Comparison of Gross Pathology, Histopathology, and Mycobacterial Culture for the Diagnosis of Tuberculosis in Elk (Cervus elaphus)

Using the isolation of Mycobacterium bovis as the reference standard, this study evaluated the sensitivity, specificity and kappa statistic of gross pathology (abattoir postmortem inspection), histopathology, and parallel or series combinations of the two for the diagnosis of tuberculosis in 430 elk and red deer. Two histopathology interpretations were evaluated: histopathology I, where the presence of lesions compatible with tuberculosis was considered positive, and histopathology II, where lesions compatible with tuberculosis or a select group of additional possible diagnoses were considered positive. In the 73 animals from which M. bovis was isolated, gross lesions of tuberculosis were most often in the lung (48), the retropharyngeal lymph nodes (36), the mesenteric lymph nodes (35), and the mediastinal lymph nodes (16). Other mycobacterial isolates included: 11 M. paratuberculosis, 11 M. avium, and 28 rapidly growing species or M. terrae complex. The sensitivity estimates of gross pathology and histopathology I were 93% (95% confidence limits [CL] 84,97%) and 88% [CL 77,94%], respectively, and the specificity of both was 89% [CL 85,92%]). The sensitivity and specificity of histopathology II were 89% (CL 79,95%) and 77% (CL 72,81%), respectively. The highest sensitivity estimates (93- 95% [CL 84,98%]) were obtained by interpreting gross pathology and histopathology in parallel (where an animal had to be positive on at least one of the two, to be classified as combination positive). The highest specificity estimates (94-95% [CL 91-97%]) were generated when the two tests were interpreted in series (an animal had to be positive on both tests to be classified as combination positive). The presence of gross or microscopic lesions showed moderate to good agreement with the isolation of M. bovis (Kappa = 65-69%). The results show that post-mortem inspection, histopathology and culture do not necessarily recognize the same infected animals and that the spectra of animals identified by the tests overlaps.

The Role of a Wildlife Reservoir in the Epidemiology of Bovine Tuberculosis

The objective of this project was to study the epidemiology of bovine tuberculosis in the presence of a wildlife reservoir species. Cross-sectional and longitudinal studies of possum populations with endemic bovine tuberculosis infection were analyzed. The results were used to develop a computer simulation model of the dynamics of bovine tuberculosis infection in possum populations. A case-control study of breakdowns to tuberculosis infection in cattle herds in the Central North Island of New Zealand was conducted to identify risk factors other than exposure to tuberculosis in local possum populations.

Recommendations for Elimination of Bovine Tuberculosis in Free-Ranging White-Tailed Deer in Michigan

A significant infection rate of bovine TB in the deer population of the northeastern lower peninsula poses a potential risk to several important values including public health, United States Department of Agriculture (U.S.D.A.) TB-free accreditation for Michigan cattle, wildlife health, wildlife-related recreation and tourism and economic stability in several sectors. A risk assessment study by the U.S. D.A. Centers for Epidemiology and Animal Health (Fort Collins, CO) predicted that if no changes were made in the management of the affected free-ranging deer population, the TB prevalence (compared to the current prevalence of 2.3%). Although the current annual risk of TB transfer to cattle in the affected area is .I%, the report estimated a 12% cumulative risk that at least one head of cattle would become infected over the next 25 years if no changes are made in deer and/or cattle management.

The Viability of B. tuberculosis (Bovinus) on Pasture Land, In Stored Faeces and In Liquid Manure

The object of these experiments was to determine the length of time during which B. tuberculosis in cow's faeces remain alive and virulent on pasture land in the south of England. The method of testing for living B. tuberculosis is given in Appendix II.

Bovine Tuberculosis in Michigan Wildlife and Livestock

Since 1994, the state of Michigan has recognized a problem with bovine tuberculosis (TB), caused by Mycobacterium bovis, in wild white-tailed deer from a 12-county area in northeastern Lower Michigan. A total of 65,000 free-ranging deer have been tested, and 340 have been found to be positive for M. bovis. The disease has been found in other wildlife species, and, in 1998, in domestic cattle, where to date 13 beef cattle and 2 dairy cattle herds have been diagnosed with bovine TB. Unfortunately, the situation is unique in that there have never been reports of self-sustaining bovine TB in a wild, free-ranging cervid population in North America. Scientists, biologists, epidemiologists, and veterinarians who have studied this situation have concluded that the most logical theory is that high deer densities and the focal concentration caused by baiting (the practice of hunting deer over feed) and feeding are the factors most likely responsible for the establishment of self-sustaining TB in free-ranging Michigan deer. Baiting and feeding have been banned since 1998 in counties where the disease has been found. In addition, the deer herd has been reduced by 50% in the endemic area with the use of unlimited antlerless permits. The measures of apparent TB prevalence have been decreased by half since 1997, providing hopeful preliminary evidence that eradication strategies are succeeding.

Efficacy of Oral and Parenteral Routes of Mycobacterium bovis Bacille Calmette-Guerin Vaccination Against Experimental Bovine Tuberculosis in White-Tailed Deer (Odocoileus virginianus): A Feasibility Study

We investigated the efficacy of oral and parenteral Mycobacterium bovis bacille Calmette-Guerin Danish strain 1331 (BCG) in its ability to protect white-tailed deer (Odocoileus virginianus) against disease caused by M. bovis infection. Twenty-two white-tailed deer were divided into four groups. One group (n=5) received 109 colony-forming units (cfu) BCG via a lipid-formulated oral bait; one group (n=5) received 109 cfu BCG in culture directly to the oropharynx, one group (n=6) was vaccinated with 106 cfu BCG subcutaneously, and one group served as a control and received culture media directly to the oropharynx (n=6). All animals were challenged 3 mo after vaccination. Five months postchallenge the animals were examined for lesions. Results indicate that both oral forms of BCG and parenterally administerd BCG offered significant protection against M. bovis challenge as compared to controls. This study suggests that oral BCG vaccination may be a feasible means of controlling bovine tuberculosis in wild white-tailed deer populations.

Evaluation of a New Strategy for Control of Bovine Tuberculosis in Michigan White-Tailed Deer: Year 1 Progress Report

The State of Michigan is striving to eliminate bovine tuberculosis (Tb) infection among free-ranging white-tailed deer in the northeastern Lower Peninsula of the state. Aggressive reduction in the overall deer population abundance may help to further reduce TB prevalence, but this course of action is unacceptable to many hunters and landowners. Targeted culling of sick deer would likely be far more acceptable to these stakeholders, so in the winter of 2003 the Michigan Department of Natural Resources pilot-trialed a new strategy based on live-trapping and Tb-testing of wild deer. The field study was conducted in a township with relatively high TB prevalence within Deer Management Unit 452 in the northeastern Lower Peninsula. Over a 2-month trapping period, 119 individual deer were live-trapped, blood sampled, fitted with a radio-collar, and released. A total of 31 of these deer were subsequently classified as Tb-suspect by at least one of five blood tests employed (however there was a low level of agreement among tests). A delay in testing meant that only six of these suspect deer were culled by sharpshooters before pre-programmed release of their radio-collars, after which they could no longer be located. Mycobacterium bovis was cultured from one of these six suspect deer; the other five were negative on culture. All target deer were located to within shooting range with 1 – 2 days of effort, and all the radio-collars on the apparently-healthy deer dropped off after the intended 90-day interval, and were thereafter recovered for re-use. There was considerable support for this pilot project among hunters, farmers, state and federal agriculture agencies, the media and the general public, and so we recommend that further field trials be undertaken using this technique. The initial focus of these trials should be on improving the efficacy and reliability of the blood testing procedure.

The Eradication of Bovine Tuberculosis From Infected Wildlife Populations: A New Zealand Scenario

The Animal Health Board (AHB) is the agency responsible for controlling bovine tuberculosis (Tb) in New Zealand. In 2000, the AHB embarked on a strategy designed to reduce the annual period prevalence of Tb infected cattle and farmed deer herds from 1.67% to 0.2% by 2012/13. Under current rules of the Office International des Epizooties (OIE) this would allow New Zealand to claim freedom from Tb. The epidemiology of Tb in New Zealand is largely influenced by wildlife reservoirs of infection and control of Tb vector populations is central to the elimination of Tb from New Zealand’s cattle and deer herds. The AHB has classified New Zealand’s land area into Vector Risk Areas (VRAs) where Tb is established in wildlife (currently 39%) and Vector Free Areas (VFAs) where the disease is not established (61%). Within the VRAs the introduced Australian brushtail possum (Trichosurus vulpecula) is the primary wildlife maintenance host and the main source of infection for domestic cattle and deer herds. Southland is a region of New Zealand with a long history of wildlife associated Tb. Progress in reducing infected herd numbers has been impressive in recent years, primarily due to an intensive possum control program. As a result of this reduction, the focus is now shifting to that of providing increasing levels of confidence that Tb is absent from the remaining susceptible wildlife. High levels of confidence of Tb freedom in wildlife will allow the AHB to reduce the wildlife control programs and ultimately cease control altogether, with minimal risk of Tb reemerging. This paper examines the strategies being utilized to provide that confidence. The types of data, the format in which it is collected and the methods of analysis and review are outlined.

Avaliação da atividade mutagênica de complexos heterolépticos de Rutênio(II) com atividade anti - Mycobacterium tuberculosis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nanoencapsulação de compostos de rutênio, análise de sua atividade anti - Mycobacterium tuberculosis e biodisponibilidade oral

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A study of multidrug-resistant tuberculosis in risk groups in the city of Santos, Sao Paulo, Brazil

Monitoring the extent of and trends in multidrug-resistant tuberculosis (MDR-TB) is a priority of the Brazilian National Tuberculosis Control Programme. The current study aimed to estimate the incidence of MDR-TB, describe the profile of TB drug resistance in risk groups and examine whether screening for MDR-TB adhered to the recommended guidelines. A descriptive study that examined diagnosed cases of pulmonary TB was conducted in the city of Santos, Brazil, between 2000-2004. Of the 2,176 pulmonary TB cases studied, 671 (30.8%) met the criteria for drug sensitivity testing and, of these cases, 31.7% (213/671) were tested. Among the tested cases, 9.4% were resistant to one anti-TB drug and 15% were MDR. MDR was observed in 11.6% of 86 new TB cases and 17.3% of 127 previously treated cases. The average annual incidence of MDR-TB was 1.9 per 100,000 inhabitants-years. The extent of known MDR-TB in the city of Santos is high, though likely to be underestimated. Our study therefore indicates an inadequate adherence to the guidelines for MDR-TB screening and suggests the necessity of alternative strategies of MDR-TB surveillance.

DELAY IN THE DIAGNOSIS OF TUBERCULOSIS IN PRISONS: THE EXPERIENCE OF INCARCERATED PATIENTS

This study analyzed the causes of delay in the diagnosis of tuberculosis in the prison system, according to the experience of incarcerated patients. The theoretical and methodological framework of the French school of discourse analysis was used, which seeks to comprehend the processes of meaning production, in the relationship of language with ideology and the development of subjects in their positions. Semi-directed interviews were conducted with seven incarcerated tuberculosis patients in a hospital of Joao Pessoa, Paraiba, Brazil, between August and October 2009. The delay in the diagnosis of tuberculosis was related to the naturalization of the lack of care for the prisoner, to the interpretation of the prison as a place of death and suffering and to the deprivation of the right to health for the detainees as a result of their position in the asymmetric power relationships and ideological effects.

CARING FOR TUBERCULOSIS PATIENTS IN THE FAMILY HEALTH STRATEGY: THE NURSES' PERCEPTIONS

The objective of this study was to analyze the nurses' perceptions regarding tuberculosis control, according to the theoretical axis of comprehensive healthcare and the concepts of attachment and teamwork. This qualitative study involved 13 nurses from the Family Health Strategy of a priority city in the metropolitan region of Joao Pessoa, Paraiba, Brazil. Data were collected in focal groups and subjected to thematic content analysis. Factors that strengthen tuberculosis control were: supervised treatment, free medication and the provision of supplies. Weakening factors were: worker's turnover, the lack of encouragement for patients and incipient educational actions. The factors that, according to the nurses, weaken tuberculosis patient care should be reviewed by administrators, workers, users and educators with a view to redefining healthcare activities that strengthen attachment, comprehensive healthcare and teamwork.

Assessment of tuberculosis treatment accessibility for patients co-infected or not with the human immunodeficiency virus

This study aimed to evaluate accessibility to treatment for people with TB co-infected or not with HIV. This cross-sectional study addressed issues regarding accessibility to treatment in a city in the interior of Sao Paulo state, Brazil. The instrument Primary Care Assessment Tool was utilized with 95 people. To evaluate access to treatment, Student's t test was used. The mean scores of variables were analyzed separately and compared between two groups (people with TB co-infected with HIV and people with TB not co-infected with HIV). Mean scores showed that HIV co-infected people presented greater difficulties in gaining access than those not co-infected. Professionals visited co-infected people more often when compared to those not co-infected; the co-infected people almost never accessed treatment for their disease in the Health Unit nearest their home. There is, therefore, the need for greater integration and communication between the programs for treatment of Tuberculosis and STD/AIDS.

Epidemiological aspects of tuberculosis in children and adolescents in Rio de Janeiro

Objective: To describe the epidemiological aspects of childhood tuberculosis (TB) in a Brazilian reference hospital. Methods: This was a retrospective study (1999-2008) of 473 subjects (0-14 year olds) with confirmed TB, or with clinical improvement by the fourth month of treatment under the unit's care, including the review of medical records, monitoring reports and notifications by the TB unit. Results: Among 473 TB cases included in the study, positive tuberculin skin test was observed in 52%, history of contact with a patient with pulmonary tuberculosis in 66%, mostly intra-household, and with the father/stepfather most commonly involved; and disseminated TB in 22%. The result of HIV testing was obtained in 265 (56%) cases, being positive in 45 (17%). The diagnosis of TB was confirmed in 31% of cases, most frequently in children older than 5 years, with negative tuberculin skin test, and in disseminated forms. Of the 65 cultures positive for TB performed in the study, drug sensitivity testing to anti-TB drugs was done in 30 (46%) clinical samples, among which 10 (33%) were resistant to one or more anti-TB drugs, and 2 (0.8%) were multi-drug-resistant. Among patients with confirmed pulmonary TB, 31% did not meet the criteria for starting anti-TB treatment according to the scores of the Ministry of Health (<= 25 points). Conclusion: The high proportion of drug-resistant TB and co-infection with HIV identified in this study highlight the necessity to carry out additional studies in order to evaluate the impact of TB control activities on childhood TB.