Mycobacterium bovis as a Significant Cause of Tuberculosis in Children Residing Along the United States–Mexico Border in the Baja California Region

Abstract

ABSTRACT. Objective. To determine the role of Mycobacterium bovis in active pediatric tuberculosis (TB) in a United States-Mexico border region.Method. We reviewed all new cases of pediatric (<15 years old) TB presenting to San Diego hospitals and clinics from 1980 to 1997. Patients were categorized by age, ethnicity, country of origin, culture results, and disease manifestations. Case definitions were similar to those used by the Centers for Disease Control and Prevention. M bovis was distinguished from Mycobacterium tuberculosis by standard biochemical tests.Results. The median age of the 563 identified patients was 4.1 years old. The yearly incidence began rising in 1989 and peaked in the mid-1990s. Hispanics constituted 78.9% of the patients, but they were less likely to be foreign-born (21.6%) than were black children and Asian/ Pacific Islanders. Overall, M bovis caused 10.8% of all TB during this period. Of the 180 patients with positive culture results, however, M bovis accounted for 33.9% and M tuberculosis 66.1%. This high percentage of M bovis infections was largely attributable to its contribution to extrapulmonary TB (55.2% of all culture-positive specimens). M bovis patients were also even more likely to be Hispanic (90.2%), to present with extrapulmonary disease (95.1%), and to be older than 12 months (96.8%).Conclusion. These data demonstrate the dramatic impact of this underappreciated cause of zoonotic TB on US children at the Mexican border and underscore the need for cross-collaboration to enforce existing Mexican pasteurization laws. Pediatrics 2000;105(6). URL: http:// www.pediatrics.org/cgi/content/full/105/6/e79; pediatric tuberculosis, Mycobacterium bovis, Mycobacterium tuberculosis, zoonotic tuberculosis, extrapulmonary tuberculosis, United States-Mexico border area.ABBREVIATIONS. HIV, human immunodeficiency virus; TB, tuberculosis; CDC, Centers for Disease Control and Prevention; PPD, purified protein derivative; INH, isoniazid; AFB, acid-fast bacillus.B eginning in the mid-1980s, a sharp increase in the incidence and prevalence of tuberculous disease in the United States reversed the steady decline of the last several decades. This increase, which persisted through the early-to mid-1990s, was fueled by the human immunodeficiency virus (HIV) epidemic and by an increasing proportion of active disease in foreign-born individuals.1,2 Although most of the attention was directed toward the significant rise of disease in adults, there was an alarming increase in the pediatric-aged population as well. 3,4 Much of the pediatric disease was identified in minority populations, especially in children from large cities, mirroring the increasing epidemic in adults. 3Traditional teaching has stressed that children with tuberculous disease are sentinel events for active adult disease and that preadolescents usually acquire disease from close contact with a family member or other adult household contact.4 Because aerosols are the route of transmission to these pediatric patients, Mycobacterium tubercu...

Diagnostic Challenges of Central Nervous System Tuberculosis

“…Further complicating therapy, lengthy cultures, and isolate sensitivities are necessary to optimize choices of antimicrobial drugs. Ten percent (2) of our patients were infected with M. bovis, a relatively higher percentage than in other reports (6)(7)(8). Intrinsic pyrazinamide resistance (9) of M. bovis required modifi cation of use of empiric antimicrobial drugs.…”

Emerging or re-emerging bacterial zoonoses: factors of emergence, surveillance and control

“…However, a non-negligible number of cases are still caused by bovine bacilli excreted in the milk of infected cows, since 5 to 10% of human cases are caused by Mycobacterium bovis [19,45]. In a recent review of tuberculosis (TB) in 563 children living along the United States/Mexico border for the period 1980-1997, M. bovis caused 10.8% of all TB cases [18]. The yearly incidence of pediatric tuberculosis cases began rising in 1989 and peaked in the mid-1990s, with Hispanics constituting 78.9% of the patients.…”

An unusual cause of acute abdomen following allogeneic transplantation: a zoonotic disease revisited

“…5 In the San Diego region of CA, USA., M. bovis has been reported to cause 10.8% of tuberculosis and 55.2% of extrapulmonary cases. 6 Our patient is of Mexican origin and admitted ingesting unpasteurized milk in childhood.…”