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Animal Disease Factsheets


www.cfsph.iastate.edu
This factsheet is made available by:
The Center for Food
Security and Public Health
Iowa State University
College of Veterinary Medicine
The mission of the CFSPH is to increase national and international
preparedness for accidental or intentional introduction of disease
agents that threaten food production or public health.

Other resources at www.cfsph.iastate.edu


Handbook for Zoonotic Diseases of Companion Animals
Emerging and Exotic Diseases of Animals Book
Avian Influenza Resources
Wall Charts and Handouts

Published in IVIS with the permission of the Center for Food


Security & Public Health, Iowa State University.

Paratuberculosis
(Johnes Disease)
and
Crohns Disease

Last Updated: Oct. 6, 2004


Author: Anna Rovid Spickler

Etiology

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Paratuberculosis is caused by Mycobacterium avium subsp. paratuberculosis, an


acid-fast rod in the family Mycobacteriaceae.1,2 This organism was previously known
as Mycobacterium paratuberculosis and M. johnei. Some strains of this organism seem
to preferentially infect specic hosts. The C strain has a broad host range including
cattle, goats and camelids, as well as ruminant and non-ruminant wildlife.3,4 Two strains
isolated from humans with Crohns disease were also C strains.4 The S strain is found
mainly in sheep.3,4 The C strains are occasionally transmitted from cattle to sheep, and
the S strains from sheep to cattle, but such cross-species transmission is uncommon.3
There is evidence for a goat-specic strain and a unique strain in bison.3,4
M. avium paratuberculosis can be zoonotic. Injection of paratuberculosis vaccines can
cause localized reactions in humans.1,2 A M. avium paratuberculosis infection was recently
identied in an AIDS patient.5 M. avium paratuberculosis has been implicated as a possible
cause of Crohns disease, a human intestinal disease of unknown etiology.

Geographic Distribution

Paratuberculosis is thought to occur worldwide.6

Transmission

In animals, M. avium paratuberculosis is mainly transmitted by the fecal-oral


route.1,3 Cattle, and probably most species, are most susceptible to infection when they
are young.3,4,7 Calves are usually infected when they are exposed to the feces of older
cows, often when they nurse from a feces-contaminated udder.2-4,8 Some infected cows
also shed the bacteria in the milk and colostrum.1,3,8 M. avium paratuberculosis can
cross the placenta.3 In cattle, this organism has also been found in semen and embryos,
but the importance of transmission by these routes has not been determined.3 It can be
spread on fomites, and ies have been implicated in mechanical transmission.3 It has
been suggested that M. avium paratuberculosis may be transmitted to humans in milk or
as an environmental contaminant in food or water.4,6
M. avium paratuberculosis can remain viable on pastures for more than a year.2,3
Sunlight, drying and alkaline soils help to inactivate the organism.2 Live bacteria can
be found for up to a week in bovine urine, up to nine months in pond, tap or distilled
water, and up to 8 to 11 months in bovine feces.3 This organism has been found in
municipal water supplies.9,10

Institute for International


Cooperation in Animal Biologics
An OIE Collaborating Center
Iowa State University
College of Veterinary Medicine

Disinfection

M. avium paratuberculosis is resistant to disinfection.8 Decontamination of surfaces


requires thorough cleaning with soap and water, followed by a tuboricidal disinfectant.8
Mycobacteria not protected by organic matter can be killed by cresylic disinfectants
and sodium orthophenylphenate.7,8 M. avium paratuberculosis can survive drinking
water treatment, including chlorination, and it may be able to survive pasteurization of
milk.3,6,9,11,12 Its ability to survive various techniques for cooking meat is unknown.6

M. avium subsp. paratuberculosis


Infections in Humans
Center for Food
Security and Public Health
College of Veterinary Medicine
Iowa State University
Ames, Iowa 50011
Phone: (515) 2947189
FAX: (515) 2948259
Email: cfsph@iastate.edu
Web: http://www.cfsph.iastate.edu

If they are injected into humans, the paratuberculosis vaccines can cause severe
local reactions that may include sloughing of the tissues, chronic synovitis and tendonitis.1,2 Some cases may require surgery. M. avium paratuberculosis was recently isolated
from the blood, urine, sputum, feces and biopsy samples of an AIDS patient.5 His symptoms included profuse diarrhea, fever and weight loss. Antibiotic treatment appeared
to stop the progression of the infection but the response was not clearly positive. The
patient, who was in poor health, died of cardiorespiratory failure. A link between M.
avium paratuberculosis and Crohns disease has also been suggested.

2005
Animal Disease Factsheets, The Center for Food Security & Public Health
Iowa State University, Ames, IA, USA.

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Paratuberculosis

Crohns Disease and


M. avium subsp. paratuberculosis

Crohns disease is a chronic inammatory disease of


humans that primarily affects the intestinal tract. The etiology of this disease is unknown.1,3,6,10,16,17 Currently, it
is thought to be the result of interacting factors that may
include a genetic predisposition, an abnormal or exaggerated
immune response, and environmental factors such as intestinal microorganisms.6,16 Some genetic polymorphisms found
in Crohns disease patients, including a defect in the NOD2/
CARD15 gene, are associated with defective responses to
bacteria.4,6,9,18 Various precipitating factors for this disease
have been proposed, including:
Immune reactions to normal commensal
intestinal bacteria6,18
M. avium subsp. paratuberculosis6
A variety of other viruses and bacteria6
Chemical or physical exposure (e.g. microparticles
of metallic elements used as food additives)6
There may be a variety of causes for Crohns disease
rather than a single cause.3,6 M. avium subsp. paratuberculosis has been isolated from some patients with Crohns disease,
and some investigators have suggested that it may be one cause
of the disease. The data linking M. avium paratuberculosis to
Crohns disease are controversial.1,3,6,18 The following sections
describe the current evidence for and against this hypothesis.
Pathology and Clinical Features
Some aspects of the pathology, histopathology and
clinical features of Crohns disease resemble paratuberculosis.4,6,8,18,19 Both diseases are intestinal, and diarrhea and
weight loss are features of both.8 However, fever is seen only
in Crohns disease.8 Abdominal pain, a feature of Crohns
disease, also appears to be absent in paratuberculosis.8 In
addition, the course of disease is progressive in animals with
symptomatic paratuberculosis but intermittent, with remissions and relapses, in Crohns disease.6
The pathology of Crohns disease resembles paratuberculosis.4,6 However, there are also important differences,
including the frequent presence of brosis, ssures, stulas
and pseudopolyps in Crohns disease, and the absence of
these features in paratuberculosis.4,6 Unlike paratuberculosis
granulomas, Crohns disease granulomas are not caseated.6
Identication of M. avium subsp.
paratuberculosis in Crohns disease patients
Early studies found little or no evidence of M. avium
paratuberculosis in Crohns disease patients by culture or
staining. However, this organism can be difcult to culture,
and isolation has become more common with improved culture techniques.8 There is also some evidence that the M. avium paratuberculosis found in Crohns disease patients may
be cell wall-decient (spheroplastic bacteria or L forms).20
Last Updated: May 2005

Many recent studies have identied the organism with DNA


technologies rather than by culture. One concern about
these studies is that nucleic acid methods cannot distinguish
between dead and viable organisms.
Some studies have found M. avium paratuberculosis
in a signicant proportion of intestinal tissues from Crohns
disease patients.4,6,8,10,12,21-24 Other studies, including some that
used DNA techniques, have been unable to substantiate this
link.4,6,25,26 Studies that found a positive correlation include:
M. avium subsp. paratuberculosis was identied
by PCR in the cervical lymph nodes of a 7 year old
boy with scrofula, who developed Crohns disease 5
years later.6
M. avium paratuberculosis has been cultured from:
14 of 33 intestinal biopsy samples (42%) from
Crohns patients, and 3 of 33 controls (9%)
with inammatory bowel disease.21
7 of 8 patients (88%) with Crohns disease,
and 0 of 3 controls.19
6 of 7 intestinal tissue samples (86%) and 4 of
20 biopsy specimens (20%) from Crohns disease
patients.4 The overall recovery of positive cultures
was 37% from Crohns disease patients and 6%
from controls.4
PCR studies found M. avium paratuberculosis
DNA in:
tissue samples taken at surgery from 26 of 40
Crohns disease patients (65%), 1 of 23 patients
(4.3%) with ulcerative colitis, and 5 of
40 patients (12.5%) without inammatory
bowel disease.23
intestinal biopsy samples from 34 of 37 patients
(92%) with Crohns disease, and 9 of 34 controls
(26%) with inammatory bowel disease.21
6 of 15 granulomas (40%) from Crohns
disease patients and 0 of 12 granulomatous disease
controls. (Ten of the control granulomas came
from the intestines and 2 from non-intestinal
sites).22
A RT-PCR study found M. avium paratuberculosisspecic RNA in 8 of 8 patients with Crohns disease,
2 of 2 patients with ulcerative colitis (controls), and
0 of 2 controls with colon cancer.10
In situ hybridization has identied M. avium paratuberculosis DNA in:
35 of 48 granulomas (73%) from 33 Crohns
disease patients.12
Approximately 69% of intestinal tissue samples
from Crohns disease patients.24
Recent studies have also reported the presence of this
organism in human milk and peripheral blood. These studies
remain to be conrmed by other laboratories.

2005

Animal Disease Factsheets, The Center for Food Security & Public Health
Iowa State University, Ames, IA, USA.

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Paratuberculosis

In 2000, a single study found the organism in the


breast milk of 2 of 2 lactating mothers with Crohns
disease and 0 of 5 controls.19,27
A recent study cultured the organism from the
peripheral blood of 14 of 28 patients (50%) with
Crohns disease, 2 of 9 controls (22%) with ulcerative colitis, and 0 of 15 controls without inammatory bowel disease.19 In this same study, M. avium
paratuberculosis DNA was found in 13 (45%) of
the patients with Crohns disease, 4 (45%) of the
patients with ulcerative colitis, and 3 (22%) of the
healthy controls.19
Studies addressing whether M. avium
paratuberculosis has a causative role
in Crohns disease
Studies to date have not determined whether M. avium
paratuberculosis has a causative role or is an innocent
bystander that can grow in the inamed intestinal wall.4,6,18
However, one recent study suggests that it may be an innocent bystander. Ryan et al had previously demonstrated a
correlation between Crohns disease and the presence of M.
avium paratuberculosis DNA in granulomas.22,28 Using PCR
analysis, they have now found E. coli DNA in granulomas
from 12 of 15 Crohns disease patients and 1 of 10 granulomas not from Crohns disease patients.28 They also found E.
coli DNA in 8 of 15 Crohns full thickness intestinal sections
and 4 of 10 control full-thickness sections. This study suggests that there may be a non-specic increase in bacterial
DNA in Crohns disease granulomas, and argues against a
causative role for M. avium paratuberculosis.28
Serologic evidence
Several serological studies have reported an association
between humoral immunity to M. avium paratuberculosis and
Crohns disease.4,8 One study demonstrated an association of
the disease with cellular immunity to this organism.8 These
studies are difcult to interpret, as many M. avium paratuberculosis antigens cross-react with antigens from other mycobacteria, other acid-fact organisms or host proteins.6,8
Transmission of Crohns disease to animals
M. avium paratuberculosis isolated from Crohns disease patients produced granulomatous ileocolitis within 5 to
6 months when it was fed to 7 day old goats.6 A human strain
(Linda) caused a disease similar to Crohns disease in mice
but not in other laboratory animals.6
Antibiotic treatment
If M. avium paratuberculosis causes Crohns disease,
effective antibiotic treatment should cure or alleviate this
disease.4 Antibiotics are also active against commensal
intestinal bacteria, which can make antibiotic trials difcult
to interpret.4,18 The waxing and waning nature of the disease
also complicates their interpretation.
Last Updated: May 2005

To date, antibiotic trials have been inconclusive. Small


scale trials have either produced remissions or been ineffective.6 Some early studies may not be valid, as it was recently
discovered that macrolide antibiotics are necessary for effective treatment of M. avium paratuberculosis.9 In four openlabel antibiotic trials that included macrolides, complete
clinical remissions were seen in up to 66% of patients.9 In
one recent randomized blinded trial, no improvement was
seen in patients treated with antibiotics for 3 months in addition to their regular treatment.4 An Australian double-blind
randomized placebo-controlled trial, containing 214 Crohns
disease patients, was begun in 1999 and is due to be completed in late 2004.9
Lack of an association between the incidence of
Crohns disease and contact with cattle
There is no association between contact with farm animals and an increased incidence of Crohns disease.6,8 In
fact, some studies have suggested that this disease is more
prevalent in urban areas.6 Some authors suggest that bacteria
from wildlife reservoirs or contaminated food or water could
be the source of infection for humans.4,6

Crohns Disease
Incubation Period

The incubation period for Crohns disease in unknown;


however, the triggering event is thought to occur early in
life, suggesting that the incubation period may be up to 30
years or more.8

Clinical Signs

Crohns disease is a chronic inammatory enteritis of


humans, usually associated with spontaneous remissions and
relapses.3,6 The disease onset is often insidious.16 Crampy
intermittent pain, which may progress to a constant dull
ache, is the most common sign.16 Most patients also have
diarrhea.16 Other common symptoms include fever, night
sweats, fatigue, rectal bleeding, weight loss, anorexia, malaise and nausea.3,4,6,16 Vomiting can occur if stulas form in
the stomach or duodenum.4 Complications may include perforations, abscesses, stulas, intestinal obstruction and strictures.3,4 Over time, the symptomatic periods may become
more frequent and severe.16
Some patients also have extraintestinal signs. Approximately 25% of patients have arthralgia or arthritis.16 Skin
manifestations, including erythema nodosum, pyoderma
gangrenosum, and aphthous ulcers of the mouth, are seen
in 15%.16 Eye disease, including episcleritis, uveitis and
recurrent iritis occurs in 5%.16 An increased incidence of
gallstones and kidney stones has also been associated with
Crohns disease.4

2005

Animal Disease Factsheets, The Center for Food Security & Public Health
Iowa State University, Ames, IA, USA.

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Paratuberculosis

Communicability

There is no evidence that Crohns disease is


communicable.

Diagnostic Tests

Crohns disease is suggested by the clinical signs and


radiography, and is conrmed by endoscopy and biopsy.16
Computed tomography may be used to identify abscesses
and other complications.16

Treatment

There is no cure for Crohns disease.3,6 Medical management is used to treat disease exacerbations and maintain remission.6,16 Management may include salicylates, monocolonal
antibodies to tumor necrosis factor (e.g. , iniximab), corticosteroids, immunosuppressant drugs such as azathioprine or
mercaptopurine, and/or antibiotics such as metronidazole and
ciprooxacin.6,16,17 Surgery may be used to treat complications
such as intestinal obstructions, perforations, hemorrhages and
perianal disease.6,16

Prevention

There is no known means of prevention.

Morbidity and Mortality

Crohns disease is estimated to affect 380,000 to 480,000


people in the U.S.16 This disease often begins between the ages
of 15 and 40, and persists for life.3,6 It is more common in women and in those of Jewish descent.16 The disease is uncommon
in Africa, but the incidence is similar in Caucasians and African
Americans in the U.S.16 Crohns disease is a chronic disease,
with exacerbations and remissions.6,16 Spontaneous remissions occur in approximately 20% of patients.6 Complications may include perforations, abscesses, stulas, intestinal
obstruction, and strictures.3,6

Infections in Animals
Species Affected

The most important host species are ruminants, including cattle, sheep and goats.1,3 Infections have also been
reported in alpaca, bison, elk, camelids and deer.1,3,4 Infections have also been reported in a variety of non-ruminant
species including horses, pigs, rabbits, foxes, stoats, weasels, non-human primates, mice, voles and birds.1,3,4,8,9 The
signicance of wildlife reservoirs is unknown.3 M. avium
paratuberculosis has been isolated from a variety of wildlife.1,3,4,8,9 In the U.S., the only known foci of infection are in
tule elk in California, and bighorn sheep and mountain goats
in Colorado.3 Infections in other species or locations have
not been ruled out.3 There is some epidemiologic evidence
for transmission from red deer to cattle, and cattle to red
Last Updated: May 2005

deer.3 The organism can also be transmitted experimentally


between wild and domestic animals.3

Incubation Period

The incubation period in domestic ruminants varies


from 4 months to 15 years.3

Clinical Signs

Paratuberculosis is chronic and progressive, with a long


asymptomatic phase preceding the clinical signs. Infected
animals do not always develop clinical disease.1,3
In cattle, symptomatic infections are unusual in animals
less than 1-2 years old.1 Initially, only subtle nonspecic signs
may be seen, such as weight loss, decreased milk production
or roughening of the hair coat.3 The characteristic symptoms
in cattle are diarrhea and wasting.1 The diarrhea is usually
thick, without blood, mucus or epithelial debris, and may be
intermittent at rst.1,2 Over weeks or months, the diarrhea
becomes more severe and persistent, and intermandibular
edema (bottle jaw) or ventral edema may develop.1-3 Fever
and anorexia are usually absent and affected animals are
alert.2 Increasing emaciation occurs over time, and affected
animals usually die from dehydration and severe cachexia.3
The clinical signs are similar in other ruminants; however, diarrhea is less common in sheep and goats than in
cattle, and the symptoms usually develop at a younger age
in sheep.1-3 Paratuberculosis can be rapidly progressive in
deer.2 Intestinal disease has also been reported in rabbits and
non-human primates.3

Communicability

Paratuberculosis is a communicable disease among


ruminants. Both symptomatic and asymptomatic cattle can
shed M. avium paratuberculosis in the feces. Asymptomatic
cattle often shed the bacteria intermittently, with increasing
numbers of organisms as the clinical signs appear.1,13 This
organism can also be found in the colostrum, milk, semen,
uterus and embryos.3 An estimated 3-19% of asymptomatic
cows shed M. avium paratuberculosis in the milk and 9-36%
in the colostrum.3 Up to 35% of symptomatic cows shed bacteria in the milk.3 Approximately a quarter of calves born to
culture positive cows are estimated to be infected in utero;3
however, the risk of fetal infection may be much lower in
asymptomatic cattle.3,8 Cattle, and probably other species,
are most susceptible to infection when they are young.3

Diagnostic Tests

Symptomatic animals can be diagnosed by culture, fecal


smears to detect acid-fast bacilli, polymerase chain reaction
(PCR) tests, gross lesions and histology.1,3 Serology and tests
of cell mediated immunity are useful in some animals, but
immunity can diminish in the later stages of disease.3
Asymptomatic animals are more difcult to identify.
Some animals can be detected by fecal culture, serology,

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Iowa State University, Ames, IA, USA.

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Paratuberculosis

tests of cell-mediated immunity, PCR or histology.1,3,13 In the


earliest stage of infection, infected animals can be detected
only by culturing M. avium paratuberculosis from postmortem tissues or, rarely, by histology.3 The only useful tests in
vaccinated animals are those that test for the organism.1
Clumps of acid-fast bacilli in fecal smears, or acid-fast
bacilli in the intestinal mucosa or lymph nodes, are suggestive of paratuberculosis.1,3 Fecal smears are mainly useful in
symptomatic animals.3
Culture is the most denitive test but can take 5-16
weeks.1,3 M. avium paratuberculosis can be cultured from
the feces, thickened areas of the intestinal wall, and ileal,
mesenteric and ileocecal lymph nodes.3,14 Fecal culture is
usually diagnostic in clinical cases, but is less reliable for
asymptomatic animals.1,3,13 Sheep strains can be more difcult to isolate than cattle strains.1,3
DNA probes use a unique genetic element (the insertion
element IS900) to detect M. avium paratuberculosis in feces
or tissues.1 Commercial test kits are available.1
Antibodies usually develop 10 to 17 months after infection; titers tend to increase as the intestinal lesions become
more extensive but can decrease in late stage disease.1,3
Serology is unreliable for asymptomatic cases.3 Serologic
tests in cattle include complement xation, enzyme-linked
immunosorbent assays (ELISAs) and agar gel immunodiffusion.1-3 An ELISA has been developed for milk.3
Tests for cell-mediated immunity include intradermal
testing with johnin or avian puried protein derivative tuberculin, as well as an in vitro gamma interferon assay and a
lymphocyte transformation test.1,3 Cell-mediated immunity
develops early and may be seen in some asymptomatic animals, but can diminish or disappear in the later stages of
disease.1,3,13 False positives are common, due to exposure to
cross-reactive environmental saprophytes.1,3

Treatment

Although antibiotic treatment may theoretically be


possible,9 there is currently no satisfactory treatment for
paratuberculosis.3

Prevention

M. avium paratuberculosis is usually introduced into a


herd in an infected animal, and persists in the breeding stock.1
To prevent the introduction of this disease, farmers should
buy replacement animals from test-negative herds with good
records and management practices.3,7,15 Herds that have had
no cases of paratuberculosis for the last 5 years can also be
considered.15 Vaccines can decrease the severity of symptoms
and the bacterial load but do not prevent infection or the shedding of bacteria.1,3,15
Once paratuberculosis has entered the herd, the basic
control techniques are 1) to prevent the exposure of young
animals to infected manure, colostrum and milk and 2) to
decrease exposure in the herd by culling infected animals.3,15
Last Updated: May 2005

Test and slaughter may not be successful without management


changes to reduce transmission.1,3
In infected dairy herds, newborns should be separated
from all adult cattle immediately after birth.3,7,8,14 The calves
should receive colostrum from a single low-risk or paratuberculosis negative cow with a cleansed and sterilized udder,
then should be raised on milk replacer or powdered milk.3,7,14
In an infected dairy herd, the calves should be kept separate
from the adult herd for at least the rst year.3 A similar strategy may be considered for beef herds or other species, but
may not be practical.8 In beef herds, the density of cow-calf
pairs should be minimized as much as possible, and weaned
calves that will be herd replacements should be raised separately from the adult herd.14
Culling of infected and, in particular, symptomatic
animals, can decrease the risk of infection for other animals.3,8,15 Animals not culled should be separated from
the rest of the herd. The culling or separation of offspring
born to infected dams should also be considered.1,8 Manure
build-up should be minimized, and fecal contamination of
feed should be prevented.7,8,14
A voluntary paratuberculosis control program has been
adopted by many states.14 Aspects of this program include 1)
producer education, 2) a management program to prevent the
introduction of the disease and spread within the herd, and 3)
programs for both test-positive and test-negative herds that
incorporate regular testing as well as management changes.
The program does not certify herds to be free of paratuberculosis; however, herds in higher levels of the test-negative
program are more likely to be free of disease.14

Morbidity and Mortality

Paratuberculosis is particularly prevalent in dairy cows.


In 1996, approximately 24% of dairy herds were infected in
the Midwest and West, 17% in the Southeast, and 16% in the
Northeast.3 Approximately 8% of U.S. beef herds were also
infected.3 Nearly a third of all U.S. zoos have also reported
at least one case.3 Worldwide, the prevalence of this disease
seems to be increasing.6
At any given time, only a small fraction of the infected animals in a herd has clinical signs;2,3,8 however, up to
50% of the herd can be subclinically infected.2 Four stages
of infection have been recognized in cattle. The rst stage,
a silent infection, can be seen in either young animals or
adults.3 At this stage, cattle can either eliminate the infection
or become healthy carriers (stage II).1 Although subclinically infected cattle appear normal, they are estimated to
produce 15-16% less milk.13 Some of these healthy carriers
eventually become symptomatic but the proportion that does
is unknown.3 In cattle, symptomatic infections (stage III) are
not usually seen in animals less than 1 to 2 years old.1 Once
the symptoms appear, paratuberculosis is usually progressive and fatal.3 Animals sometimes progress to the fourth
stage, advanced clinical disease, within a few weeks.3

2005

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Iowa State University, Ames, IA, USA.

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Paratuberculosis

Newly infected herds are usually asymptomatic for years


before the rst cases appear.15 Herds with minimal infection
rates have few clinical cases, and these cases are seen mainly
in older animals.7 If the infection becomes widespread, cases
can appear in second- and rst-calf cows, and even springers
or bred heifers.7 The overall herd mortality rate is approximately 1%.2

The Merck Veterinary Manual


http://www.merckvetmanual.com/mvm/index.jsp
United States Animal Health Association Prevention and
Control of Johnes Disease in Dairy Cattle
http://www.usaha.org/njwg/jddairy.html.
USDA APHIS. Johnes Disease
http://www.aphis.usda.gov/vs/nahps/johnes/
USDA APHIS Uniform Program Standards for the
Voluntary Bovine Johnes Disease Control Program
http://www.aphis.usda.gov/vs/nahps/johnes/johnesumr.pdf.
University of Wisconsin School of Veterinary Medicine
Diagnosis and Control of Johnes Disease
http://www.johnes.org/
World Organization for Animal Health (OIE)
http://www.oie.int/eng/normes/mmanual/a_summry.htm

Post-Mortem Lesions

Gross lesions are usually absent in early asymptomatic infections.3 In cattle, the earliest visible lesions may
be discrete plaques in the distal small intestine, which can
sometimes be detected by holding the intestine up to a light
source.1 The mesenteric lymph nodes and other regional
nodes may also be enlarged.1-3 In more advanced disease,
the wall of the distal small intestine becomes thickened and
often corrugated.1-3 In the late stages, these lesions can extend
from the duodenum to the rectum.3 The carcass may be thin
or emaciated and there can be effusions in the body cavities and dependent subcutaneous edema.2,3 Extraintestinal
lesions have also been reported in the liver and kidneys.4
In sheep and goats, the intestinal mucosa may only be
slightly thickened, but caseated or calcied nodules may be
found in the intestines and associated lymph nodes.1,2 Some
sheep strains produce a pigment that stains the intestinal
lesions brownish-yellow or yellow-orange.2,3

References

Internet Resources
A review of the evidence for a link between exposure to
Mycobacterium paratuberculosis (MAP) and Crohns
disease (CD) in humans. A Report for the Food
Standards Agency.
http://www.foodstandards.gov.uk/multimedia/pdfs/
mapcrohnreport.pdf
Johnes Information Center
http://www.paratuberculosis.org/
Material Safety Data Sheets Canadian Laboratory
Center for Disease Control
http://www.hc-sc.gc.ca/pphb-dgspsp/msds-ftss/index.
html#menu
Diagnosis and Control of Johnes Disease
http://www.nap.edu/books/0309086116/html
OIE Manual of Diagnostic Tests and Vaccines for
Terrestrial Animals
http://www.oie.int/
Prevention and Control of Johnes Disease in Dairy
Herds. A Workbook for Veterinarians and Producers
http://www.usaha.org/njwg/jddairym.html.
The Merck Manual
http://www.merck.com/pubs/mmanual/

Last Updated: May 2005

1. Manual of standards for diagnostic tests and vaccines.


Paris: Ofce International des Epizooties; 2004. Paratuberculosis. Available at: http://www.oie.int/eng/normes/
mmanual/A_00045.htm. Accessed 23 Sept., 2004.
2. Aiello SE, Mays A, editors. The Merck veterinary manual. 8th ed. Whitehouse Station, NJ: Merck and Co.;
1998. Paratuberculosis (Johnes disease); pp 537-9.
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Animal Disease Factsheets, The Center for Food Security & Public Health
Iowa State University, Ames, IA, USA.

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Paratuberculosis

(NJWG) Subcommittee on Education Prevention


and Control of Johnes Disease in Dairy Herds; 2002
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RH. Evaluation of a new fecal PCR test for detection
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Culture of Mycobacterium avium subspecies paratuberculosis from the blood of patients with Crohns
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JA. Spheroplastic phase of mycobacteria isolated
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Durkin D, Neild P, Rhodes G, Pickup R, Hermon-Taylor J. Detection and verication of Mycobacterium
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2005

Animal Disease Factsheets, The Center for Food Security & Public Health
Iowa State University, Ames, IA, USA.

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