Treatment and Prevention in Humans
Anti-tuberculosis therapy is very long-term and must be continued for a minimum of six months, as a result of the slow growth of the pathogen. It is mandatory to administer more than three effective drugs during the first two months of treatment at least, to prevent the bacteria becoming resistant.
Should there be resistance to one or more antibiotics, older antibiotics with even with more side effects must be administered.
Treatment of MDR TB becomes especially problematic if the pathogen is resistant to at least the two most important drugs: Isoniazid and Rifampicin. In such cases, surgery must be used during which the affected part of the lung is removed. Therapy for a newer, special form called extensively drug-resistant TB (XDR TB) is even more difficult and takes several years.
Preventative inoculation with the vaccine strain BCG has not resulted in satisfactory infection prevention, despite having been used for many years. The best prevention is the identification of an outbreak. This means that the patients’ environment is examined for potential TB infections following diagnosis and treatment is started if required. It is important to compare the pathogen’s genetic fingerprint when trying to identify unclear infection routes. However, these laborious techniques make it possible to identify the index case even years after transmission.
Human TB Monitoring: Tuberculosis in the Epidemiologic Warning System (in German).
Control and Surveillance Measures in Animals
Control focuses on the identification of infected animals during the examination of slaughtered animals and the dissection of animals that have died. M. bovis has not been detected in livestock in Austria since the country was declared TB-free. The EU cross-border project “Tuberculosis (TB) in Alpine Wildlife” was completed in 2013. Austria, Germany, Italy, Switzerland and Liechtenstein teamed up in this project to develop a cross-border health and control strategy protecting livestock and, eventually, humans from imported tuberculosis from the red deer population into livestock. Cattle in certain risk areas have been examined on an annual basis as M. caprae-positive infections have been detected in wild red deer in certain regions in Tyrol and Vorarlberg.
All examinations carried out on cattle and red deer from selected risk areas in Austria (“indicator mountain pastures”) to date were/are adapted to the epidemiologic situation and the results of any previous examination periods and continued in the following years. Cattle that has been grazing on Alpine pastures in Austrian regions with a dense red deer population is examined in line with statistically safe, risk-based sample plans, to identify any potential transmission of TB from red deer to bovines.
Legal regulations and current situation in red deer and cattle
Tuberculosis in red deer in the Alpine region Folder (pdf)
Fink et al. (2015): Red Deer as maintenance host for bovine tuberculosis, alpine region