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Canadian Journal of Public Health

, Volume 99, Issue 2, pp 145–155 | Cite as

The Zoonotic Potential of Mycobacterium avium spp. paratuberculosis

A Systematic Review
  • Lisa A. WaddellEmail author
  • Andrijana Rajić
  • Jan Sargeant
  • Janet Harris
  • Rocio Amezcua
  • Lindsay Downey
  • Susan Read
  • Scott A. McEwen
Commentaire

Abstract

Background

The zoonotic potential of Mycobacterium avium ssp. paratuberculosis (MAP) has been debated for almost a century because of similarities between Johne’s Disease (JD) in cattle and Crohn’s disease (CD) in humans. Our objective was to evaluate scientific literature investigating the potential association between these two diseases (MAP and CD) and the presence of MAP in retail milk or dairy products using a qualitative systematic review.

Method

The search strategy included 19 bibliographic databases, 8 conference proceedings, reference lists of 15 articles and contacting 28 topic-related scientists. Two independent reviewers performed relevance screening, quality assessment and data extraction stages of the review.

Results

Seventy-five articles were included. Among 60 case-control studies that investigated the association between MAP and CD, 37 were of acceptable quality. Twenty-three studies reported significant positive associations, 23 reported non-significant associations, and 14 did not detect MAP in any sample. Different laboratory tests, test protocols, types of samples and source populations were used in these studies resulting in large variability among studies. Seven studies investigated the association between CD and JD, two challenge trials reported contradictory results, one cross-sectional study did not support the association, and four descriptive studies suggested that isolated MAP is often closely related to cattle isolates. MAP detection in raw and pasteurized milk was reported in several studies.

Conclusions

Evidence for the zoonotic potential of MAP is not strong, but should not be ignored. Interdisciplinary collaboration among medical, veterinary and other public health officials may contribute to a better understanding of the potential routes of human exposure to MAP.

Key words

Review, systematic [Publication Type] Crohn’s disease paratuberculosis zoonoses 

Résumé

Contexte

Le potentiel zoonotique de la paratuberculose aviaire (Mycobacterium avium ssp paratuberculosis–MAP) fait l’objet de débats depuis près d’un siècle en raison des similitudes entre la maladie de Johne (MJ) chez les bovins et la maladie de Crohn (MC) chez les humains. À l’aide d’un examen qualitatif systématique, nous avons évalué la documentation scientifique sur les liens éventuels entre ces deux maladies (le MAP et la MC) et la présence du MAP dans le lait ou les produits laitiers vendus au détail.

Méthode

Nous avons consulté 19 bases de données bibliographiques, les actes de 8 conférences et 15 articles cités en référence, et contacté 28 scientifiques spécialistes du sujet. Deux évaluateurs indépendants ont effectué un tri des documents selon leur pertinence, en ont évalué la qualité et ont extrait les données.

Résultats

Soixante-quinze articles ont été analysés. Sur les 60 études cas-témoins portant sur ‘association entre le MAP et la MC, 37 étaient de qualité acceptable. Vingt-trois études faisaient état d’associations significativement positives, 23 faisaient état d’associations non significatives, et 14 n’ont détecté le MAP dans aucun échantillon. Les études utilisaient différents essais de aboratoire, protocoles d’essai, types d’échantillons et populations sources, ce qui explique la très grande variabilité d’une étude à l’autre. Sept études portaient sur l’association entre la MC et la MJ, deux tests de provocation ont produit des résultats contradictoires, une étude transversale n’a pas confirmé d’association, et quatre études descriptives donnaient à penser que le MAP isolé est souvent étroitement lié aux isolats du bétail. Plusieurs études ont détecté le MAP dans du lait cru et pasteurisé.

Conclusion

Bien qu’elles ne soient pas concluantes, les preuves du potentiel zoonotique du MAP ne sont pas négligeables. Une collaboration interdisciplinaire entre les autorités de santé publique (médicales, vétérinaires et autres) pourrait contribuer à améliorer les connaissances des voies possibles d’exposition humaine au MAP.

Mots clés

examen systématique [type de publication] maladie de Crohn paratuberculose zoonoses 

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Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Lisa A. Waddell
    • 1
    • 2
  • Andrijana Rajić
    • 1
    • 2
  • Jan Sargeant
    • 1
    • 3
  • Janet Harris
    • 1
  • Rocio Amezcua
    • 1
    • 3
  • Lindsay Downey
    • 1
  • Susan Read
    • 1
  • Scott A. McEwen
    • 2
  1. 1.Policy Advice and Effectiveness Program, Laboratory for Foodborne ZoonosesPublic Health Agency of CanadaGuelphCanada
  2. 2.Department of Population Medicine, Ontario Veterinary CollegeUniversity of GuelphCanada
  3. 3.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada

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