Juste Ramon A
Department of Animal Health, NEIKER-Tecnalia, Berreaga 1, 48160 Derio, Bizkaia, Vizcaya, Spain.
Vet Immunol Immunopathol. 2012 Jul 15;148(1-2):16-22. doi: 10.1016/j.vetimm.2011.05.034. Epub 2011 Jun 6.
Paratuberculosis is a regional chronic enteritis caused by Mycobacterium avium subsp. paratuberculosis (MAP). The first complete description of this disease was made in 1895, but previous reports on clinical cases compatible with this entity can already be found in the literature of early 1800 s. Its obvious similarities with tuberculosis gave it the name of paratuberculosis, although it was clearly recognized it was not the same entity as that caused by mammal tuberculosis mycobacteria. Eradication has been considered the ideal goal for control of paratuberculosis, but the lack of efficient diagnostic tools and the high costs involved in testing and culling approaches have shifted the focus to control given the better benefit/cost ratios of more conservative strategies like vaccination. Up to now the control of paratuberculosis has been driven by its negative effects on the ruminant farming industry, however recent growing discussion on its links with human regional enteritis might require control strategies changes if a zoonotic role is considered by Public Health authorities. Paratuberculosis was described nearly 40 years earlier than what is usually considered the first full type description of human regional chronic enteritis or inflammatory bowel disease (IBD) which is pathologically a similar entity. No microbiological evidence was found to link both entities until the 1980s in spite of a number of more or less serious attempts. Afterwards there have been numerous studies showing the association of MAP with human IBD. Microbiological, pathological, immunological, therapeutic and epidemiologic associations have not been considered proof of causality and, currently, no widely accepted consensus has been reached about the etiologic role of MAP in human cases. This puts ruminant farming under suspicion and causes a difficult balance between Public Health precaution and practical control measures.
副结核病是由副结核分枝杆菌（MAP）引起的一种区域性慢性肠炎。1895年对该病进行了首次完整描述，但在19世纪早期的文献中就已经能找到与该病症相符的临床病例报告。尽管人们清楚地认识到它与哺乳动物结核分枝杆菌引起的疾病并非同一实体，但因其与结核病有明显相似之处，故而得名副结核病。根除一直被视为控制副结核病的理想目标，但由于缺乏有效的诊断工具以及检测和扑杀方法成本高昂，鉴于疫苗接种等更保守策略具有更好的效益成本比，控制重点已发生转移。到目前为止，副结核病的防控一直是受其对反刍动物养殖业的负面影响驱动，但如果公共卫生当局认为它具有人畜共患病的作用，那么近期关于其与人类区域性肠炎之间联系的讨论日益增多，可能需要改变防控策略。副结核病的描述比通常被认为是人类区域性慢性肠炎或炎症性肠病（IBD）的首次完整类型描述早了近40年，而IBD在病理上是类似的实体。尽管进行了一些或轻或重的尝试，但直到20世纪80年代才找到微生物学证据来将这两种病症联系起来。此后，有大量研究表明MAP与人类IBD有关联。微生物学、病理学、免疫学、治疗学和流行病学上的关联尚未被视为因果关系的证据，目前对于MAP在人类病例中的病因作用尚未达成广泛认可的共识。这使得反刍动物养殖业受到怀疑，并在公共卫生预防措施和实际控制措施之间造成了艰难的平衡。
