CLINICAL AND PATHOLOGICAL SIMILARITIES BETWEEN PARATUBERCULOSIS AND CROHN’S DISEASE. ¿A POSSIBLE ZOONOTIC LINK?

This review assesses the evidence for an association between Mycobacterium avium subspecies paratuberculosis (MAP) and Crohn’s disease and describes the main clinical and pathological similarities. The review is limited to publications contained in the program HINARI of the WHO, especially Elsevier Science, International Bioline, Blackwell Publishing, BMJ Publishing, Lippincott Williams & Wilkins, Nature Publishing, PubMed, Springer Science and publications of the International Association for study of Paratuberculosis. Evidence supporting a link between these diseases include the isolation of Mycobacterium avium subspecies paratuberculosis from intestine, milk, peripheral blood and lymph nodules of Crohn’s patients and the specific immune response to some Mycobacterium antigens in Crohn’s patients. Nevertheless each of these findings is controversial. The currently available evidence is not sufficient to prove or disprove that Mycobacterium avium subspecies paratuberculosis is a cause of Crohn’s disease, due to the multifactorial nature of this disease, studies do not conclusively allow the acceptance of a zoonotic link. Studies are required to determine if Mycobacterium is only a spectator or a pathogenic agent. In addition, epidemiologic studies are required at a sufficiently large scale to permit analysis of the geographical and temporal distribution of both diseases.