2008-2020年臺灣人畜共通牛型結核病監測分析

Bovine Tuberculosis in Taiwan, 2008–2020

牛型結核病(bovine tuberculosis, bTB)是人畜共通結核病，可能跨物種傳播，卻長期受到忽視，造成盛行率被低估。此外，bTB病原牛型結核菌(Mycobacterium bovis biovar bovis, M. bovis)先天對治療結核病藥物pyrazinamide (PZA)具抗藥性，是臨床診治之挑戰。本研究篩驗臺灣2008–2020年24,717例以結核菌群(Mycobacterium tuberculosis complex, MTBC)陽性確診之TB個案中，共發現251 (1%)例bTB：77.7%為男性、71.8%年齡≥45歲、85.7%為新案及83.3%為肺部結核病；個案多來自於中部(51.0%)及南部(25.5%)。然而，在僅有19.5%個案具已知動物接觸史中，49.0%與有鹿隻相關。菌株抗藥性分析顯示：除對PZA抗藥外，29.1%對isoniazid抗藥及1.6%為多重抗藥性。基因分型結果顯示：人類及動物M. bovis主要型別為SB0265及MIRU 5-2-2-3-4-2-3-2-11-5-3。本研究探討臺灣人畜共通結核病，以符合世界衛生等相關組織提出防治藍圖中之優先執行策略，期強化人畜傳播介面解析，落實防疫一體，達成2035年結核病根除計畫最終目標。

Bovine tuberculosis (bTB) is a zoonosis caused by Mycobacterium bovis biovar bovis (M. bovis). The impact of bTB on global tuberculosis (TB) control has been underestimated. The pathogen is intrinsically resistant to pyrazinamide (PZA), which poses challenges to TB treatment and management. In this study, of the 24,717 culture-confirmed human TB cases reported during 2008–2020, there were 251 (1%) cases of bTB. Among these, 77.7% were male; 71.8% were aged over 45 years; 85.7% were new cases; 83.3% had pulmonary TB; and cases came mainly from central (51.0%) and southern (25.5%) Taiwan. Only 19.5% of bTB patients had known animal contacts. Among them, 49.0% had direct or indirect contact with deer. Of the human PZA-resistant M. bovis isolates, 29.1% were concurrently resistant to isoniazid (INH), and 1.6% were multidrug-resistant (defined as being resistant to at least INH and rifampin). The predominant genotype, SB0265/ MIRU 5-2-2-3-4-2-3-2-11-5-3, was prevalent in both human and livestock populations. Diagnosing bTB and detect its drug resistance are crucial for TB control. Comprehensive surveillance and integrated human-animal investigations are needed to align with the One Health approach.