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Mycobacterium Tuberculosis Exposure of Livestock in a German Dairy Farm: Implications for Intra Vitam Diagnosis of Bovine Tuberc

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Mycobacterium Tuberculosis Exposure of Livestock in a German Dairy Farm: Implications for Intra Vitam Diagnosis of Bovine Tuberc Epidemiol. Infect. (2016), 144, 724–731. © Cambridge University Press 2015 doi:10.1017/S0950268815001995 Mycobacterium tuberculosis exposure of livestock in a German dairy farm: implications for intra vitam diagnosis of bovine tuberculosis in an officially tuberculosis-free country T. EISENBERG1*, A. NESSELER1,C.SAUERWALD1,U.KLING1,K.RIßE1, U. KAIM1,G.ALTHOFF1,N.FIEGE1,K.SCHLEZ1,H.-P.HAMANN1, 1,2 3 4 4 1 A. FAWZY ,I.MOSER,R.RIßE,G.KRAFT,M.ZSCHÖCK AND C. MENGE3 1 Hessian State Laboratory (LHL), Division for Veterinary Medicine, Gießen, Germany 2 Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University, Egypt 3 Institute of Molecular Pathogenesis, Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), Jena, Germany 4 Veterinary Office, District Vogelsbergkreis, Lauterbach, Germany Received 20 January 2015; Final revision 2 July 2015; Accepted 7 August 2015; first published online 7 September 2015 SUMMARY Germany has been an officially bovine tuberculosis (bTB)-free (OTF) country since 1996. Gradually rising numbers of bTB herd incidents due to Mycobacterium bovis and M. caprae in North-Western and Southern Germany during the last few years prompted the competent authorities to conduct a nationwide bTB survey in 2013/2014. This led to the detection of a dairy herd in which as many as 55 cattle reacted positively to consecutive intra vitam testing. Test- positive animals lacked visible lesions indicative of bTB at necropsy. Extensive mycobacterial culturing as well as molecular testing of samples from 11 tissues for members of the M. tuberculosis complex (MTC) yielded negative results throughout. However, caseous lymphadenitis of Ln. mandibularis accessorius was observed during meat inspection of a fattening pig from the same farm at regular slaughter at that time. Respective tissue samples tested MTC positive by polymerase chain reaction, and M. tuberculosis T1 family were identified by spoligotyping. Four human reactors within the farmer’s family were also found to be immunoreactive. As exposure of livestock to M. tuberculosis is not generally considered, its impact may result in regulatory and practical difficulties when using protocols designed to detect classical bTB, particularly in OTF countries. Key words: Bovine tuberculosis, legislation, monitoring, Mycobacterium tuberculosis, pig, skin test. INTRODUCTION in animal production. Mycobacterium bovis and M. caprae Bovine tuberculosis (bTB) is one of the most relevant are the primary causative agents in countries of Central and Southern Europe. Both species are zoo- epizootics worldwide and leads to significant losses notic and 99·9% genetically identical to M. tuberculosis. Together with other approved and recently described TB-causing mycobacterial species, i.e. M. africanum, * Author for correspondence: Dr T. Eisenberg, Hessisches M. microti, M. pinnipedii, M. orygis, M. suricattae, Landeslabor, Abteilung Veterinärmedizin, Schubertstr. 60/Haus ‘ ’ 13, 35392 Gießen, Germany. M. mungi and the dassie bacillus , they form the M. tu- (Email: [email protected]) berculosis complex (MTC) [1–7]. Bovine M. microti Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.58, on 27 Sep 2021 at 17:33:49, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0950268815001995 M. tuberculosis exposure of OTF cattle 725 infections are very rarely seen and appear to be asso- exposure to M. tuberculosis. This case, described ciated with high rodent densities [8]. Occasionally, infec- here, led to significant difficulties in case declaration tions due to M. tuberculosis have been observed in cattle and implementation of appropriate legal measures [9–12]. The prevalence of bTB caused by M. tuberculosis and was accompanied by substantial financial losses is low, mostly restricted to countries with a high burden for the affected farm. of human TB, and normally does not exceed 1% of bTB herd incidents (‘breakdowns’;summarizedin[13]). The route of M. tuberculosis transmission to cattle may in- METHODS volve aerosol inhalation from infected humans, but In September 2013 the study herd consisted of 234 cattle oral transmission by ingestion of feed or water contami- in total. Besides two fattening pigs for personal con- nated with infective human nasal secretions, faeces or sumption, some cats were also kept on the farm and urine is also possible [14]. four persons regularly cared for the animals. Fifteen In Germany, bTB prevalence as high as 59% at farm bovines aged >2 years were subjected to an intra level was recorded for the first half of the last century vitam diagnosis of bTB. SICCT testing was performed [15]. National eradication programmes were established with matched equipotent doses of bovine and avian on a voluntary basis in 1952 in Western Germany and in purified protein derivative (PPD), respectively. In- 1955 in Eastern Germany and later became mandatory. crease in skin thickness was measured 72 h after injec- Programmes were based on regular tuberculin skin test- tion, and the reaction was interpreted as positive if ing of all cattle aged >6 weeks and removal of reactor clinical signs were observed or there was an increase animals. Germany finally met the requirements of in the thickness of the skin fold at the injection Article 2(d) of Directive 64/432/EEC by having 99·9% site together with a positive reaction to bovine PPD of cattle herds certified bTB-free for at least 6 consecutive being >4 mm greater than the reaction to avian PPD. years and was subsequently declared officially bTB-free Inconclusive reactors (1-4 mm thickness increase) were (OTF), effective from 1 July 1996 (Decision 97/76/EC). re-tested by interferon-gamma release assay (IGRA; Consequently, Germany abandoned the elaborate and Bovigam®, Prionics, Germany) within 3 weeks accord- costly regular tuberculin testing and bTB surveillance ing to the manufacturer’s instructions. If the IGRA result was maintained at the level of official veterinary meat in- was positive, the animal was culled. Animals testing spection instead. negative by IGRA were re-tested by SICCT and culled From 1995 to 2012, the annual number of bTB inci- if reacting inconclusive. Pathological examinations dents in cattle herds varied between two and 23. were performed on the carcases and organs with special Numbers rose to 46 in 2013 (http://tsis.fli.bund.de/ regard to detection of lesions suspicious for bTB. For Reports/Info.aspx) following an intensified regional molecular and histological investigations, tissues of 11 surveillance in two counties in Southern Germany prescribed organs and lymph nodes (lung, intestine, bordering Austria. In this region, alpine farming liver, spleen, kidney and respective tributary lymph practices were suspected of fostering transmission of nodes as well as retropharyngeal lymph nodes) were M. caprae between free-ranging red deer and cattle. subjected to polymerase chain reaction (PCR) (duplex Indeed, an apparent local endemic driven by three dif- real time PCR for IS1081 and a hypothetical helicase ferent molecular types of M. caprae was discovered (HELI) for the detection of MTC members; [18]) and which accounted for 73·9% of German bTB cases in fixed in neutral buffered formalin, paraffin embedded 2013 [16]. Other cases of bTB notified in 2013 affected and routinely stained with haematoxylin and eosin, re- farms in North-Western Germany with a wide spatial spectively. Sections showing inflammatory alterations, distribution and were exclusively attributed to M. with granulomas in particular, were Ziehl–Neelsen bovis [17]. For a deeper insight into the true prevalence (ZN)-stained for detection of acid-fast bacilli (AFB). of bTB, a nationwide survey was prescribed due to a Up to 12 tissue samples per animal were collected revision to the German Regulation on bTB issued from cattle (n = 55), pig (n = 1) and cat (n = 1) between on 12 July 2013. Between July 2013 and 30 April September 2013 and January 2014 and screened for 2014, approximately 3350 cattle aged >2 years were pathological lesions, growth and/or genomic evidence selected from each federal state for single intradermal for the presence of MTC members. Caseous lymph- comparative cervical tuberculin (SICCT) testing. This adenitis of one Ln. mandibularis accessorius was nationwide survey revealed a suspicious case of bTB detected at regular slaughter in the pig. Mycobacterial in a dairy farm, which was eventually attributed to culture was initiated in duplicate in two different Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.58, on 27 Sep 2021 at 17:33:49, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0950268815001995 726 T. Eisenberg and others laboratories using standard procedures as described in reactions upon initial SICCT testing. Both cows were the Official Collection of Diagnostic Methods released re-tested with negative results by IGRA 3 weeks later. by the Friedrich-Loeffler-Institut/Federal Research The remaining 174 bovines aged >6 weeks were tested Institute for Animal Health (FLI) based on DIN 222 by SICCT in mid-October. Of these, five had an incon- standard [18] or with minor modifications. Briefly, clusive result and eight a positive result. Of the former, tissue samples were homogenized and decontami- one reacted positively to a subsequent IGRA test and nated and then inoculated onto three solid (slant) was culled, as were all of the latter. The next herd survey culture tubes [Loewenstein–Jensen medium with was conducted at end of November 2013, when 46 and and without glycerol, Stonebrink medium (Merck, 12 cows tested by SICCT were inconclusive and posi- Germany)] and one liquid medium (Kirchner or tive, respectively. All SICCT-positive bovines as well Middlebrook broth; Merck) and incubated for up to as 33 IGRA-positively re-tested cows were necropsied 12 weeks at 37 °C. To inhibit growth of contaminant between December 2013 and January 2014. In flora, all media were supplemented with PACT (poly- January, one additional cow was culled after a positive myxin B, amphotericin, carbenicillin, and trimetho- SICCT test.
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