Hlavsa Michele C, Moonan Patrick K, Cowan Lauren S, Navin Thomas R, Kammerer J Steve, Morlock Glenn P, Crawford Jack T, Lobue Philip A
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2008 Jul 15;47(2):168-75. doi: 10.1086/589240.
Understanding the epidemiology of human Mycobacterium bovis tuberculosis (TB) in the United States is imperative; this disease can be foodborne or airborne, and current US control strategies are focused on TB due to Mycobacterium tuberculosis and airborne transmission. The National TB Genotyping Service's work has allowed systematic identification of M. tuberculosis-complex isolates and enabled the first US-wide study of M. bovis TB.
Results of spacer oligonucleotide and mycobacterial interspersed repetitive units typing were linked to corresponding national surveillance data for TB cases reported for the period 2004-2005 and select cases for the period 1995-2003. We also used National TB Genotyping Service data to evaluate the traditional antituberculous drug resistance-based case definition of M. bovis TB.
Isolates from 165 (1.4%) of 11,860 linked cases were identified as M. bovis. Patients who were not born in the United States, Hispanic patients, patients <15 years of age, patients reported to be HIV infected, and patients with extrapulmonary disease each had increased adjusted odds of having M. bovis versus M. tuberculosis TB. Most US-born, Hispanic patients with TB due to M. bovis (29 [90.6%] of 32) had extrapulmonary disease, and their overall median age was 9.5 years. The National TB Genotyping Service's data indicated that the pyrazinamide-based case definition's sensitivity was 82.5% (95% confidence interval; 75.3%-87.9%) and that data identified 14 errors in pyrazinamide-susceptibility testing or reporting.
The prevalence of extrapulmonary disease in the young, US-born Hispanic population suggests recent transmission of M. bovis, possibly related to foodborne exposure. Because of its significantly different epidemiologic profile, compared with that of M. tuberculosis TB, we recommend routine surveillance of M. bovis TB. Routine surveillance and an improved understanding of M. bovis TB transmission dynamics would help direct the development of additional control measures.
了解美国牛分枝杆菌所致人类结核病（TB）的流行病学情况势在必行；这种疾病可通过食物传播或空气传播，而美国目前的控制策略主要集中于结核分枝杆菌所致的结核病及空气传播途径。国家结核病基因分型服务工作已能系统鉴定结核分枝杆菌复合群分离株，并促成了美国首次关于牛分枝杆菌所致结核病的全国性研究。
间隔区寡核苷酸和分枝杆菌散布重复单位分型结果与2004 - 2005年期间报告的结核病病例的相应国家监测数据以及1995 - 2003年期间的部分病例相关联。我们还利用国家结核病基因分型服务数据评估了基于传统抗结核药物耐药性的牛分枝杆菌所致结核病病例定义。
在11860例关联病例中，165例（1.4%）的分离株被鉴定为牛分枝杆菌。非美国出生的患者、西班牙裔患者、15岁以下患者、报告感染艾滋病毒的患者以及肺外疾病患者感染牛分枝杆菌而非结核分枝杆菌的校正比值比均升高。大多数美国出生、因牛分枝杆菌感染结核病的西班牙裔患者（32例中的29例[90.6%]）患有肺外疾病，其总体中位年龄为9.5岁。国家结核病基因分型服务数据表明，基于吡嗪酰胺的病例定义的敏感性为82.5%（95%置信区间；75.3% - 87.9%），且该数据在吡嗪酰胺敏感性检测或报告中发现了14处错误。
美国出生的年轻西班牙裔人群中肺外疾病的流行情况表明牛分枝杆菌近期有传播，可能与食物传播暴露有关。由于其流行病学特征与结核分枝杆菌所致结核病显著不同，我们建议对牛分枝杆菌所致结核病进行常规监测。常规监测以及对牛分枝杆菌所致结核病传播动态的更好理解将有助于指导制定更多控制措施。
