Mycobacterium paratuberculosis Cervical Lymphadenitis followed five years later by terminal ileitis similar to Crohn's Disease.

This paper was published in the British Medical Journal on February 7th 1998. This paper is a breakthrough in paratuberculosis research, because it describes the worlds first documented case of disease in a human being caused by Mycobacterium paratuberculosis. The summary of the paper contains all of the salient points, so I reproduce that here.

Full text available: Mycobacterium paratuberculosis Cervical Lymphadenitis followed five years later by terminal ileitis similar to Crohn's Disease.
Full text, with diagrams, also available from the British Medical Journal Website.

Summary

In September 1988 a seven year old boy living in a village outside Cambridge, developed non-tuberculous mycobacterial cervical lymphadenitis. The nodes were removed and later shown to contain abundant Mycobacterium paratuberculosis. This pathogen causes chronic inflammation of the intestine ranging from a pluribacillary 'lepromatous' type to a paucimicrobial 'tuberculoid' type, in many species of animals including primates. Five years later he presented with chronic inflammation of the intestine affecting the terminal ileum and ascending colon, similar to Crohn's disease. This resolved on prolonged treatment with a combination of rifabutin and clarithromycin, leaving a healed ileal scar which required excision. As with M. bovis earlier this century, infection with M. paratuberculosis was probably acquired by the consumption of milk contaminated with these robust versatile organisms.

Important points to note.

• The form of Mycobacterium paratuberculosis that was isolated from the patient was the "bacillary" form, i.e. the same form as that generally isolated from animals. In all cases of Crohn's disease where Mycobacterium paratuberculosis has been isolated, it is been the elusive "spheroplast" form. This isolation and culture of bacillary Mycobacterium paratuberculosis from a human being proves conclusively that this bacterium can cause disease in humans.

• The area first affected in the patient was the lymph nodes of the neck. This almost certainly indicates that the route of infection for the bacterium was the mouth, i.e. through consumption of Mycobacterium paratuberculosis contaminated food. This route for infection with paratuberculosis is identical to a common route for infection with the related bacterium Mycobacterium tuberculosis before milk pasteurization was introduced. In the days before compulsory milk pasteurization was introduced, it was common for people to develop cervical lymphadenitis after consuming milk contaminated with live Mycobacterium tuberculosis bacteria. After an incubation period of months or years, the infection would spread to other organs of the body, i.e. the lungs or the intestines.

• The intestinal disease contracted by this patient was indistinguishable from Crohn's disease, as tested by clinical, radiological and white-cell-scanning methods.

• After treatment with an antibiotic regime which is active against Mycobacterium paratuberculosis, the patient went into profound remission from the Crohn's disease. The antibiotic regimen used was identical to that described in the paper Two year outcomes analysis of Crohn's disease treated with rifabutin and macrolide antibiotics.

Source: http://archive.crohn.ie/htround.htm
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