"Unfit for human consumption": tuberculosis and the problem of infected meat in late Victorian Britain

By the 1890s, questions about tuberculous meat in Britain served to transform the issue of infected meat from an ill-defined to a concrete threat. Veterinarians, building on European inoculation (or transmission) experiments, played a prominent part in constructing the debate, with medical officers of health following. With the emergence of bacteriology in the 1880s, a consensus emerged about the dangers of tuberculous meat: Robert Koch's identification of the tubercle bacillus in 1882, and the connection he saw between bovine tuberculosis and the disease in man, provided confirmation of the disease's danger to man. It was from this point that veterinary and public health interests diverged. Whereas a general agreement had been reached, the extent of the problem remained open to doubt. Confusion revolved around two issues: the localization of infection, and the question of cooking. The latter was thought to make tuberculous meat "safe," as attention shifted to the problem of milk; whereas the former frustrated efforts to combat the sale of meat showing signs of infection.     

Fascioloidiasis in game-ranched elk from Montana

The distribution of Fascioloides magna in game-ranched elk and the potential for spread of the parasite through movement of infected animals was examined in Montana (USA). Fecal samples (n = 448) collected from captive elk on 29 game ranches were examined for eggs of F. magna by fecal sedimentation. Eggs were detected in elk on 5 ranches. This suggests that F. magna has been translocated by infected game-ranched elk. The wide distribution of snail intermediate hosts for F. magna in Montana indicates a potential to spread the parasite to other captive cervids domestic livestock or free-ranging wildlife.     

Meat inspection: an overview of present practices and future trends

This is a review of meat inspection literature, its history, current concerns and needs for the future. The value and limitations of meat inspection are discussed, along with the possible modifications or changes that are being developed to modernize an increasingly outdated method of safeguarding public health. The potential of on-farm risk assessment of slaughter animals and the practical considerations that need to be overcome are outlined. The needs of the consumer and subsequent challenges to the meat and farming industry are proposed as the driving force behind the changes occurring in veterinary public health. The current risk to consumers, from such microbial pathogens as Salmonella, Escherichia coli O157:H7 and Campylobacter infection, are highlighted.     

Epidemiology and control of egg-associated Salmonella enteritidis in the United States of America

The isolation rate for Salmonella enterica serotype Enteritidis (SE) in humans in the United States of America (USA) increased from 1,207 sporadic isolates identified in 1976 (0.6 isolates/100,000 population) to 10,201 identified in 1995 (4.0/100,000 population). The proportion of reported Salmonella isolates which were SE increased from 5% to 25% during the same time period. In 1990, 1994, and 1995, SE was the most commonly reported reported Salmonella serotype in the USA. Much of this increase has been associated with the consumption of contaminated shell eggs. An examination of the results of a United States Department of Agriculture (USDA) survey of spent hens at slaughter and unpasteurised liquid egg at breaker plants (liquid egg processors) in 1991 and 1995 reveals an increase in the prevalence of SE isolates overall and in most regions of the USA. SE phage type 4 (pt 4), the predominant SE phage type in other parts of the world, has emerged in the egg industry in the western USA concurrent with a sharp increase in the number of sporadic human SE pt 4 isolates in California and Utah. Research on the molecular structure and virulence of SE pt 4 isolates from the USA as compared with isolates from other parts of the world (human and poultry) should be a priority. A comparison of DNA from pt 4 isolates from the USA and Europe may provide information about the potential threat to public health and poultry in the USA from this phage type. Some regional success in the reduction of human illness as a result of SE control efforts is apparent. The Pennsylvania Egg Quality Assurance Program has shown progress in reducing SE infection in participating flocks. At a national level, however, neither the incidence of human illness due to SE nor the prevalence of SE in flocks and unpasteurised liquid eggs have decreased significantly, despite the implementation of the USDA 'trace back' regulation from 1990 to 1995, and intensified efforts to educate food handlers and to enforce safe food handling practices. More effort is needed to control SE at every stage of the egg continuum, from production through to consumption. A risk-reduction approach, with barriers to the introduction and multiplication of the pathogen throughout the farm-to-table continuum, is the most practical method for reducing human illness from SE in shell eggs at present. An effective long-term solution will require interdisciplinary efforts involving government, industry, consumers, and academics. Interventions should be developed and evaluated in compliance with the potential for reducing the risk to human health and cost-effectiveness.     

The anti-neoplastic drug 5-fluorouracil produces echinocytosis and affects blood rheology

Small ruminants are very important livestock species in the English-speaking Caribbean. Total populations for the Caribbean region are approximately 677,000 goats and 281,000 sheep. Although the primary purpose of sheep and goats is meat production for local consumption, the animals are also a source of emergency income. Production systems are generally characterised as small-scale and low-input, and few breeding or productivity records are kept. Although intra-regional trade does occur between Caribbean countries, there is insufficient production for extra-regional trade. The Caribbean countries collectively have a very favourable animal health situation, which is maintained by strict import restrictions on livestock. Zoonotic diseases are relatively rare, with the exception of leptospirosis. The most important public health risk relates to the slaughter of small ruminants in small, unregulated butcheries which do not have acceptable standards of hygiene. In addition, meat is often transported or sold under unhygienic conditions. Recommendations are made for the reduction of these risks.     

Isolation of pathogenic Mycobacterium strains in cattle slaughtered in the abattoir of Bobo-Dioulasso, Burkina Faso

The major cause of meat rejection at the slaughterhouse of Bobo-Dioulasso is bovine tuberculosis. The objective of this work was to confirm the postmortem diagnosis pronounced at the slaughterhouse using laboratory methods (direct examination following Ziehl-Hielsen staining and isolation of Mycobacterium strains following culture in a Loewenstein-Jensen medium. During the study, 39 pathogenic Mycobacterium strains (38 Mycobacterium bovis and 1 Mycobacterium tuberculosis) out of 100 sampled out suspicious strains, were studied. No Mycobacteria typical of M. farcinogenes was found on direct examination. We were then able to differentiate between bovine tuberculosis and bovine farcy. The results confirm the well-founded decision in the slaughterhouse to discard the meat on the grounds of tuberculosis. The majority of cattle is located in villages around Bobo-Dioulasso and its is therefore highly likely that the disease is enzootic in the area with a fairly high level of infection in animals.     

Tuberculosis, 1994

In 1994, a total of 2,074 people in Canada were diagnosed with tuberculosis, a rate of 7.1 cases per 100,000 population. The same year, tuberculosis and its late effects caused 150 deaths-just over one in every 1,400 deaths. Although tuberculosis is no longer a major health problem in Canada or a leading cause of death, some groups are particularly susceptible to the disease: Aboriginal people, residents of low-income households, immigrants, and the elderly. In the first two instances, the occurrence of tuberculosis is associated with poor living conditions. The risk of tuberculosis among immigrants is high because of the greater likelihood of exposure in their countries of origin. Among the elderly, the potential for developing active tuberculosis is relatively high due to exposure decades ago when the disease was far more prevalent. Since 1980, the rate of pulmonary tuberculosis has declined, while the rate of extra-pulmonary tuberculosis has remained steady. As a result, the proportion of cases attributable to extra-pulmonary tuberculosis has risen.     

Sporadic Creutzfeldt-Jakob disease in the United Kingdom: analysis of epidemiological surveillance data for 1970-96

OBJECTIVE: To identify changes in the occurrence of Creutzfeldt-Jakob disease that might be related to the epidemic of bovine spongiform encephalopathy. DESIGN: Epidemiological surveillance of the United Kingdom population for Creutzfeldt-Jakob disease based on (a) referral of suspected cases by neurologists, neuropathologists, and neurophysiologists and (b) death certificates. SETTING: England and Wales during 1970-84, and whole of the United Kingdom during 1985-96. SUBJECTS: All 662 patients identified as sporadic cases of Creutzfeldt-Jakob disease. MAIN OUTCOME MEASURES: Age distribution of patients, age specific time trends of disease, occupational exposure to cattle, potential exposure to causative agent of bovine spongiform encephalopathy. RESULTS: During 1970-96 there was an increase in the number of sporadic cases of Creutzfeldt-Jakob disease recorded yearly in England and Wales. The greatest increase was among people aged over 70. There was a statistically significant excess of cases among dairy farm workers and their spouses and among people at increased risk of contact with live cattle infected with bovine spongiform encephalopathy. During 1994-6 there were six deaths from sporadic Creutzfeldt-Jakob disease in the United Kingdom in patients aged under 30. CONCLUSIONS: The increase in the incidence of sporadic Creutzfeldt-Jakob disease and the high incidence in dairy farmers in the United Kingdom may be unrelated to bovine spongiform encephalopathy. The most striking change in the pattern of Creutzfeldt-Jakob disease in the United Kingdom after the epidemic of bovine spongiform encephalopathy is provided by the incidence in a group of exceptionally young patients with a consistent and unusual neuropathological profile. The outcome of mouse transmission studies and the future incidence of the disease in the United Kingdom and elsewhere, will be important in judging whether the agent causing bovine spongiform encephalopathy has infected humans.     

EXG1p, a novel exo-beta1,3-glucanase from the fungus Cochliobolus carbonum, contains a repeated motif present in other proteins that interact with polysaccharides

During a survey for tuberculosis in wild carnivores and omnivores, Mycobacterium bovis was cultured from pooled lymph nodes of three adult female coyotes (Canis latrans) harvested by hunters in Michigan (USA). No gross or histologic lesions suggestive of tuberculosis were seen in these animals. One coyote was taken from Montmorency county and two coyotes from Alcona county located in the north-eastern portion of Michigan's Lower Peninsula where free-ranging white-tailed deer (Odocoileus virginianus) have been found infected with bovine tuberculosis. It is thought that these coyotes became infected with M. bovis through the consumption of tuberculous deer. Other species included in the survey were the opossum (Didelphis virginiana), raccoon (Procyon lotor), red fox (Vulpes vulpes), bobcat (Felis rufus), and badger (Taxidea taxus).     

PHLS work on the surveillance and epidemiology of tuberculosis

The re-emergence worldwide of tuberculosis as a major threat to public health and continuing and changing challenges in the control of tuberculosis in England and Wales provide the basis for the designation, by the PHLS, of tuberculosis as a priority area. In addition to the mycobacteriology reference services provided by the PHLS in England and Wales (summarised in an accompanying article) the PHLS contributes to the control of tuberculosis through its surveillance and other epidemiological work. This article summarises the range of this work, emphasising the collaborative nature of the effort required for surveillance, prevention, and control of tuberculosis.     

Expression of vimentin and cytokeratin in eutopic and ectopic endometrium of women with adenomyosis and ovarian endometrioma

Tuberculosis is a continuous threat for health in all parts of the world. In industrialized centers an emerging increase of tuberculosis is observed due to low health standards, poor health education and control, increasing migration and the HIV epidemic. This should alert the pediatrician, since most tuberculosis infections in childhood start with contacts of infected adults with children. There is still a good response to most drugs against tuberculosis, but in some parts of the world the resistance to conventional treatment is an emerging problem. In general incidence, morbidity and mortality of tbc in children of the western world is low and has good prognosis. However, the diagnostic principles and the education of pediatricians for recognizing tbc is still of utmost importance.     

Detection of proliferating cell nuclear antigen (PCNA) in peripheral blood mononuclear cells and sera of patients with malignant lymphoma

The proximity of farms to badger setts was compared between farms that had experienced a tuberculosis breakdown and those that had not, over the 6 year period from 1988 to 1993. The data were derived from a badger removal study conducted in East Offaly County in the Republic of Ireland. Badger removal began in 1989 and continued through 1993; by the end of 1990, approximately 80% of all badgers caught in the 6 year period had been removed. All badgers were examined, grossly, for evidence of tuberculosis. Tuberculosis status of the approximately 900 study herds was based on the results of the single intradermal comparative skin test and/or lesions of bovine tuberculosis. All herds were tested at least once annually. The number of herds experiencing bovine tuberculosis declined over the period, particularly in the years 1992 and 1993. The data on farm and badger sett location were stored and analysed, initially, in a geographical information system. Owing to the badger removal programme, the distance between the barn yard of a typical farm and the nearest occupied badger sett increased, by about 300 m year-1, and by about 600 m year-1 to the closest infected sett. In bivariate analyses, in the years 1988 and 1989, the risk of tuberculosis declined with increasing distance to a badger sett containing one or more tuberculous badgers. In multivariable logistic regression analyses, year and the average number of cattle tested per farm per year were controlled. A second identical analysis was conducted to control for the repeated observations on the same herds using generalised estimating equations. In both analyses, the risk of a multiple reactor tuberculosis breakdown decreased for herds at least 1000 m away from an infected badger sett, and increased as the number of infected badgers per infected sett increased. Despite the significantly reduced risk of a breakdown with increasing distance to infected badger setts, the relationship was not strong (sensitivity and specificity of the model in the low 70% range) and explained only 9-19% of tuberculosis breakdowns.     

Alerting the general population to genetic risks: The value of health messages communicating the existence of genetic risk factors for public health promotion.

Background: Health messages alerting the public to previously unknown genetic risk factors for multifactorial diseases are a potentially useful strategy to create public awareness, and may be an important first step in promoting public health. However, there is a lack of evidence-based insight into its impact on individuals who were unaware of the existence of genetic risk factors at the moment of information exposure. Method: The authors conducted 3 experimental studies with health messages communicating information about genetic risk factors for salt sensitivity (Studies 1A and 1B) and heightened cholesterol (Study 2) compared with general information without reference to genetic risk factors as a between-subjects variable and risk perception and intention to engage in preventive behavior as dependent variables. Results: All 3 studies revealed lower perceived susceptibility among participants who received information on genetic risk factors, which was associated with lowered intentions to engage in preventive behavior. In Studies 1A and 1B, these effects were observed only for previously unaware individuals, whereas in Study 2, they were observed for the entire sample. Conclusion: Alerting the public to the existence of genetic risk factors may not necessarily be beneficial to public health. Public health promoters should be aware of the possible adverse effects of alerting the general population to genetic risk factors, and should simultaneously educate the public about the meaning and consequences of such factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of public health for twenty-first-century health care: lessons from tuberculosis

Once epidemic, tuberculosis has re-emerged, often in newly drug-resistant forms. This public health threat calls for strong public action as well as improved private care. Action has been hampered by failures in public health infrastructure and legal-philosophical support for government intervention. Josephine Gittler's accompanying article usefully suggests rebuilding public-health agencies and adapting traditional authority and controls from the age of epidemics to take account of today's circumstances and sensibilities.     

Two-dimensional transferred-echo double resonance study of molecular motion in a fluorinated polycarbonate

A case-control study was undertaken to provide information about the role of some husbandry practices and farm characteristics in the epidemiology of bovine tuberculosis in the Veneto Region. Twenty-seven breeding herds where a positive result to the single intradermal cervical tuberculin test was confirmed by post-mortem examination were compared with seventy-four herds which had been free of the disease for at least three years. Epidemiological information was collected on farms. The factors taken into account in the study were chosen on the basis of their epidemiological plausibility and of the local livestock characteristics. Multiple logistic regression was applied to analyse the data. Factors identified as possibly involved in increasing the risk of bovine tuberculosis in the Veneto Region were the presence of mixed (dairy and beef) enterprises (OR = 4.9, P = 0.001) and of cattle purchase (OR = 5.8; P = 0.003). Other factors (such as herd size, housing system, summer mountain pasture, possible contact with wild animals, and indirect contacts with other herds) did not appear to significantly contribute to tuberculosis presence in this area. The results of this case-control study support the hypothesis that in the Veneto Region bovine tuberculosis infection is still associated with classical risk factors both (directly or indirectly) related to cattle movements.     

Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study

One in every three people on Earth is believed to be infected with Mycobacterium tuberculosis, leading to seven to eight million cases of active tuberculosis (TB) per year and approximately three million deaths annually. this epidemic, like those of most infectious diseases, creates scientific challenges and opportunities as it raises the demand for public health solutions. The currently available weapons for fighting TB are inadequate. The ultimate goal of biomedical TB research is to lessen the public health burden of this disease by developing improved diagnostic, therapeutic, and intervention strategies. Achieving this goal requires a base of knowledge about the biology of M. tuberculosis and related mycobacteria, their interactions with human and animal hosts, and the nature of an effective host-protective immune response. TB researchers are applying this accumulating base of knowledge to developing rapid, easy-to-use diagnostic assays appropriate for low-as well as high-income countries, improving the current complicated therapeutic regimen, identifying potential new drugs to combat multidrug-resistant TB, and creating more effective vaccines.     

Food lobbies, the food pyramid, and U.S. nutrition policy

The U.S. Department of Agriculture's 1991 withdrawal of its Eating Right Pyramid food guide in response to pressure from meat and dairy producers was only the latest in a long series of industry attempts to influence federal dietary recommendations. Such attempts began when diet-related health problems in the United States shifted in prevalence from nutrient deficiencies to chronic diseases, and dietary advice shifted from "eat more" to "eat less." The Pyramid controversy focuses attention on the conflict between federal protection of the rights of food lobbyists to act in their own self-interest, and federal responsibility to promote the nutritional health of the public. Since 1977, for example, under pressure from meat producers, federal dietary advice has evolved from "decrease consumption of meat" to "have two or three (daily) servings." Thus, this recent incident also highlights the inherent conflict of interest in the Department of Agriculture's dual mandates to promote U.S. agricultural products and to advise the public about healthy food choices.     

Strategies for suppression, containment, and eradication of resurgent tuberculosis

This review provides strategies for the suppression, containment, and eventual eradication of resurgent tuberculosis. Some ethnic minority communities are at greatest risk because of the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome, poverty and malnutrition, congregate living situations, aberrant lifestyles, illegal immigration, and underemployment among these populations. Proposed strategies include the education of the population at risk as well as health care providers to permit the optimization of preventive, diagnostic, and therapeutic technologies. Also necessary is the development of effective, safe, newer medications to enhance patient compliance and decrease drug resistance. Strategic planning embraces national socioeconomic policy to permit adequate resources to combat poverty and malnutrition, to rebuild the infrastructure of the public health system, and to improve access to health care among rural and urban dwellers. It is concluded that these efforts must continue to ensure the eradication of tuberculosis.     

The importance of quality of life research for health care reform in the USA and the future of public health

Quality of life research data have significant implications for the social and public policy in the USA as it can be used to evaluate the cost-effectiveness of various permutations of treatment as well as the 'human effectiveness' of health care system restructuring. The USA spends more on health care per capita than any other industrialized nation, yet on major health indicators, such as infant mortality rate, this expenditure is not related to beneficial effects on the community. When epidemiological and quality of life data drive national health care planning, improved approaches to the management of health service delivery may become apparent. Ultimately only the patient or consumer can determine if a particular treatment is successful; the same may be true for health care reform.     

Still the great mimicker: abdominal tuberculosis

Since the mid 1980s, a resurgence of tuberculosis has occurred. The disease is and will remain a serious public health threat worldwide. The clinical and radiologic features of abdominal tuberculosis may mimic those of many diseases. Radiologists evaluating abdominal images should consider the diagnosis of abdominal tuberculosis in immigrants from areas endemic for tuberculosis, in immunocompromised patients, and in high-risk patients such as the homeless. Imaging features that suggest the correct diagnosis are cecal amputation, ileocecal thickening and inflammation, shortening of the ascending colon, gaping of the ileocecal valve, mesenteric adenopathy, a misty mesentery, diffuse omental infiltration, loculate high-density ascites, an enhancing peritoneum with or without an omental line, nodularity of the surface of the mesenteric leaves, and transperitoneal permeation.