The zoonotic potential of Mycobacterium avium ssp. paratuberculosis: a systematic review and meta-analyses of the evidence.

This systematic review-meta-analysis appraises and summarizes all the
available research (128 papers) on the zoonotic potential of
Mycobacterium avium ssp. paratuberculosis. The latter has been debated
for a century due to pathogenic and clinical similarities between
Johne's disease in ruminants and Crohn's disease (108 studies) in humans
and recently for involvement in other human diseases; human
immunodeficiency virus (HIV) infection (2), sarcoidosis (3), diabetes
mellitus type 1 (T1DM) (7) and type 2 (3), multiple sclerosis (5) and
Hashimoto's thyroiditis (2). Meta-analytical results indicated a
significant positive association, consistently across different
laboratory methods for Crohn's disease [odds ratio (OR) range
4·26-8·44], T1DM (OR range 2·91-9·95) and multiple sclerosis (OR range
6·5-7·99). The latter two and the thyroiditis hypothesis require further
investigation to confirm the association. Meta-regression of Crohn's
disease studies using DNA detection methods indicated that choice of
primers and sampling frame (e.g. general population vs. hospital-based
sample) explained a significant proportion of heterogeneity. Other
epidemiological studies demonstrated a lack of association between
high-risk occupations and development of Crohn's disease. Due to
knowledge gaps in understanding the role of M. paratuberculosis in the
development or progression of human disease, the evidence at present is
not strong enough to inform the potential public health impact of M.
paratuberculosis exposure.

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