Zoonotic Tuberculosis in Humans: Control, Surveillance, and the One Health Approach

Abstract

Zoonotic tuberculosis is a reemerging infectious disease in high-income countries and a neglected one in low- and middle-income countries. Despite major advances in its control as a result of milk pasteurization, its global burden is unknown, especially due the lack of surveillance data. Additionally, very little is known about control strategies. The purpose of this review was to contextualize the current knowledge about the epidemiology of zoonotic tuberculosis and to describe the available evidence regarding surveillance and control strategies in high-, middle-, and low-income countries. We conducted this review enriched by a One Health perspective, encompassing its inherent multifaceted characteristics. We found that the burden of zoonotic tuberculosis is likely to be underreported worldwide, with higher incidence in low-income countries, where the surveillance systems are even more fragile. Together with the lack of specific political commitment, surveillance data is affected by lack of a case definition and limitations of diagnostic methods. Control measures were dependent on risk factors and varied greatly between countries. This review supports the claim that a One Health approach is the most valuable concept to build capable surveillance systems, resulting in effective control measures. The disease characteristics and suggestions to implement surveillance and control programs are discussed.

The puzzle of the evolutionary natural history of tuberculosis

“…Cases of transmission of M. tuberculosis by aerosolized M. tuberculosis have been reported during autopsy [ 7 ] and surgical procedures of incision and irrigation of tuberculous abscesses [ 7 ]. Respiratory transmission also includes M. bovis tuberculosis, not only in persons exposed to aerosols from animals infected with M. bovis [ 27 , 28 ], but also by human-to-human transmission of M. bovis [ [28] , [29] , [30] ].…”

“…For M. canettii , current clinical and experimental data [ 12 , 39 ] suggest the existence of an unknown environmental reservoir, and digestive transmission via food with local replication in the oropharynx and cervical lymph nodes and increased dissemination in the respiratory and digestive tracts [ 12 ]. Digestive transmission of tuberculosis is known particularly for zoonotic tuberculosis caused mainly by M. bovis [ 27 ]. Zoonotic tuberculosis is primarily a foodborne disease that follows consumption of unpasteurized milk or milk products [ 27 ].…”

“…Digestive transmission of tuberculosis is known particularly for zoonotic tuberculosis caused mainly by M. bovis [ 27 ]. Zoonotic tuberculosis is primarily a foodborne disease that follows consumption of unpasteurized milk or milk products [ 27 ]. Meat from animals with tuberculosis is not recognized as a vehicle for transmission of M. bovis , at least when cooked, and M. bovis is rarely found in muscle [ 27 ].…”

“…Zoonotic tuberculosis is primarily a foodborne disease that follows consumption of unpasteurized milk or milk products [ 27 ]. Meat from animals with tuberculosis is not recognized as a vehicle for transmission of M. bovis , at least when cooked, and M. bovis is rarely found in muscle [ 27 ]. WHO has estimated that in 2018 zoonotic tuberculosis with M. bovis caused 143 000 new cases and 12 300 deaths [ 2 ].…”

“…More than 15 species of animals can be infected with M. tuberculosis , including parrots [ 5 , 72 , 73 ]; similarly, M. africanum has been sporadically isolated from African monkeys with active tuberculosis and from cows [ 18 , 74 ]. Five MTBC have already been reported as zoonoses, causing tuberculosis in animals and transmissible to humans, including M. bovis [ 27 , [75] , [76] , [77] ], Mycobacterium caprae [ 78 , 79 ], Mycobacterium microti [ [80] , [81] , [82] ], Mycobacterium orygis [ 83 , 84 ] and Mycobacterium pinnipedii [ 85 , 86 ]. However, the main agent of tuberculosis in animals is M. bovis , which can infect a wide range of mammals and has a worldwide distribution in cows [ 75 , 87 ].…”