containing a few bacilli. Tubercle bacilli are not only excreted by bovines with open pulmonary lesions but also by those in the initial period .


Tuberculous Mastitis


U.S.A. agri 1957 book- Tuberculosis and its eradication


US agriculture yearbook 1957

*When they swallow the tub sputum, the tubercle bacilli in it are passed unchanged through the intestines, and their dung is extremely infectious.*In animals, the organs most commonly affected are lungs.


US agriculture yearbook 1957The death rate from tuberculosis was 150 per 100,000 population in 1918. The rate came down to 15 per 100,000 in 1952.The eradication of bovine tuberculosis must be recognised as a factor in this improved condition.


Exploring PCR technology veterinarian , June 1997,

Striking homologies at genomic level between M.tuberculosis and M. bovis made it very difficult to differntiate between the two by PCR based methods.


Tuberculosis,(2001),81,71-77, J.M.Grange• Strictly speaking, all strains within this

(M.tuberculosis complex) complex should be regarded as belonging to a single species but , for convenience, the separate specific names M.tuberculosis M.bovis were proposed in 1970.


Veterinarians established facts• 1. T.T. stands alone in the determination of TB in

animal’s body.• 2. Herditary predisposition of a animal breed has

no significance.• 3. Tubercle bacilli are not ubiquitous. They are

present only in places where tuberculous animals (or human beings) live.

• 4.Digestive tract is the most common portal of entry .

• 5.The ratio between the tuberculous mortality for the TT reactors :non-reactors was 38:1 (children) 55ABSENCE of Opportunity is CHARACTER

Dr. Robert Koch , died in 1910

• Koch’s convictions that bovine tuberculosis is different from human tuberculosis, and that it “does not seem advisable to take any measures against bovine tuberculosis,” were most striking, because they were diametrically opposed to the opinions which he had held before.


Koch*Koch defended his new views with extreme tenacity.* At a special meeting of the International Tuberculosis Congress at Washington in 1908, he rejected the evidence of the British Tuberculosis Commission on the existence of types of intermediate and unstable pathogenicity as well as the arguments of Calmette, Fibiger, Ravenel, Dorset, and others who defended the possibility of the evolution of types.


Unequal Vertical split,(274)

• The Washington International Tuberculosis Congress split the tuberculosis workers into two unequal groups:

• The great majority followed Koch and accepted the existence of different constant types of tubercle bacilli, responsible for tuberculosis in humans, bovines, and birds. This was the beginning of the reign of the dogma of types in tuberculosis bacteriology.

• The scientists of the opposite camp, who regarded the types, varieties, and intermediate forms as links between the evolving forms, remained a small minority.


Thank you.



Studied Answers

1. M. bovis and M. tuberculosis( human )are not two species . They are one. (conclusion of Royal Tub Com. in 1911)

2. They are antigenically 99.95 % similar.3. There is difference in virulence. 4. Many scientists ,including Calmette , Jenson (L-J

media), Dorset (culture media)believed that Bovis gets transformed (converted) into M. tuberculosis after a prolong stay in human body.


Trends after Th.smith

274- To designate differences in origin and virulence of tubercle bacilli, Koch accepted the term “type” proposed by Kossel but emphasized that to him this term is no better than the word “variant” or any other name.


Conclusions.

Final years’ work toward the typing of tubercle bacilli has shown the

inconstancy of the types, and in a great many cases impossibility of

differentiating them.


Conclusions

Facts are not compatible with the opinion of Th. Smith and the final views of Koch on the constancy of

the types of tubercle bacilli.A return to the early unitary concept

is necessary.


Conclusions

The bacilli of “bovine type” are those with high virulence to experimental

animals and more frequent in bovines than in humans; the bacilli of

the “human type” are bacilli less virulent to experimental animals than the bovine ones and more common

in humans than in bovines.


Real Situation in India as stated by one French doctor 94 years back.

• “The authority of Koch, which proclaims the nontransmission of bovine tuberculosis to human beings, has for too long proved a fatal illusion to consumers, has excused administrative indifference, and has encouraged frauds in every country.”

• Source - JULY II, 1914, BMJ, 75, DR. LASSANLIIRE,Chef do Laboratoire A la Facul$t de ihidecine de Paris., April 29th.


2001 understanding


saMixaPt mao vaO&ainak sa%ya

1. baaovaIsa AaOr Tyaubar@yaulaaosaIsa xayaijavaaNaU ko dao $p hO.

2. xayaraogaI gaaovaMSa gaaobar AaOr saaMsa sao xayaijavaaNa U]%saija-t krta hO.

3. Tyaubar@yaulaIna TosT sakara%mak Aanao ka Aqa- hO pSaU saaMsaiga-k hO.

4.baaovaa[-na TIbaI ka Aqa- pSauxaya hO naa kI baaovaIsa xayaijavaaNaU ko karNa huvaa xayaraoga.

5.gaaovaMSa mao xayaraoga p`gatISaIla haota hO.

6. xayainayaM~aNa ko ivanaa gaaovaMSa SauwIkrNa AsaMBava hO.


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ZoonoticTuberculosis in India p`aNaIjanya xayaroaga