- 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 .
The epidemiology, transmission, clinical manifestations, diagnosis, treatment, and prognosis of human M. bovis will be reviewed here. Issues related to the BCG vaccine strain are discussed separately. (See "BCG vaccination".)
EPIDEMIOLOGY AND RISK FACTORS
Worldwide — The burden of M. bovis may be underestimated as a cause of tuberculosis in humans, due to the absence of systematic surveillance for M. bovis as a cause of tuberculosis in people in countries where bovine tuberculosis is endemic and because the laboratory procedures used to diagnose human tuberculosis do not differentiate M. bovis from M. tuberculosis .
Despite these limitations, it is estimated that M. bovis caused an estimated 147,000 new cases and 12,500 deaths in 2016 . Stated as a proportion, M. bovis causes approximately 1.4 and 2.8 percent of pulmonary tuberculosis cases outside of and within Africa, respectively . Among patients with extrapulmonary tuberculosis, the proportion of M. bovis is higher because human M. bovis infection generally occurs in the setting of consumption of infected cow's milk products, so scrofula (lymph node) and gastrointestinal disease are important clinical manifestations .
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 a Spanish hospital, M. bovis caused approximately 0.95 percent of tuberculosis cases between 1980 and 2003 . However, the proportion may be higher among certain at-risk populations; as an example, one retrospective study among HIV-infected patients in France noted that M. bovis infection accounted for 1.6 percent of tuberculosis cases .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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