ZoonoticTuberculosis in India p`aNaIjanya xayaroaga

1. ZoonoticTuberculosis in Indiap`aNaIjanya xayaroaga Dr. Ashok Kale M.D.(Community Medicine ) Mob : 9406109410 ashokpkale2003@yahoo.com ashok.kale995@gmail.com ABSENCE of Opportunity is CHARACTER

2. Yearwise Tuberculosis mortality and different interventions ABSENCE of Opportunity is CHARACTER

3. Times of India ,Nov 8, 1996. Dr. Ashok Kale & Dr. S. V. Gore wrote: 1.Tuberculin Test + vity has a special relevance in animals. 2. In tub. animals majority (80 %) have lung tub. 3.Only 1% of tub. Animals have lesions in milking part mastitis (udder) 4.Animals shed tubercle bacilli through exhaled air and faeces (gober). 5. In Indian rural household animals and human stay under one roof. 6. South African study – INH cures Tub. Of Animals. ABSENCE of Opportunity is CHARACTER

4. National Medicos Organisation’s resolution , Jan 1997- Tiru. • Zoonotic aspect of pulmonary tuberculosis needs to be attended by controlling tuberculosis in animals, especially cattle to protect the rural people staying with animals under one roof. • District TuberculousCentres should coordinate with the Veterinary department. • GOI should initiate necessary action in this regard. ABSENCE of Opportunity is CHARACTER

5. TAI’s Nagpal’s letter 1997 ABSENCE of Opportunity is CHARACTER

6. Views of Vice-chairman of TAI(1997) 1.Report of RTC, TT testing etc is now history 2.Invariable boiling of milk practice can not cause Zoonotic Tub, even if there are tub.cows 3. Cross reaction due to non-tub mycobacteria 4.Culture of samples did not yield M.bovis. I(Nagpal) know all this does not mean we should ignore this (ZTB) issue. ABSENCE of Opportunity is CHARACTER

7. Dr. Kale Ashok*, Dr. DeshpandeShailesh, Dr. Gore • Medico Friends Circle Bulletin – Jan-Feb 2000 Can Human Tuberculosis be Controlled in India Without Control of TB in Domestic Animals ? ABSENCE of Opportunity is CHARACTER

8. Understanding tubercle bacillus, some queries to the audience. 1. Why bovine bacillus was taken by Dr. Albert Calmette for human vaccine (BCG) development? 2. Why we cannot differentiate by observing Tuberculin reaction the type of causative organism ,i.e. human or animal (bovis) ? 3. Why there is cross immunity? 4. If M. bovis & M.tuber. are 2 species , how can they have cross immunity ? 5. Are they different species or variants of same species? ABSENCE of Opportunity is CHARACTER

9. Tubercle Bacillus Infection & Tuber . In Man & Animals- Dr.Calmette , 1923 ABSENCE of Opportunity is CHARACTER

10. Tuberculosis in Animals and Man- Francis, 1957 ABSENCE of Opportunity is CHARACTER

11. Bovine Tub control in Man & Animals- Dr. Steele & Myers, 1971 , USA ABSENCE of Opportunity is CHARACTER

12. Steele and Myers from USA • Tuberculin and it’s use : • Dr. Robert Koch– 1890 • Russia – Guttman, Denmark- Bang • On postmortem they found– reacting animals had TB in one or more organs. ABSENCE of Opportunity is CHARACTER

13. Tuberculin Test studies • Pearson’s study in 1891 (USA) • Tested 80 cattle – reacted 30 – PM showed TB lesions • Russel, Europe, 1892-- 30 tested--26 +ve ABSENCE of Opportunity is CHARACTER

14. Tuberculin Test in Human • Ghon- 1908-12- PM of 183 children who during lifetime had no evidence of Tuberculosis except TT positivity. • Children had died of Nontuberculous conditions. • Except one ,all had tuberculous lesions. • He had done the study to test the specificity of Pirquet’s belief. ABSENCE of Opportunity is CHARACTER

15. Francis– What happens in cattle after infection of tub bacillus? • Unlike human ,Primary tuberculous infection in cattle – *Lesions do not heal, progressive TB. * In man – large population reacts to the tuberculin test but does not spread infection. *But in cattle – All T.T. positive are INFECTIOUS, verified by Bang, Pearson and other veterinarians. ABSENCE of Opportunity is CHARACTER

16. Veterinary pathology • Lesions in the dog – Three- quarters of natural cases of infection- Caused by human type of bacillus. • The disease runs a progressive course in the dog. • One rarely encounters healed TB in PM examinations. ABSENCE of Opportunity is CHARACTER

17. True meaning of the term-- Bovine Tuberculosis • Strictly ,this term should only be used to refer to tuberculosis in cattle , but is often used to denominate tuberculosis caused by bovine strains irrespective of the host. • --- Bovine tubercle bacilli and disease in animals and man, Epidem Inf (1987), 92, 221-234. Grange & Collins. ABSENCE of Opportunity is CHARACTER

18. Grange J.M. and Collins, Epidem Inf. (1987), 92, 221-- 234 , Bovine tubercle bacilli and disease in animals and man • As in man, in animals ,the lung is the usual site of disease, and spread of infection occurs by the respiratory route. Although milk is the principal vector for transmission of infection to man, disease of the udder relatively uncommon, effecting only about 1% of tuberculous cows. ABSENCE of Opportunity is CHARACTER

19. (BMJ,Oct.24,1908).Why TT +ve cattle are called infectious? • Dr. E. C. Schroeder, of the Department of Agriculture, Washington, read a paper on his investigations,( International Congress on Tuberculosis held in Washington, September, 1908 ) • About 40 per cent of cattle apparently healthy, and known to be tuberculous only because they had reacted with tuberculin, intermittently passed tubercle bacilli with their faeces.

20. When a number of such cattle were kept under continued observation, the percentage that expelled tubercle bacilli per rectum was found to double in about eighteen months; and both the frequency with which bacilli occurred and the number found in individual animals also showed an increase. Among twelve cows, bacilli in the faeces were at first found in five, but before the end of two years the number had risen to ten. ABSENCE of Opportunity is CHARACTER

21. Tople wilson Bacteriology • Response of Bacteria to the Environment (Section B) : Bacteria flourish in physical environments that differ widely. Bacteria prove to be the most ADAPTABLE of the living organisms in their modes of obtaining energy for growth. ABSENCE of Opportunity is CHARACTER

22. Tople wilson Bacteriology • May alter their phenotype in response to environment change while the genotype remains unchanged. • Mutant cell with a temporary selective advantage can over grow a population of unaltered cells within a few hours. • If cells are examined on times scales that permit many generations, what is in reality genotype variation may appear to be phenotypic variation. ABSENCE of Opportunity is CHARACTER

23. The Bacteriology of Tuberculosis, ErgonsDarzins, Univ. of Minnesota, 1958, Chapter XXI, 273 – 286. • Pathogenicity is the disease-producing property of microorganisms. • Virulence expresses the degree of pathogenicity of bacilli. ABSENCE of Opportunity is CHARACTER

24. Do Fixed Types of Tubercle Bacilli Exist? Chapter XXI , ABSENCE of Opportunity is CHARACTER

25. Price’s (1932), study of the incidence of bovine tub infection in same region of Canada ABSENCE of Opportunity is CHARACTER

26. Rich,1951- “very curious phenomenon” ABSENCE of Opportunity is CHARACTER

27. Explanation of supporters of the theory of stable types of bacilli • Generally children are more frequently exposed to bovine infection than adults, because milk is the chief food of children, • That the resistance of adults to tuberculous infection is greater than that of children ABSENCE of Opportunity is CHARACTER

28. But • These hypotheses are insufficient to explain why the bacillus of bovine type disappears from the human body and why the bacillus of human type takes its place when the infected child develops into a tuberculous adult. ABSENCE of Opportunity is CHARACTER

29. Another explanation? • The theory of the superinfection with bacilli of human type cannot explain this phenomenon; *Consequently, it is necessary to seek a different answer to the problem. ABSENCE of Opportunity is CHARACTER

30. Jensen and Frimodt-Moller (1936)-Change of types • Described seven strains of tubercle bacilli, all of low virulence for rabbits, as bacilli of human type. • In all seven cases the authors • were able to cultivate bacilli of the bovine type from rabbits inoculated with these strains. ABSENCE of Opportunity is CHARACTER

31. Interesting history of strain 1832 Jensen and Frimodt-Moller (1936b). This strain of human type was cultured from urine and grew dysgonic, being virulent for guinea pigs and only slightly virulent for rabbits and calves. The passage of this strain through a rabbit produced a typical bovine type bacilli. This transformation of the original human type into a bovine type of bacilli was performed seven times. ABSENCE of Opportunity is CHARACTER

32. Conclusion ofJensen and Frimodt-Moller The appearance of bovine type of bacilli was the result of the transformation of the original human type of bacilli into the bovine type within the rabbit organism. ABSENCE of Opportunity is CHARACTER

33. Pinner (1935) • by means of passages through guinea pigs succeeded in transforming two strains of nonpathogenic acid-fast bacilli, isolated from tuberculous patients, into bacilli producing typical tuberculosis in guinea pigs ABSENCE of Opportunity is CHARACTER

34. Smithburn (1939) • restored the virulence of attenuated bovine and human types of bacilli by serial transfer of these strains to rabbits and by serial brain-to-brain passages through guinea pigs. ABSENCE of Opportunity is CHARACTER

35. RTC-(Griffith ) • tubercle bacilli derived from cases of human pulmonary tuberculosis, discovered cultures consisting of a mixture of both the human and bovine types of bacilli. • out of 1,068 cases studied, 5 were mixtures of bovine and human types of bacilli. ABSENCE of Opportunity is CHARACTER

36. Griffith gives two reasons 1. Transformation, within the human body, of one type of bacilli into another OR 2. Later association of another type of bacilli with the already existing infection ABSENCE of Opportunity is CHARACTER

37. British Medical Journal, March3, 1934,371, Walker • Discussion :- • It has been suggested that mutation of type occurs in the human body, so that an • infecting bovine organism after many years in human tissues acquires the characteristics associated with human type bacilli, and becomes manifest as such in chronic pulmonary tuberculosis in adults. ABSENCE of Opportunity is CHARACTER

38. British Medical Journal, Aug 15, 1936,pg 324-325.John Blacklock ,Tuberculosis in Infancy and Childhood. • The immunity from childhood infection – It seems certain, from my figures that tub infection in the child under 3 years is serious, and should , if possible, be prevented. ABSENCE of Opportunity is CHARACTER

39. British Medical Journal, Aug 15, 1936,pg 324-325.John Blacklock • Tuberculin-positive children more frequently develop fatal phthisis in later life than those who react negatively ABSENCE of Opportunity is CHARACTER

40. British Medical Journal, Aug 15, 1936,pg 324-325.John Blacklock • After many years' sojourn in the tissues it may mutate to a more pathogenic form or even to a human type. Calmette himself thought it possible that in naturally occurring bovine infections in man, mutation to the human type after a time was possible, and might be the cause of pulmonary tuberculosis. ABSENCE of Opportunity is CHARACTER

41. Bovine and Human Tuberculosis– Prof.Orth, BMJ ,1913 ABSENCE of Opportunity is CHARACTER

42. ABSENCE of Opportunity is CHARACTER

43. Rabinowitsh, The transmission of Tuberculosis through Domestic animals, Amer Rev Tuber,1927,v.15,419-428 Author believes that it is not impossible for the biological properties of the various types of bacilli to alter while in the human body- the bovine becoming converted into the human. ABSENCE of Opportunity is CHARACTER

44. Book. --Tubercle Bacillus Infection AND Tuberculosis in Man & Animals, Dr. Albert Calmette , 1923, page 294. • We are not justified in inferring the duality of human and bovine tuberculous bacillus. • These types differ one from another only because they have more or less adapted themselves, through a series of successive cultural generations to a human or bovine environment. • And it cannot be conceived to constitute special types. • In all of these we have to do with the same bacillus. ABSENCE of Opportunity is CHARACTER

45. Book. --Tubercle Bacillus Infection AND Tuberculosis in Man & Animals, Dr. Albert Calmette , 1923, page 294. • Many efforts have been made in a variety of ways to convert what by agreement is called the human type into thebovinetype, for example by inoculating successively the same virus from man to cattle, then from cattle to cattle or through an intermediate stage in the goat. It would seem that in a few cases partial success has been attained. ABSENCE of Opportunity is CHARACTER

46. Zoonoses ABSENCE of Opportunity is CHARACTER

47. Dung of Tuberculous animal Milk Borne diseases, Douglas, BMJ, July 30 ,1932 , 198 – 200. • Frequently such animals excrete large number of tubercle bacilli in the faeces. • virulent bovine tubercle have been recovered from cow manure after one year, from a lump of cow dung for upwards of two years, and even from the effluent of a drainage system of the septic tank type

48. Mode of Infection from Cattle to Human • Magnussen emphasizes the danger children run when they play in infected cowsheds. • Infection between cattle generally occurs by the airborne route. The most infectious particle is a recently exhaled moist droplet containing a few bacilli. Tubercle bacilli are not only excreted by bovines with open pulmonary lesions but also by those in the initial period . ABSENCE of Opportunity is CHARACTER

49. Tuberculous Mastitis ABSENCE of Opportunity is CHARACTER

50. U.S.A. agri 1957 book- Tuberculosis and its eradication ABSENCE of Opportunity is CHARACTER