Zoonotic tuberculosis-a call for an open One Health debate.
Zoonotic tuberculosis-a call for an open One Health debate.
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人畜共患结核病——呼吁开展一场公开的“同一个健康”辩论。
DOI：
10.1016/s1473-3099(20)30166-3
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Zumla A
中科院分区：
文献类型：
--
作者：
Zumla A
结核病是由结核分枝杆菌复合体（MTBC）细菌引起的，对人类和动物种群都有影响。适应动物的MTBC威胁着人类、动物及其生计的福祉。世卫组织年度结核病报告估计，全球有143,000例人畜共患结核病（zTB）新病例，其中12,300例死亡是由牛分枝杆菌引起的(1)。zTB的流行率估计是不准确的，因为常规实验室检测无法区分由人类和动物适应的MTBC物种引起的感染，包括新成员，如水稻分枝杆菌(2)。因此，zTB对人类结核病流行的真正影响仍不清楚。准确的疾病鉴别也很重要，因为牛分枝杆菌普遍对吡嗪酰胺（一种关键的一线结核病药物）耐药。zTB通过食用未经巴氏消毒的奶制品获得，或者通常通过直接接触受感染的牲畜或内脏获得(3)。zTB的真正野生来源仍然未知(4)。MTBC菌株能够在家畜和其他宿主物种之间传播，特别是维持牛分枝杆菌。牛结核病通常与集约化管理的家畜、圈养和半圈养或围栏野生动物或适应人类驯化农业景观的野生动物有关(5)。虽然正在努力根除牲畜感染的牛结核病，但其他宿主仍然对控制规划构成威胁。这些动物包括欧洲獾、帚尾负鼠、雪貂、野猪、水牛、野猪、麋鹿和白尾鹿。牛结核病通过损失生产和控制成本造成经济损失，对牲畜贸易造成障碍，并阻碍保护工作。目前，非洲关于牛分枝杆菌的辩论受到南非和埃塞俄比亚等国家的区域重要性的影响，这些国家的养牛业集约化程度较高。像荷斯坦弗里西亚这样的进口牛把欧洲的牛支原体带进了它们的国家牛群。这是反对强化的理由。在没有生物安全保障的情况下加强工作，忽视具有高度抗灾能力的畜牧部门，对畜牧业系统来说仍然是目光短浅的做法，并会阻碍牛结核病控制规划。接触率和种群密度是动物适应MTBC进化的主要驱动因素。牛分枝杆菌感染和野生动物结核病很少在自然生态系统中表达，混合系统中本地牛的低患病率的经验表明，这不一定是一个问题，尽管有风险报告(7)。例如，在乌干达伊丽莎白女王国家公园，60多年来通过血清学在大约20%的非洲水牛中检测到牛分枝杆菌，偶尔出现公开病例，没有任何明显的生态意义。相反，共享牧场的周围Ankole牛有隐藏性牛支原体感染（患病率约2%），在畜群或zTB方面没有明显问题(8)。随着土地使用压力的增加以及对牛奶和肉类需求的增加，非洲的这种“复原力”正在迅速改变。在牛结核病得到控制的国家，zTB病例并不常见。重点应放在更好地发现和报告病例以及提高食品安全和卫生标准上。
Tuberculosis is caused by bacteria of the Mycobacterium tuberculosis complex (MTBC) and impacts on both human and animal populations. Animal-adapted MTBC threatens the well-being of humans, animals and their livelihoods. The WHO annual TB Report estimated there were 143,000 new human cases of zoonotic tuberculosis (zTB) with 12,300 deaths caused by Mycobacterium bovis globally (1). Prevalence estimates of zTB are inaccurate since routine laboratory tests cannot differentiate between infections caused by the human and animal-adapted species of the MTBC, including newer members such as Mycobacterium orygis (2). Thus, the true effect of zTB on the human TB epidemic remains unclear. Accurate disease differentiation is also important since M. bovis is universally resistant to pyrazinamide, a key first line TB drug. zTB is acquired through consuming unpasteurized milk products, or unusually from direct contact with infected livestock or offal (3). A true wildlife source of zTB remains unknown (4). MTBC strains are able to transmit between domestic cattle and other reservoir species, specifically maintaining M. bovis. Bovine TB is usually associated with intensively managed farmed livestock, captive and semi-captive or fenced wild animals, or those adapted to human domesticated agricultural landscapes (5). Whilst efforts to eradicate bovine TB from livestock are ongoing, other reservoirs remain a threat to control programs. These include European badgers, brushtail possums, ferrets, feral pigs, buffalo, wild boars, elks and white-tailed deer (6). Bovine TB inflicts economic losses through lost production and control costs, creating barriers to livestock trade, and impedes conservation efforts. The M. bovis debate in Africa is currently influenced by regional importance in countries such as South Africa and Ethiopia where intensification of cattle industry is more advanced. Imported cattle like Holstein Friesian bring European strains of M. bovis into their national herds. This argues against intensification. Intensifying without biosecurity and neglecting the highly resilient pastoral sector remain shortsighted approaches to livestock systems, and retards bovine TB control programs.Contacts rates and population densities are the major drivers for evolution of the animal-adapted MTBC. M. bovis infection and wildlife TB are rarely expressed in natural ecosystems and experience of low disease prevalence in indigenous cattle in mixed systems suggests this is not necessarily a problem, although risks are reported (7). For example, in Queen Elizabeth National Park, Uganda, M. bovis has been detected by serology in around 20% of African buffalo for over 60 years, with occasional open cases, it is without any apparent ecological significance. Conversely, the surrounding Ankole cattle, which share pasture, have cryptic M. bovis infection (~ 2% prevalence) with no perceived issues in the stock or regarding zTB (8). This African ‘resilience’is fast changing consequential to increasing pressure being put on land use and increasing demand for milk and meat. Cases of zTB are uncommon in countries where bovine TB in cattle is controlled. The focus should be on better detection and reporting of cases and improving standards of food safety and hygiene.
人畜共患结核病路线图
DOI：
--
发表时间：
2017
期刊：
影响因子：
--
作者：
Oie
通讯作者：
Oie
影响因子：
3.2
作者：
Miller, Michele A.;Buss, Peter;van Helden, Paul
通讯作者：
van Helden, Paul
大独角犀 (Rhinoceros UNICORNIS) 中由米分枝杆菌引起的结核病：西半球的第一份报告
影响因子：
0.7
作者：
D. Love;M. Garner;K. Lyashchenko;Alina Sikar;D. Bradway;S. Robbe;Michele A. Miller;J. Ramer
通讯作者：
J. Ramer