Causation of Crohn's disease by Mycobacterium avium subspecies paratuberculosis
Causation of Crohn's disease by Mycobacterium avium subspecies paratuberculosis
复制标题
DOI：
10.1155/2000/798305
复制
发表时间：
2000-06-01
影响因子：
2.7
通讯作者：
Sumar, N
中科院分区：
文献类型：
--
作者：
Hermon-Taylor, J;Bull, TJ;Sumar, N
副结核分枝杆菌亚种(MAP)是禽类复合体(MAC)的一员。它与其他MAC在基因上的不同之处在于，它有14到18个IS900拷贝和参与表面碳水化合物生物合成的单盒DNA。与其他MAC不同，MAP是包括灵长类动物在内的许多动物肠道慢性炎症的特定原因。这种疾病的范围从多杆菌到少菌，在人类中有像麻风一样的慢性肉芽肿性炎症。MAP感染可以持续数年而不会导致临床疾病。据报告，西欧和北美MAP感染的群体流行率在21%到54%之间。这些亚临床感染的动物将MAP从乳汁中散落到牧场上。MAP比结核病更强大，通过零售牛奶和家庭供水向人类传播的风险很高。MAP存在于一部分正常人的回结肠粘膜中，如果使用正确的方法，通过改进的培养系统和IS900聚合酶链式反应，可以在高比例的全层炎性克罗恩病肠道样本中检测到MAP。克罗恩病中的MAP以一种抗蛋白酶的非细菌形式存在，可以逃避免疫识别，并可能导致免疫失调。与其他MAC一样，MAP对大多数标准抗结核药物具有耐药性。使用利福布汀和克拉霉素等对MAC更有效的药物组合治疗克罗恩病可以带来深刻的改善，在少数情况下，可以明显根除疾病。需要针对动物和人类的新药以及有效的MAP疫苗。MAP造成的问题是一个悲剧性的公共卫生问题，迫切需要采取一系列补救措施。
Mycobacterium avium subspecies paratuberculosis (MAP) is a member of the M avium complex (MAC). It differs genetically from other MAC in having 14 to 18 copies of IS900 and a single cassette of DNA involved in the biosynthesis of surface carbohydrate. Unlike other MAC, MAP is a specific cause of chronic inflammation of the intestine in many animal species, including primates. The disease ranges from pluribacillary to paucimicrobial, with chronic granulomatous inflammation like leprosy in humans. MAP infection can persist for years without causing clinical disease. The herd prevalence of MAP infection in Western Europe and North America is reported in the range 21% to 54%. These subclinically infected animals shed MAP in their milk and onto pastures. MAP is more robust than tuberculosis, and the risk that is conveyed to human populations in retail milk and in domestic water supplies is high. MAP is harboured in the ileocolonic mucosa of a proportion of normal people and can be detected in a high proportion of full thickness samples of inflamed Crohn's disease gut by improved culture systems and IS900 polymerase chain reaction if the correct methods are used. MAP in Crohn's disease is present in a protease-resistant nonbacillary form, can evade immune recognition and probably causes an immune dysregulation. As with other MAC, MAP is resistant to most standard antituberculous drugs. Treatment of Crohn's disease with combinations of drugs more active against MAC such as rifabutin and clarithromycin can bring about a profound improvement and, in a few cases, apparent disease eradication. New drugs as well as effective MAP vaccines for animals and humans are needed. The problems caused by MAP constitute a public health issue of tragic proportions for which a range of remedial measures are urgently needed.