Rea Tschopp

Mycobacterial Lineages Causing Pulmonary and Extrapulmonary Tuberculosis, Ethiopia

Molecular typing of 964 specimens from patients in Ethiopia with lymph node or pulmonary tuberculosis showed a similar distribution of Mycobacterium tuberculosis strains between the 2 disease manifestations and a minimal role for M. bovis. We report a novel phylogenetic lineage of M. tuberculosis strongly associated with the Horn of Africa.

Risk factors of bovine tuberculosis in cattle in rural livestock production systems of Ethiopia

This study shows a representative stratified cluster sample survey of the prevalence of comparative intradermal tuberculin test in cattle from four regions in Ethiopia. Using a cut-off for positivity of 2 mm, it assesses possible risk factors for tuberculin-positive reaction in cattle. Seventy-three villages in 24 kebeles (administrative units) were randomly selected, from which 2216 cattle from 780 owners were tested. In addition, 450 of these cattle owners were interviewed for risk factor assessment. Ninety-nine percent of the tested cattle in this rural livestock production system were traditional zebus. The individual overall prevalence of cattle bovine tuberculosis (BTB)e was 3%, with the highest found in Meskan Mareko, in Central Ethiopia (7.9%) and the lowest in Woldia, in the North East edge of the Rift Valley (1.2%). Generalised Linear Mixed Models (GLMM) with random effect on kebeles was used to analyse risk factors of cattle reactors and human tuberculosis (TB) infection. Purchase of cattle and presence of other livestock in the herd were statistically significant, with OR: 1.7, p-values of 0.03 and OR: 2, p = 0.05, respectively. Family members diagnosed with TB or showing clinical signs of extra-pulmonary TB (EPTB) were reported in 86 households (19%). None of the assessed potential risk factors of disease transmission between cattle and human (food consumption, livestock husbandry and presence of BTB-positive cattle) were statistically significant.

High Prevalence of Bovine Tuberculosis in Dairy Cattle in Central Ethiopia: Implications for the Dairy Industry and Public Health

Background Ethiopia has the largest cattle population in Africa. The vast majority of the national herd is of indigenous zebu cattle maintained in rural areas under extensive husbandry systems. However, in response to the increasing demand for milk products and the Ethiopian governments efforts to improve productivity in the livestock sector, recent years have seen increased intensive husbandry settings holding exotic and cross breeds. This drive for increased productivity is however threatened by animal diseases that thrive under intensive settings, such as bovine tuberculosis (BTB), a disease that is already endemic in Ethiopia. Methodology/Principal Findings An extensive study was conducted to: estimate the prevalence of BTB in intensive dairy farms in central Ethiopia; identify associated risk factors; and characterize circulating strains of the causative agent, Mycobacterium bovis. The comparative intradermal tuberculin test (CIDT), questionnaire survey, post-mortem examination, bacteriology, and molecular typing were used to get a better understanding of the BTB prevalence among dairy farms in the study area. Based on the CIDT, our findings showed that around 30% of 2956 tested dairy cattle from 88 herds were positive for BTB while the herd prevalence was over 50%. Post-mortem examination revealed gross tuberculous lesions in 34/36 CIDT positive cattle and acid-fast bacilli were recovered from 31 animals. Molecular typing identified all isolates as M. bovis and further characterization by spoligotyping and MIRU-VNTR typing indicated low strain diversity within the study area. Conclusions/Significance This study showed an overall BTB herd prevalence of 50% in intensive dairy farms in Addis Ababa and surroundings, signalling an urgent need for intervention to control the disease and prevent zoonotic transmission of M. bovis to human populations consuming dairy products coming from these farms. It is suggested that government and policy makers should work together with stakeholders to design methods for the control of BTB in intensive farms in Ethiopia.

Prevalence of bovine tuberculosis in pastoral cattle herds in the Oromia region, southern Ethiopia

A cross-sectional study of bovine tuberculosis (BTB) was conducted in pastoral cattle herds in southern Ethiopia, from February to August 2008 using the comparative intradermal tuberculin test. The prevalence of BTB and the risk factors for having positive reactor herds were assessed in four pastoral associations in two districts of southern Ethiopia, namely Goro-Dola with 242 cattle in 16 herds and Liben with 231 cattle in 15 herds. A herd was considered positive if there was at least one reactor animal in a herd. The test results were interpreted based on the Office Internationale des Epizooties recommended 4-mm and a recently suggested 2-mm cut-off. The apparent individual animal prevalence of tuberculin reactors was 5.5% (95% confidence interval (CI), 4.0–8.0%) and 7.0% (95% CI, 5.0–10.0%), whereas the true prevalence estimate was 4.4% (95% CI, 0.8–8.0%) and 6.1% (95% CI, 2.6–9.5%), when using the 4-mm and the 2-mm cut-offs, respectively. The overall herd apparent prevalence of tuberculin reactor animals was 41.9% (95% CI, 24.9–60.9%) and 48.4% (95% CI, 30.2–66.9%) with the 4-mm and 2-mm cut-offs, respectively. A positive tuberculin test was associated with the age of animals and the main drinking water sources during dry seasons. In order to investigate the public health risks and the epidemiological importance of BTB in the area, we recommend to include other livestock species (camels and goats) as well as humans in future studies.

Bovine tuberculosis at the wildlife-livestock-human interface in Hamer Woreda, South Omo, Southern Ethiopia

Bovine tuberculosis (BTB) is endemic in cattle in the Ethiopian Highlands but no studies have been done so far in pastoralists in South Omo. This study assessed the prevalence of bovine tuberculosis (BTB) at an intensive interface of livestock, wildlife and pastoralists in Hamer Woreda (South Omo), Ethiopia. A cross-sectional survey including a comparative intradermal skin testing (CIDT) was conducted in 499 zebu cattle and 186 goats in 12 settlements. Sputum samples from 26 symptomatic livestock owners were cultured for TB. Fifty-one wildlife samples from 13 different species were also collected in the same area and tested with serological (lateral flow assay) and bacteriological (culture of lymph nodes) techniques. Individual BTB prevalence in cattle was 0.8% (CI: 0.3%–2%) with the >4 mm cut-off and 3.4% (CI: 2.1%–5.4%) with the >2 mm cut-off. Herd prevalence was 33.3% and 83% when using the >4 and the >2 mm cut-off respectively. There was no correlation between age, sex, body condition and positive reactors upon univariate analysis. None of the goats were reactors for BTB. Acid fast bacilli (AFB) were detected in 50% of the wildlife cultures, 79.2% of which were identified as Mycobacterium terrae complex. No M. bovis was detected. Twenty-seven percent of tested wildlife were sero-positive. Four sputum cultures (15.4%) yielded AFB positive colonies among which one was M. tuberculosis and 3 non-tuberculous mycobacteria (NTM). The prevalence of M. avium-complex (MAC) was 4.2% in wildlife, 2.5% in cattle and 0.5% in goats. In conclusion, individual BTB prevalence was low, but herd prevalence high in cattle and BTB was not detected in goats, wildlife and humans despite an intensive contact interface. On the contrary, NTMs were highly prevalent and some Mycobacterium spp were more prevalent in specific species. The role of NTMs in livestock and co-infection with BTB need further research.

Bovine tuberculosis at a cattle-small ruminant-human interface in Meskan, Gurage region, Central Ethiopia

BackgroundBovine tuberculosis (BTB) is endemic in Ethiopian cattle. The aim of this study was to assess BTB prevalence at an intensive contact interface in Meskan Woreda (district) in cattle, small ruminants and suspected TB-lymphadenitis (TBLN) human patients.MethodsThe comparative intradermal test (CIDT) was carried out for all animals involved in the cross-sectional study and results interpreted using a > 4 mm and a > 2 mm cut-off. One PPD positive goat was slaughtered and lymph nodes subjected to culture and molecular typing. In the same villages, people with lymphadenitis were subjected to clinical examination. Fine needle aspirates (FNA) were taken from suspected TBLN and analyzed by smear microscopy and molecular typing.ResultsA total of 1214 cattle and 406 small ruminants were tested for BTB. In cattle, overall individual prevalence (> 2 mm cut-off) was 6.8% (CI: 5.4-8.5%) with 100% herd prevalence. Only three small ruminants (2 sheep and 1 goat) were reactors. The overall individual prevalence in small ruminants (> 2 mm cut-off) was 0.4% (CI: 0.03-5.1%) with 25% herd prevalence. Cattle from owners with PPD positive small ruminants were all PPD negative. 83% of the owners kept their sheep and goats inside their house at night and 5% drank regularly goat milk.FNAs were taken from 33 TBLN suspected cases out of a total of 127 screened individuals with lymph node swellings. Based on cytology results, 12 were confirmed TBLN cases. Nine out of 33 cultures were AFB positive. Culture positive samples were subjected to molecular typing and they all yielded M. tuberculosis. M. tuberculosis was also isolated from the goat that was slaughtered.ConclusionsThis study highlighted a low BTB prevalence in sheep and goats despite intensive contact with cattle reactors. TBLN in humans was caused entirely by M. tuberculosis, the human pathogen. M. tuberculosis seems to circulate also in livestock but their role at the interface is unknown.

Repeated cross-sectional skin testing for bovine tuberculosis in cattle kept in a traditional husbandry system in Ethiopia

Representative repeated cross-sectional skin testing for bovine tuberculosis (TB) was conducted over a period of three years in a total of 5377 cattle in three randomly selected woredas (districts) in Ethiopia (Meskan, Woldia and Bako-Gazer) that had never previously been tested for TB. Almost all (99 per cent) of the animals included local zebus kept in traditional husbandry systems. The comparative intradermal tuberculin test with two diagnostic thresholds were used to define positive test results, one according to the World Organisation for Animal Health (OIE) recommended cut-off of more than 4 mm, and the other with a cut-off of >2 mm. Data analysis was performed using a logistic regression model with a random effect at the village level. Applying the OIE definition, the overall representative apparent prevalence of bovine TB in skin test-positive local zebus was 0.9 per cent (95 per cent confidence interval [CI] 0.6 to 1.3 per cent). Using a cut-off of more than 2 mm the overall representative prevalence increased to 4 per cent (95 per cent CI 2.4 to 4.8 per cent). Due to the low apparent prevalence, the true prevalence could be calculated only in Meskan (4.5 per cent) and Bako-Gazer (2.4 per cent) for the more than 2 mm cutoff. With the exception of Meskan, prevalence by woreda did not change significantly over the years. Mycobacterium avium reactor animals were found at all study sites, but there were significant geographical variations. Overall, bulls and oxen were more at risk of being positive reactors (odds ratio [OR] 1.6, 95 per cent CI 1.1 to 2.3; OR 2, 95 per cent CI 1.4 to 2.6, respectively), as were animals in good body condition (OR 2, 95 per cent CI 1.5 to 2.9). Similar results were found at woreda level with the exception of Woldia, where none of the analysed variables was significantly associated with a positive test result.

Population Genomics of Mycobacterium tuberculosis in Ethiopia Contradicts the Virgin Soil Hypothesis for Human Tuberculosis in Sub-Saharan Africa

Summary Colonial medical reports claimed that tuberculosis (TB) was largely unknown in Africa prior to European contact, providing a “virgin soil” for spread of TB in highly susceptible populations previously unexposed to the disease [1, 2]. This is in direct contrast to recent phylogenetic models which support an African origin for TB [3, 4, 5, 6]. To address this apparent contradiction, we performed a broad genomic sampling of Mycobacterium tuberculosis in Ethiopia. All members of the M. tuberculosis complex (MTBC) arose from clonal expansion of a single common ancestor [7] with a proposed origin in East Africa [3, 4, 8]. Consistent with this proposal, MTBC lineage 7 is almost exclusively found in that region [9, 10, 11]. Although a detailed medical history of Ethiopia supports the view that TB was rare until the 20th century [12], over the last century Ethiopia has become a high-burden TB country [13]. Our results provide further support for an African origin for TB, with some genotypes already present on the continent well before European contact. Phylogenetic analyses reveal a pattern of serial introductions of multiple genotypes into Ethiopia in association with human migration and trade. In place of a “virgin soil” fostering the spread of TB in a previously naive population, we propose that increased TB mortality in Africa was driven by the introduction of European strains of M. tuberculosis alongside expansion of selected indigenous strains having biological characteristics that carry a fitness benefit in the urbanized settings of post-colonial Africa.

BOVINE TUBERCULOSIS IN ETHIOPIAN WILDLIFE

Bovine tuberculosis (BTB) is endemic in Ethiopian cattle. However, the status of the disease in wildlife populations that often share habitat with livestock is unknown. We screened for BTB in wildlife in five regions in Ethiopia. Blood and tissue samples from 133 mammals of 28 species were collected from 2006 to 2008. We used a rapid serology test (RT) based on lateral flow technology, and performed culture of lymph node specimens inoculated onto Lowenstein-Jensen and Middlebrook 7H11 media. Acid-fast colonies were further analyzed by molecular typing. Sera from 20 of 87 animals (23%) were positive for BTB by RT; acid-fast bacilli were cultured from 29 of 89 animals (32.5%). None of the positive cultures yielded mycobacteria from the Mycobacterium tuberculosis complex but many environmental mycobacteria were isolated. Among these, Mycobacterium terrae was the most common. We demonstrated a high prevalence of environmental mycobacteria in wildlife, the role of which is unknown. Flagship rare endemic species such as the mountain nyala (Tragelaphus buxtoni) and the Ethiopian wolf (Canis simensis) may be at risk for BTB. We also assessed the utility of RT for field purposes.

Low prevalence of bovine tuberculosis in Somali pastoral livestock, southeast Ethiopia

A cross-sectional study of bovine tuberculosis (BTB) detected by the comparative intradermal tuberculin test (CIDT) was conducted in livestock of the Somali region in southeast Ethiopia—in four pastoral associations from January to August 2009. In 94 herds, each of 15 cattle, camels, and goats was tested per herd leading to a total of 1,418 CIDT tested animals, with 421 cattle, 479 camels, and 518 goats. A herd was considered positive if it had at least one reactor. Prevalence per animal species was calculated using a xtgee model for each species. The individual animal prevalence was 2.0% [95% confidence interval (CI), 0.5–8.4], 0.4% (95% CI, 0.1–3%), and 0.2% (95% CI, 0.03–1.3) in cattle, camels, and goats, respectively. Prevalence of avian mycobacterium purified protein derivative (PPD) reactors in cattle, camels, and goats was 0.7% (95% CI, 0.2–2.0%), 10.0% (95% CI, 7.0–14.0%), and 1.9 (95% CI, 0.9–4.0%), respectively, whereby camels had an odds ratio of 16.5 (95% CI, 5.0–55.0) when compared to cattle. There was no significant difference between livestock species in BTB positivity. In the present study, the prevalence of bovine tuberculosis was low in Somali pastoral livestock in general and in camels and goats in particular. The high proportion of camel reactors to avian PPD needs further investigation of its impact on camel production.