Comparison of three diagnostic detection methods for tuberculosis in French cattle

Morphology of Naturally-Occurring Tuberculosis in Cattle Caused by Mycobacterium caprae

This study describes the pathomorphological alterations of bovine tuberculosis through gross and histopathological examinations, assessment of the distribution of lesions and the demonstration of mycobacteria. Samples from lungs, liver, small intestine, their regional lymph nodes and retropharyngeal lymph nodes were collected from 84 cattle with tuberculosis from the Allgäu, Germany. Organs were evaluated grossly, histopathologically and by transmission electron microscopy. Mycobacteria and mycobacterial antigens were demonstrated using acid-fast staining and immunohistochemistry (IHC). Bacteriological tests revealed Mycobacterium caprae in all animals. Gross alterations were classified into five patterns (I to V) with an additional pattern of acute exudative pulmonary inflammation (pattern VI). Histological lesions were classified into four types (1-4) with additional lesions occurring in lungs only. Acid-fast staining revealed a low number of bacteria in all tissues, while IHC showed comparatively more mycobacterial antigens within the lesions and also at their periphery. The alimentary tract (68%) was the main portal of entry followed by an aerosol infection (19%). It was assumed that the observed lesions reflect a continuous primary period of infection; there were no lesions typical of a secondary (post-primary) period, as reported in man and also described in the older literature on bovine tuberculosis. The broad spectrum of changes described formerly was not observed in the present cases and the route of infection and nature of acid fast staining showed differences when compared with previous studies of naturally-occurring bovine tuberculosis.

Second line molecular diagnosis for bovine tuberculosis to improve diagnostic schemes

Surveillance of bovine tuberculosis (bTB) is partly based on the sanitary inspection of carcasses at the abattoir to detect bTB-like lesions which, in compliance with EU recommendations, are analysed by bacteriology and histopathology to disclose Mycobacterium bovis (or M. caprae) infection. Moreover, since 2012, a PCR method with similar sensitivity and specificity values of histopathology and bacteriology respectively is additionally employed in France, partially compensating for the weaknesses of classical diagnostic methods. We analysed a collection of bTB-like lesions from cattle presenting positive histological results albeit with negative PCR results. We present here the results of these samples, recovered from 292 animals culled between 2013 and 2016, analysed with a second line molecular diagnosis approach that consists in a combination of PCRs targeting the M. tuberculosis-M. avium complexes as well as the Mycobacterium genus and sequencing of hsp65 gene. These molecular analyses disclosed to identify the presence of non-tuberculous bacteria which could be responsible for most of these non-specific TB lesions: non tuberculous mycobacteria (24%) or Actinomycetales (56%) such as Rhodococcus equi (53%); 24% of the samples were negative. M. bovis -or any other MTBC members- was neither detected by molecular methods nor isolated in any of them at the end of the 3 months of culture. In conclusion, these results highlight the lack of specificity of histopathology and the usefulness of a first line PCR with a second line molecular diagnostic test to circumvent it. This diagnostic strategy makes it possible to reduce the number of suspect bTB cases raised at the abattoir or shortening their lock-up periods. By simplifying diagnostic schemes, the use of this tool could improve bTB surveillance and make eradication programs more efficient in the future.

Exames complementares no diagnóstico da tuberculose em bovinos reagentes à tuberculinização comparada

RESUMO: Objetivou-se com este estudo comparar diferentes métodos complementares de diagnóstico (macroscópico, histopatológico, sorológico e molecular) da tuberculose, em bovinos naturalmente infectados. O trabalho deu-se por meio de amostras colhidas em abate sanitário de 40 bovinos reagentes no teste cervical comparativo (TCC) para tuberculose. A inspeção macroscópica post mortem das carcaças foi acompanhada de colheita de amostras de muco nasal, sangue e tecido (fígado, pulmão e linfonodo mediastínico) para realização do exame de reação em cadeia pela polimerase (PCR), de Enzyme-Linked Immunosorbent Assay (ELISA) e histopatológico com colorações de hematoxilina-eosina (HE) e Ziehl-Neelsen (ZN), respectivamente. Dos 40 bovinos inspecionados no abate, 22 (55%) animais apresentaram algum tipo de lesão macroscópica sugestiva de tuberculose. Nos achados histopatológicos visualizados em HE, 13 (32,5%) carcaças apontaram alterações histológicas, sendo 6 (15%) nos linfonodos mediastínicos, 5 (12,5%) no fígado e 3 (7,5%) no pulmão. Não foi observada a presença de bacilos álcool-ácido resistentes em nenhuma das amostras avaliadas. O ensaio sorológico de ELISA/IDEXX(r) identificou um (2,5%) animal reagente, e o teste de PCR detectou DNA de Mycobacterium bovis em uma (2,5%) amostra. Concluiu-se que entre os exames complementares de diagnóstico avaliados nenhum foi capaz de detectar todos os animais que estavam positivos na tuberculinização, porém a associação de diferentes métodos pode garantir a confiabilidade do diagnóstico.

Prevalência e histopatologia de lesões sugestivas de tuberculose em carcaça de bovinos abatidos no Sudoeste da Bahia

O objetivo deste estudo foi determinar a prevalência de lesões sugestivas de tuberculose em carcaças de bovinos abatidos na região Sudoeste da Bahia. No período de março a novembro de 2012 foram inspecionados 58.268 bovinos abatidos em um matadouro frigorífico em Vitória da Conquista-BA. A inspeção consistiu na avaliação sistemática dos gânglios linfáticos e órgãos em busca das lesões sugestivas, por meio de exame visual e tátil com posterior incisão dos gânglios linfáticos. A prevalência de animais com lesões sugestivas de tuberculose ao exame anatomopatológico foi de 0,12%. Os linfonodos mais acometidos foram os pré-escapulares (51,5%) traqueobronquiais (19,2%) e isquiáticos (11,1%). Dos linfonodos com lesões presuntivas, 60,6% apresentaram alterações histológicas sugestivas de micobactérias e 10,0% apresentaram bacilos álcool-ácido resistentes pela coloração de Ziehl-Neelsen, portanto, positivas para micobactérias. Conclui-se que prevalência de carcaças bovinas com lesões sugestivas de tuberculose no Sudoeste da Bahia é baixa, mas remete a necessidade de intensificação das ações para o controle e erradicação da tuberculose bovina no Estado da Bahia.

Location of intra- and extracellular M. tuberculosis populations in lungs of mice and guinea pigs during disease progression and after drug treatment

The lengthy treatment regimen for tuberculosis is necessary to eradicate a small sub-population of M. tuberculosis that persists in certain host locations under drug pressure. Limited information is available on persisting bacilli and their location within the lung during disease progression and after drug treatment. Here we provide a comprehensive histopathological and microscopic evaluation to elucidate the location of bacterial populations in animal models for TB drug development.To detect bacilli in tissues, a new combination staining method was optimized using auramine O and rhodamine B for staining acid-fast bacilli, hematoxylin QS for staining tissue and DAPI for staining nuclei. Bacillary location was studied in three animal models used in-house for TB drug evaluations: C57BL/6 mice, immunocompromised GKO mice and guinea pigs. In both mouse models, the bacilli were found primarily intracellularly in inflammatory lesions at most stages of disease, except for late stage GKO mice, which showed significant necrosis and extracellular bacilli after 25 days of infection. This is also the time when hypoxia was initially visualized in GKO mice by 2-piminidazole. In guinea pigs, the majority of bacteria in lungs are extracellular organisms in necrotic lesions and only few, if any, were ever visualized in inflammatory lesions. Following drug treatment in mice a homogenous bacillary reduction across lung granulomas was observed, whereas in guinea pigs the remaining extracellular bacilli persisted in lesions with residual necrosis. In summary, differences in pathogenesis between animal models infected with M. tuberculosis result in various granulomatous lesion types, which affect the location, environment and state of bacilli. The majority of M. tuberculosis bacilli in an advanced disease state were found to be extracellular in necrotic lesions with an acellular rim of residual necrosis. Drug development should be designed to target this bacillary population and should evaluate drug regimens in the appropriate animal models.

Bayesian receiver operating characteristic estimation of multiple tests for diagnosis of bovine tuberculosis in Chadian cattle

Background

Bovine tuberculosis (BTB) today primarily affects developing countries. In Africa, the disease is present essentially on the whole continent; however, little accurate information on its distribution and prevalence is available. Also, attempts to evaluate diagnostic tests for BTB in naturally infected cattle are scarce and mostly complicated by the absence of knowledge of the true disease status of the tested animals. However, diagnostic test evaluation in a given setting is a prerequisite for the implementation of local surveillance schemes and control measures.

Methodology/Principal Findings

We subjected a slaughterhouse population of 954 Chadian cattle to single intra-dermal comparative cervical tuberculin (SICCT) testing and two recently developed fluorescence polarization assays (FPA). Using a Bayesian modeling approach we computed the receiver operating characteristic (ROC) curve of each diagnostic test, the true disease prevalence in the sampled population and the disease status of all sampled animals in the absence of knowledge of the true disease status of the sampled animals. In our Chadian setting, SICCT performed better if the cut-off for positive test interpretation was lowered from >4 mm (OIE standard cut-off) to >2 mm. Using this cut-off, SICCT showed a sensitivity and specificity of 66% and 89%, respectively. Both FPA tests showed sensitivities below 50% but specificities above 90%. The true disease prevalence was estimated at 8%. Altogether, 11% of the sampled animals showed gross visible tuberculous lesions. However, modeling of the BTB disease status of the sampled animals indicated that 72% of the suspected tuberculosis lesions detected during standard meat inspections were due to other pathogens than Mycobacterium bovis.

Conclusions/Significance

Our results have important implications for BTB diagnosis in a high incidence sub-Saharan African setting and demonstrate the practicability of our Bayesian approach for diagnostic test evaluation.

Direct detection of Mycobacterium bovis in bovine lymph nodes by PCR

Thirty-five lymph node samples were taken from animals with macroscopic lesions consistent with Mycobacterium bovis infection. The animals were identified by postmortem examination in an abattoir in the northwestern region of state of Paraná, Brazil. Twenty-two of the animals had previously been found to be tuberculin skin test positive. Tissue samples were decontaminated by Petroff's method and processed for acid-fast bacilli staining, culture in Stonebrink and Lowenstein-Jensen media and DNA extraction. Lymph node DNA samples were amplified by PCR in the absence and presence (inhibitor controls) of DNA extracted from M. bovis culture. Mycobacterium bovis was identified in 14 (42.4%) lymph node samples by both PCR and by culture. The frequency of PCR-positive results (54.5%) was similar to that of culture-positive results (51.5%, P > 0.05). The percentage of PCR-positive lymph nodes increased from 39.4% (13/33) to 54.5% (18/33) when samples that were initially PCR-negative were reanalysed using 2.5 microl DNA (two samples) and 1 : 2 diluted DNA (three samples). PCR sensitivity was affected by inhibitors and by the amount of DNA in the clinical samples. Our results indicate that direct detection of M. bovis in lymph nodes by PCR may be a fast and useful tool for bovine tuberculosis epidemic management in the region.

Comparison of histologic techniques for the diagnosis of bovine tuberculosis in the framework of eradication programs

Rapid diagnosis of tuberculosis in cattle reacting positive in antemortem assays is crucial in countries where eradication programs are operated to confirm the presence of the infection in tuberculosis-free herds. This study evaluated the accuracy of histopathologic examination by hematoxylin and eosin and Ziehl-Neelsen (ZN) staining applied in this framework, when suspected lesions are caused by low infectious doses and are detected in early stages of the disease. For this purpose, histologic methods were compared with mycobacterial culture as reference test on suspected lymph node samples from 173 cattle reacting positive in antemortem tests. Histopathology demonstrated high sensitivity (93.4%) and specificity (92.3%), while ZN sensitivity and specificity were respectively 33.9% and 100%. There was good agreement between histopathology and bacterial culture, suggesting that histopathologic examination is a reliable tool for rapid diagnosis in countries where active tuberculosis eradication programs allow the prompt identification and elimination of reactor cattle. Histopathology permits identification of typical mycobacterial lesions and its differentiation from other causes.