- 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 .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:
- Grange JM, Yates MD, de Kantor IN. Guidelines for speciation within the Mycobacterium tuberculosis complex, 2nd ed, WHO/EMC/ZOO/96.4.
- Cole ST, Brosch R, Parkhill J, et al. Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence. Nature 1998; 393:537.
- Müller B, Dürr S, Alonso S, et al. Zoonotic Mycobacterium bovis-induced tuberculosis in humans. Emerg Infect Dis 2013; 19:899.
- O'Reilly LM, Daborn CJ. The epidemiology of Mycobacterium bovis infections in animals and man: a review. Tuber Lung Dis 1995; 76 Suppl 1:1.
- Health Protection Agency. Tuberculosis in the UK: Annual report on tuberculosis surveillance in the UK:2008. HPA, London, United Kingdom.
- Mandal S, Bradshaw L, Anderson LF, et al. Investigating transmission of Mycobacterium bovis in the United Kingdom in 2005 to 2008. J Clin Microbiol 2011; 49:1943.
- Majoor CJ, Magis-Escurra C, van Ingen J, et al. Epidemiology of Mycobacterium bovis disease in humans, The Netherlands, 1993-2007. Emerg Infect Dis 2011; 17:457.
- Esteban J, Robles P, Soledad Jiménez M, Fernández Guerrero ML. Pleuropulmonary infections caused by Mycobacterium bovis: a re-emerging disease. Clin Microbiol Infect 2005; 11:840.
- Dupon M, Ragnaud JM. Tuberculosis in patients infected with human immunodeficiency virus 1. A retrospective multicentre study of 123 cases in France. The Groupe des Infectiologues du Sud de la France. Q J Med 1992; 85:719.
- Aliyu G, El-Kamary SS, Abimiku A, et al. Prevalence of non-tuberculous mycobacterial infections among tuberculosis suspects in Nigeria. PLoS One 2013; 8:e63170.
- Abubakar UB, Ameh JI, Abdulkadir IA, et al. Bovine tuberculosis in Nigeria: A review. Veterinary Research 2011; 4:24.
- Chen Y, Chao Y, Deng Q, et al. Potential challenges to the Stop TB Plan for humans in China; cattle maintain M. bovis and M. tuberculosis. Tuberculosis (Edinb) 2009; 89:95.
- Firdessa R, Berg S, Hailu E, et al. Mycobacterial lineages causing pulmonary and extrapulmonary tuberculosis, Ethiopia. Emerg Infect Dis 2013; 19:460.
- Rocha A, Elias AR, Sobral LF, et al. Genotyping did not evidence any contribution of Mycobacterium bovis to human tuberculosis in Brazil. Tuberculosis (Edinb) 2011; 91:14.
- Scott C, Cavanaugh JS, Pratt R, et al. Human Tuberculosis Caused by Mycobacterium bovis in the United States, 2006-2013. Clin Infect Dis 2016; 63:594.
- Rodwell TC, Moore M, Moser KS, et al. Tuberculosis from Mycobacterium bovis in binational communities, United States. Emerg Infect Dis 2008; 14:909.
- Park D, Qin H, Jain S, et al. Tuberculosis due to Mycobacterium bovis in patients coinfected with human immunodeficiency virus. Clin Infect Dis 2010; 51:1343.
- Kurbatova EV, Cavanaugh JS, Dalton T, et al. Epidemiology of pyrazinamide-resistant tuberculosis in the United States, 1999-2009. Clin Infect Dis 2013; 57:1081.
- Cordova E, Gonzalo X, Boschi A, et al. Human Mycobacterium bovis infection in Buenos Aires: epidemiology, microbiology and clinical presentation. Int J Tuberc Lung Dis 2012; 16:415.
- Portillo-Gómez L, Sosa-Iglesias EG. Molecular identification of Mycobacterium bovis and the importance of zoonotic tuberculosis in Mexican patients. Int J Tuberc Lung Dis 2011; 15:1409.
- Torres-Gonzalez P, Soberanis-Ramos O, Martinez-Gamboa A, et al. Prevalence of latent and active tuberculosis among dairy farm workers exposed to cattle infected by Mycobacterium bovis. PLoS Negl Trop Dis 2013; 7:e2177.
- Centers for Disease Control and Prevention (CDC). Human tuberculosis caused by Mycobacterium bovis--New York City, 2001-2004. MMWR Morb Mortal Wkly Rep 2005; 54:605.
- Adesokan HK, Jenkins AO, van Soolingen D, Cadmus SI. Mycobacterium bovis infection in livestock workers in Ibadan, Nigeria: evidence of occupational exposure. Int J Tuberc Lung Dis 2012; 16:1388.
- Fanning A, Edwards S. Mycobacterium bovis infection in human beings in contact with elk (Cervus elaphus) in Alberta, Canada. Lancet 1991; 338:1253.
- Wilkins MJ, Meyerson J, Bartlett PC, et al. Human Mycobacterium bovis infection and bovine tuberculosis outbreak, Michigan, 1994-2007. Emerg Infect Dis 2008; 14:657.
- LoBue PA, Betancourt W, Cowan L, et al. Identification of a familial cluster of pulmonary Mycobacterium bovis disease. Int J Tuberc Lung Dis 2004; 8:1142.
- Velayati AA, Farnia P, Boloorsaze MR, et al. Mycobacterium bovis infection in children in the same family: transmission through inhalation. Monaldi Arch Chest Dis 2007; 67:169.
- Evans JT, Smith EG, Banerjee A, et al. Cluster of human tuberculosis caused by Mycobacterium bovis: evidence for person-to-person transmission in the UK. Lancet 2007; 369:1270.
- Akkerman O, van der Loo K, Nijmeijer D, et al. Mycobacterium bovis infection in a young Dutch adult: transmission from an elderly human source? Med Microbiol Immunol 2012; 201:397.
- Buss BF, Keyser-Metobo A, Rother J, et al. Possible Airborne Person-to-Person Transmission of Mycobacterium bovis - Nebraska 2014-2015. MMWR Morb Mortal Wkly Rep 2016; 65:197.
- Rullán JV, Herrera D, Cano R, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in Spain. Emerg Infect Dis 1996; 2:125.
- Rivero A, Márquez M, Santos J, et al. High rate of tuberculosis reinfection during a nosocomial outbreak of multidrug-resistant tuberculosis caused by Mycobacterium bovis strain B. Clin Infect Dis 2001; 32:159.
- Bouvet E, Casalino E, Mendoza-Sassi G, et al. A nosocomial outbreak of multidrug-resistant Mycobacterium bovis among HIV-infected patients. A case-control study. AIDS 1993; 7:1453.
- Guerrero A, Cobo J, Fortún J, et al. Nosocomial transmission of Mycobacterium bovis resistant to 11 drugs in people with advanced HIV-1 infection. Lancet 1997; 350:1738.
- Kasambira TS, Alwood K, Baker J, et al. Lymphadenitis in an 18-month-old traveler to Mexico. Pediatr Infect Dis J 2007; 26:968, 973.
- Cachafeiro-Vilar A, García-Padilla C, Reyes E, Hernández-Molina G. Polyarticular arthritis secondary to Mycobacterium bovis infection: an unusual clinical presentation. Joint Bone Spine 2007; 74:107.
- Liesegang TJ, Cameron JD. Mycobacterium bovis infection of the conjunctiva. Arch Ophthalmol 1980; 98:1764.
- González-Duarte A, Ponce de León A, Osornio JS. Importance of differentiating Mycobaterium bovis in tuberculous meningitis. Neurol Int 2011; 3:e9.
- Hlavsa MC, Moonan PK, Cowan LS, et al. Human tuberculosis due to Mycobacterium bovis in the United States, 1995-2005. Clin Infect Dis 2008; 47:168.
- LoBue PA, Moser KS. Treatment of Mycobacterium bovis infected tuberculosis patients: San Diego County, California, United States, 1994-2003. Int J Tuberc Lung Dis 2005; 9:333.
- Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147.