why rate of pulmonary TB is increasing :-

¨Homelessness

¨Intravenous drug use

¨Overcrowding in institutional settings

¨HIV infection co-infection

¨Drug-resistant strains of TB

¨Reduced TB control and treatment resources

¨Immigration from high TB prevalence areas

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Tuberculosis in humans and animals: are we a threat to each other?

J R Soc Med. 2006 Oct; 99(10): 539–540.

doi: 10.1258/jrsm.99.10.539

PMCID: PMC1592058

PMID: 17021307

Today TB in animals is a word wide problem. In England and Wales it is increasing rapidly. The same strains of M. bovis demonstrated by spoligotyping have been found in cattle and badgers living in close confines. Infection in cattle leads to economic harm to agriculture as animals cannot be traded. The clinical and economic importance of TB in cattle is as great as for bovine spongiform encephalitis and foot and mouth disease. Fatality from TB can result directly in cattle and infection means slaughter. In this situation a farmer's insurance may be terminated, with resulting loss of earnings and bankruptcy.

The main means of spread between cattle is probably due to translocation of cattle as those with infection are moved to a non-infected heard. The spread to and from wildlife is also likely to be important.

Though human TB had increased by 20% in England and Wales, since 1987 the geographical distribution of human TB is very different from the distribution of TB in cattle.

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The Risk of Bovine TB from Raw Milk Consumption with a Focus on Michigan

Posted on February 12, 2008

Last Modified on August 10, 2015

Bovine TB in Milk

Growth of the tuberculosis bacteria is extremely slow, even under ideal conditions. They are unlikely to proliferate outside of a living animal. And growth in milk is considered very unlikely. With our current understanding of the complexity of this disease, it has been shown in several rigorous studies conducted in countries where eradication programs are not in effect, that in large dairy herds with widespread infection, a few samples of milk do contain the bovine tubercle bacillus.8,9,10 This has been documented even when the milk was carefully handled to eliminate the possibility of contamination outside of the cow.

In one study in Tanzania,11 two out of 805 samples obtained from infected cows were confirmed to contain the bovine bacteria. In a 2003 study in Lahore, Pakistan, researchers were able to identify bovine tuberculosis bacteria in the milk from four of 16 cows with confirmed bovine tuberculosis.12 It is critical to note that all of the cows tested in the Lahore study were specifically selected because they were visibly ill, showing “low milk yield, emaciation, and anorexia, intermittent diarrhea, not responding to anthelmintic treatment, irregular febrile episodes, and stubborn recurring mastitis.”

It is also reported that cow’s milk can become secondarily contaminated from ulcerating tuberculous lesions on the teats of cows, as well as from milk-handlers who have active tuberculosis. These are incredibly rare circumstances. Milk-handlers in all regions of the world are much more likely to have human tuberculosis than bovine tuberculosis.

Critical analysis would conclude that the transmission of bovine tuberculosis from milk to a human would only occur under a set of extremely uncommon circumstances:

• If the infection originated in the cow’s milk, the cow would need to have active tuberculosis in the udder (i.e., tuberculous mastitis—an extraordinarily rare form of the disease and not to be confused with common mastitis), or tuberculous ulcers on her teats. Both conditions would be apparent to a vigilant farmer.
• A farmer with tuberculosis could contaminate milk during handling, but the farmer would need to have active disease and would likely be noticeably sick.
• It is theoretically possible for an uninfected farmer to physically contaminate milk with secretions from an infected cow, but those secretions would only contain the bacteria if that cow had active lung or throat disease.
• It is theoretically possible for milk to be contaminated in the dairy parlor from airborne particles originating from a cow with active tuberculosis, from either the cow being milked or from one that had distributed infected secretions in the parlor in the past.
• And theoretically it is possible for tubercle bacteria from a cow with intestinal tuberculosis shedding into manure to be the source of fecal contamination in milk.

All these circumstances are extremely unlikely, and to my knowledge not one of these theoretical cases has ever been documented. And finally, in all of these cases, the humans who ingested the infected or contaminated milk would develop tuberculosis in the mouth or neck lymph nodes, or in the intestine, not in the lungs.

I am unaware of any rigorous study that has shown that the infection of bovine tuberculosis in people in any region of the world can be traced to ingestion of infected milk. Furthermore, in regions where herd infection is widespread, the few reports of human infections with bovine tuberculosis do not describe lesions that would be associated with ingestion of milk. In a contemporary analysis in the United Kingdom, thorough clinical examinations were performed on 138 people who had close contact with herds infected with bovine tuberculosis or who drank raw milk from those herds. No cases of bovine tuberculosis were found in these people.

Thanks Khaled Almaz

That was very interesting to read

Not in under developed countries

Dear more effort efforts should be applied in developing countries.

There is generally low TB case finding in the developing countries thus by the time of diagnosis, quite a number of people are already infected. There is also the challenge of defaulting by the TB patients which leads to further spread and resistance over time.

LMIC are not into case finding as what Edwin Ochomo said above. Also the issue of availability of tb medicines is a great challenge. During end of last year most countries in Africa did not have RHZE and that lead to many patients defaulting.

In my country tuberculosis is increasingly positioned on risk groups. but also about some patients without special conditions. we are a country of intermediate incidence

Availability of drugs

Home conditions that lead to transmission

Side effects of drugs

Malnutrition and HIV: immunosuppression

IV drug use

Effectiveness of drugs

Cost of new drugs

More?

Lets work on a list for a petition to our governments.

May be,there is more to the story..lack of motivation and education among these patients to continue the long regimen is another factor leading to defaulting..and we have to mention poverty in this list...there are many patients in developing nations who do not see a doctor even if they have symptoms...awareness and education is needed..

A recent four-part debate on this matter in the pages of the Journal of Biosocial Science (items 2 and 4 have free pdfs available at ResearchGate.net):

1) Mason, P.H., Roy, A., Spillane, J. and Singh, P., 2016. Social, historical and cultural dimensions of tuberculosis. Journal of biosocial science, 48(2), pp.206-232.

https://doi.org/10.1017/S0021932015000115

2) Simandan, D., 2017. Considering neoliberalism, contempt and allostatic load in the social dynamics of tuberculosis. Journal of biosocial science, 49(4), pp.557-558. https://doi.org/10.1017/S0021932016000614

3) Mason, P.H., Roy, A. and Singh, P., 2017. Reciprocity-building and the importance of interdisciplinary collaboration in tuberculosis research. Journal of biosocial science, 49(4), pp.559-562. https://doi.org/10.1017/S0021932016000626

4) Simandan, D., 2017. Wisdom and the path-dependent politics of biomedical research. Journal of biosocial science, 49(4), pp.563-565. https://doi.org/10.1017/S0021932016000638

Refuse or negligence to integrate high dose of vitamin D and of high quality proteins in the protocols of anti-TB treatments !