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Zoonotic tuberculosis in humans, elephants, and other animals in Nepal
Mahesh Bhandari and Charles O. Thoen
Tuberculosis in elephants
Nepal has endangered Asian elephants living confined in privately or publicly owned groups or in the wild. There are a total of 208 captive elephants living in national parks, wildlife reserves, or with private owners near the national parks. Most of the privately owned elephants are present either in or around Chitwan National Park and are mainly used for tourism purposes [3,6]. At present, the number of resident wild elephants is estimated to be between 109 and 142 animals . However, it has been suggested that many more animals migrate annually between Nepal and India.
Zoonotic Tuberculosis: Mycobacterium bovis and Other Pathogenic Mycobacteria, Third Edition. Edited by Charles O. Thoen, James H. Steele, and John B. Kaneene. © 2014 John Wiley & Sons, Inc. Published 2014 by John Wiley & Sons, Inc.
Tuberculosis (TB) is a highly contagious global anthropozoonotic bacterial disease caused by the Mycobacterium tuberculosis complex, which includes M. tuberculosis and M. bovis . There is an increasing awareness of the impact of disease at the human– livestock–wildlife interface in developing countries like Nepal [1–3] that are heavily dependent on animal agriculture and tourism. It is estimated that 45% of the total Nepalese population are infected with TB; 40,000 people are reported to contract TB each year, 20,000 new sputum positive cases are reported each year, and 5,000– 7,000 people die each year from TB . In the developing countries of the world the real incidence and differential diagnosis of M. bovis and M. tuberculosis is roughly underestimated due to inadequate laboratory capability to isolate and differentiate them . Importantly, the recent reporting of XDR (extensively drug r esistant) TB in a Nepalese man detained at the U.S. border has highlighted the situation of TB in Nepal. The situation requires medical attention since there is no reporting of human/ animal XDR-TB. In addition, it has been reported that there is widening TB drug resistance in India, which is a neighbor of Nepal with an open border . People move freely between the two countries without any testing or quarantine measures. The condition may be even worse in the coming days because of the human– livestock–wildlife interface in Nepal.
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Iowa State University, USA
However. TB infects 11%–25% of tested captive elephant populations in the United States.) . 0002075135. and other endangered species.192 Zoonotic Tuberculosis: Mycobacterium bovis and other pathogenic mycobacteria Elephant tuberculosis is a chronic disease that affects captive elephants worldwide . quality of chemicals. Captive elephants are critical to Nepal’s conservation program. which aims to minimize the risk of TB transmission from captive elephants to wild elephants by managing tuberculosis at the captive– wild interface . The principle method for surveillance has been through serology.500. real-time reverse transcription-polymerase chain reaction (RT-PCR) assays in RNA-preserved whole blood samples from 106 Asian elephants. the National Trust for Nature Conservation. Elephants in other countries have similar conservation roles . A significant number of elephants have tested positive for tuberculosis. rhinoceri.INDD 192 U N C O R R EC TE D PR O O FS 11/29/2013 4:09:32 PM . tuberculosis in captive elephants was first identified in Chitwan National Park in 2002 . The Nepal Elephant Healthcare and TB Surveillance Program is a collaboration between the Department of National Parks and Wildlife Conservation. Difficulty arises because elephants may not be shedding at time of collection. In addition. the Institute of Agriculture and Animal Science. and other expenses. In Nepal. Private elephants engage in ecotourism activities. In the seven-year period from 2002 to 2009. seven captive elephants died of tuberculosis [2. the method of collection of trunk washes for mycobacteriologic examination is difficult to accomplish in Nepal because of different collection and laboratory procedures. rifampin. Recently the government of Nepal endorsed the Nepal Elephant Tuberculosis Control and Management Action Plan. Inc. tiger. and Nepal . Positively reacting animals selected for treatment are given a combination of isoniazid. This does not include the overhead costs of transportation. and the tests may yield some false negative results . They patrol the national parks. gaurs. and the Zoological Society of London . initiated the first comprehensive range-country testing of elephants for TB  in 2006 and began TB treatment in 2008 with a standardized treatment protocol . in collaboration with Elephant Care International and partners. World Wildlife Fund–Nepal. Elephant Care International. their locations. utilizing the USDA-approved Elephant TB STAT-PAK assay (Chembio Diagnostic Systems. veterinary care. In a study conducted on mRNA levels of different cytokines and chemokines using elephant- specific. and other factors . the Cummings School of Veterinary Medicine at Tufts University. To address this problem the Government of Nepal. which generate financial support for the parks. laboratory fees for monitoring treatment. It is important to emphasize that mycobacteriologic examinations are necessary to identify the etiologic agent to confirm a diagnosis of tuberculosis . Twenty-two percent (36 of 164) of captive elephants in Nepal have tested positive for TB using the Elephant TB STAT-PAK assay [2. protocols of treatment. 15% were Mycobacterium tuberculosis complex positive . multiple freezes/thaws of specimens. supervision. Seven elephants (~4% of the total Nepal population) with TB died in Nepal between 2002 and 2009 . The cost of drugs to treat one typical adult elephant averages about US$3. and limited laboratory equipment cause problems . Mycobacterium tuberculosis complex has been reported to infect elephants [2. and/or pyrazinamide for one year following a very specific protocol . which vary greatly depending on the number of elephants being treated. including Chitwan. ethambutol. The intradermal tuberculin skin test has not been accurate in elephants and is not recommended . a World Heritage site that provides habitat for elephants. 11]. 12]. 3]. India.
bovis . which is a center of milk production and is home to Nepal’s fastest growing human population. The animals selected were raised in 60 farms of TB-infected patients . Multidrug resistant (MDR) tuberculosis has been found among elephants in the United States [14. Effective control measures are very important to limit the spread of tuberculosis so it does not affect free-living wild elephants and other endangered wildlife. However. In Nepal. tuberculosis types that have been reported to infect elephants .2% of the buffalos in Chitwan District had response to the cervical SID test using PPD of M. 13 were identified as M. the organism may not be destroyed. Similarly in another study. Because of the interaction between humans. if the milk foams during boiling. The remaining 23 strains were atypical mycobacteria . mycobacteriologic examination of milk and feces from cattle and water buffalo positive on the cervical SID were subjected to genetic analysis. MDR strains of M. . In a recent study. Transmission of M. It is a common practice that Nepalese people heat milk over a wood fire to approximately 75 °C and then quickly cool it by immersing the heated container in cold water. and elephants. livestock. humans appear to have infected elephants with M. positive responses were observed in 18% of the cattle and buffalo on cervical SID. such as SARS. MDR tuberculosis may become a risk factor for elephants in Nepal . bovis. and other animals in Nepal 193 Tuberculosis in cattle and buffalo It has been reported that 5% of cattle and buffalos surveyed in Nepal were positive on cervical single intradermal skin test (SID). Animals were tested using an SID test whereby 0. Of the 36 strains. Ingestion of unpasteurized dairy products as well as inhalation of the bacteria can lead to human infection with M.INDD 193 U N C O R R EC TE D PR O O 11/29/2013 4:09:32 PM FS Humans contract diseases from animals. a practice that is considered to be effective in killing M.1 mL of USDA M. bird flu. such as Chitwan District. bovis in cattle is via either the oral route or the respiratory route through aerosol exposure . 0002075135. Ingestion is likely the most important route of infection of humans with M. bovis tuberculin purified protein derivative (PPD) . A preproject survey in 2003 found that 32.Zoonotic tuberculosis in humans. The highest incidence of bovine tuberculosis in cattle is generally found where intensive dairy production is practiced. and West Nile virus. 15]. bovis . and these strains were isolated from 17% of the buffalos and 16% of the cattle. using M. whereas 32 % of buffalos had positive responses . elephants. bovis PPD tuberculin (2 mg/mL protein) was injected by trained veterinarians using a standard tuberculin syringe with a 26-gauge needle into the skin in the cervical region . A limiting factor in control of bovine tuberculosis in Nepal is that the animals that test positive are not culled because of cultural beliefs and economic factors. 15% (total of 100 animals) of bovines were shown to be positive for single intradermal tuberculin test. bovis. A total of 36 mycobacterial strains were isolated from 39% of the buffaloes and 34% of the cattle. Tuberculosis is readily treatable in humans and in trained elephants. but it is important to emphasize that humans also infect animals. bovis that is believed to be the most common cause of tuberculosis in water buffalo in Asia . tuberculosis have not been identified in wild elephants in Nepal. In a recent study.
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