Epidemiology and Infection

Review Article

Epidemiological evidence for Mycobacterium avium subspecies paratuberculosis as a cause of Crohn's disease

J. C. UZOIGWEa1, M. L. KHAITSAa2 and P. S. GIBBSa2 c1

a1 Department of Chemistry, Biochemistry and Molecular Biology, North Dakota State University, Fargo, ND, USA

a2 Department of Veterinary and Microbiological Sciences, North Dakota State University, Fargo, ND, USA

SUMMARY

Mycobacterium avium subspecies paratuberculosis is the causative agent of Johne's disease, a chronic enteritis in ruminants including cattle, sheep, goats, and farmed deer. Recently, this bacterium has received an increasingly wide interest because of a rapidly growing body of scientific evidence which suggests that human infection with this microorganism may be causing some, and possibly all, cases of Crohn's disease. Recent studies have shown that a high percentage of people with Crohn's disease are infected with M. avium subsp. paratuberculosis; whether the association of this bacterium and Crohn's disease is causal or coincidental is not known. Crohn's disease is a gastrointestinal disease in humans with similar histopathological findings to those observed in the paucibacillary form of Johne's disease in cattle. The search for risk factors in Crohn's disease has been frustrating. However, epidemiologists have gathered enough information that points to an association between M. avium subsp. paratuberculosis and Crohn's disease. This paper reviews epidemiological models of disease causation, the major philosophical doctrines about causation, the established epidemiological criteria for causation, and the currently known epidemiological evidence of M. avium subsp. paratuberculosis as a possible cause of Crohn's disease.

(Accepted March 07 2007)

(Online publication April 20 2007)

Correspondence:

c1 Author for correspondence: Dr P. S. Gibbs, Department of Veterinary and Microbiological Sciences, North Dakota State University, Fargo, ND 58105, USA. (Email: penelope.gibbs@ndsu.edu)

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