- Elizabeth A Talbot, MD
Elizabeth A Talbot, MD
- Associate Professor of Medicine
- Geisel School of Medicine at Dartmouth
The Mycobacterium tuberculosis complex (MTBC) includes M. tuberculosis (the cause of most human tuberculosis), M. bovis, M. bovis bacillus Calmette-Guérin (BCG, the vaccine strain), M. africanum, and M. microti . M. bovis is the main cause of tuberculosis in cattle, deer, and other mammals. The human bacillus M. tuberculosis may have evolved from M. bovis in the setting of animal domestication . Human M. bovis infection generally occurs in the setting of consumption of infected cow's milk products.
The epidemiology, transmission, clinical manifestations, diagnosis, treatment, and prognosis of human M. bovis will be reviewed here. Issues related to BCG vaccination are discussed separately. (See "BCG vaccination".)
EPIDEMIOLOGY AND RISK FACTORS
Worldwide — Worldwide, M. bovis causes less than 1.4 percent of pulmonary tuberculosis cases outside of Africa. Within Africa, M. bovis causes approximately 2.8 percent of cases of pulmonary tuberculosis, for a crude incidence of 7 cases per 100,000 population . The global proportion of M. bovis is higher among patients with extrapulmonary tuberculosis because the pathogen is frequently acquired via oral ingestion, and gastrointestinal disease is an important clinical manifestation .
In developed countries where M. bovis in cattle is controlled and dairy products are routinely pasteurized, the proportion of M. bovis infection among human tuberculosis cases is often lower than the global estimate. As an example, in the United Kingdom, M. bovis caused approximately 0.5 percent of culture-confirmed human tuberculosis in 2007  and has been decreasing: between 2005 and 2008, the annual incidence of M. bovis decreased from 0.065 to 0.047 per 100,000 population . In the Netherlands, M. bovis caused approximately 1.4 percent of tuberculosis cases between 1993 and 2007 . In a Spanish university hospital, M. bovis caused approximately 0.95 percent of tuberculosis cases between 1980 and 2003 . One retrospective study among HIV-infected patients in France noted that M. bovis infection accounted for 1.6 percent of tuberculosis cases .
In developing countries, accurate data regarding the relative frequency of human tuberculosis due to M. bovis are rarely available because there is limited laboratory capacity for mycobacterial culture and identification . In one Nigerian survey including 444 patients with cultured mycobacterial isolates from 2010 to 2011, only one was confirmed to have M. bovis . In an earlier survey in Nigeria in 2007, 14 percent of human tuberculosis in Nigeria was reportedly due to M. bovis . In a retrospective Chinese study including three years of data from more than 5000 patients in a region with known M. bovis cattle infection, M. bovis accounted for 0.34 percent of human tuberculosis cases . In Ethiopia between 2000 and 2006, molecular typing of nearly 1000 isolates detected four cases of M. bovis; three of these patients had known regular animal exposure . In Brazil, no M. bovis isolates were identified among 1674 human isolates recovered using growth media enriched for M. bovis isolation .
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