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Therapeutic management of Mycobacterium avium subspecies paratuberculosis infection with complete resolution of symptoms and disease in a patient with advanced inflammatory bowel syndrome

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Abstract

Background

A 26-year-old male had a history of frequent bowel movements, mushy stool with mucus and loss of 25 kg body weight in 6 months was diagnosed as a case of inflammatory bowel disease (IBD). The patient did not respond to routine and standard treatment for IBD. His condition was steadily deteriorating, and he was in a very precarious state when he reported to us.

Methods

Upon laboratory investigation by using IS900 specific PCR [which is specific for Mycobacterium avium subspecies paratuberculosis (MAP)], the blood and stool samples were found negative. However, the presence of low titer MAP-antibodies by indigenous ELISA were found followed by detection of the typical acid-fast MAP bacilli (with 3 + or 4 + grade) microscopically. The MAP stool culture was positive after 6 months incubation. The biotyping by IS1311 specific polymerase chain reaction restriction enzyme (PCR-RE) confirmed infection with ‘Indian Bison Type Genotype’, a dominant biotype infecting the domestic livestock population of India. Standard anti-MAP therapy was initiated under supervision of the treating physician. The drug of choice in prescribed treatment regimen included Isoniazid (5 mg/kg), Rifampicin (10 mg/kg), Ethambutol (15–25 mg/kg) once a day for 24 weeks and Clarithromycin (250 mg)/Levofloxacin (250 mg) twice a day for 6 weeks.

Results

Following treatment, the patient started improving progressively with reduction in bowel movement frequency and gained body weight with an enhanced appetite propensity. Upon follow-up of the patient after 1 year of treatment, stool-microscopy and stool-culture were found negative for MAP. Till the recent past, the patient was further monitored for disease relapse, if any.

Conclusions

This patient has experienced a complete resolution of IBD using a combination of anti-MAP antibiotics. The initial detection of heavy shedding of acid-fast MAP bacilli and typical colony morphology with its characterization obtained from culturing of stool sample indicated the infection of MAP. Interestingly, the present case is one more example of the linkage of demonstrable MAP infection treated with anti-MAP therapy in the presence and then absence of disease in the human host.

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Acknowledgements

Authors are thankful to ICAR, New Delhi for providing the funds and Director, Central Institute for Research on Goats (CIRG), Mathura, India for providing necessary facilities. We acknowledge Dr. Anil K. Verma, Celiac Disease Research Laboratory, Università Politecnica delle Marche Via Toti 11, Ancona, Italy for critical reading and editing of this manuscript.

Funding

This work is supported by the Indian Council of Agricultural Research, New Delhi, India (Outreach Program on Zoonotic Diseases, Grant File Number: 2-1/OPZD/VPH/2015-16/127) and project was ethically approved by the Institutional Ethics Committee (IEC) of IVRI (Division of Vet. Public Health), Izzatnagar (Bareilly), UP for 14 collaborating centers.

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Authors and Affiliations

  1. Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India

    Saurabh Gupta, Kundan Kumar Chaubey & Shoor Vir Singh

  2. Department of Medicine, S.N. Medical College, Agra, Uttar Pradesh, India

    Prabhat Agarwal

  3. Temple University Hospital, Philadelphia, PA, USA

    J. Todd Kuenstner

  4. Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Deepak Parashar

  5. Animal Health Division, Central Institute for Research on Goats, Makhdoom, Mathura, Uttar Pradesh, India

    Saurabh Gupta, Kundan Kumar Chaubey & Shoor Vir Singh

Authors
  1. Saurabh Gupta
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  2. Kundan Kumar Chaubey
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  3. Prabhat Agarwal
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  4. J. Todd Kuenstner
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  5. Deepak Parashar
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  6. Shoor Vir Singh
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Contributions

SG carried out all the experiments, prepared figures and drafted the manuscript. KKC collected the data and analysis. PA senior physician designed the drug regiment/therapeutics, JTK and DP participated in data analysis and interpretation of results. SG, DP and SVG design the study, participated in data analysis, and drafted the manuscript.

Corresponding authors

Correspondence to Deepak Parashar or Shoor Vir Singh.

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Conflict of interest

The authors declare there were no financial or commercial conflict of interest associated with the report of the present study.

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Written informed consent was obtained from the patient for treatment and for publication of this report and accompanying images.

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Gupta, S., Chaubey, K.K., Agarwal, P. et al. Therapeutic management of Mycobacterium avium subspecies paratuberculosis infection with complete resolution of symptoms and disease in a patient with advanced inflammatory bowel syndrome. Mol Biol Rep 48, 7013–7020 (2021). https://doi.org/10.1007/s11033-021-06615-3

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