Thursday, September 24, 2009

"There was 'A wall of silence'.

Our post below has provoked two quite different reactions. In it we told the story of four dead cats, one of which was tested positive for m.bovis,(the zoonotic bacteria which causes bTB) and the medical authorities who refused screening for the family in whose air space, rugs and knees the cats had lived.

After an airing the story on Dr. Colin Fink of Warwick University replied that as there were no symptoms after eight months, then HPA were probably correct.
" In the case of the cat diagnosed to have the disease, if the owners and immediate family remain asymptomatic, then all is well . Whether they have been exposed and have been infected with a small amount of the organisms and deal with this infection in the normal immunological way, is rather academic. Many of us meet M.Tuberculosis but remain entirely asymptomatic. The cat owners et al may be reassured. If they were to become ill and remain unwell for longer than a transient infection might be expected to last, then further investigation would be justified."
Up to a point, we agree. But, and this is a big 'but', the HPA and all its satellite agencies have a duty of care to screen for bTB where contact with a confirmed case either in a human being, or any animal (farmed or domestic) is known to have occurred. And that is far from 'academic'.

We described it last year, in this posting. And the documentation relating to that responsibility, can be found in this booklet produced by HPA in April this year.

But what is becoming quite clear, is the dumbing down of 'spill over cases' of bTB in mammals other than tested cattle and the reluctance of Defra to bring other farmed mammals into their bTB eradication plans. But more reckless is the absolute brick wall of reluctance, adopted by some local authorities to screen for possible onward transmission of this long-term zoonosis, to its human contacts.

Veterinary practitioner David Denny B.VET.MED.M.R.C.V.S has sent us the following comment from his area which is close to the location of the cat in this weeks' posting.

"The frustrating experience of Kira Lily is regrettably not unique. Her experience is typical of this despicable Government’s micro management of the Authorities involved. In order to skew the bTB statistics and being virtually gagged, the authorities have to ‘sing from the political hymn sheet’.

Mr. Denny then describes his own involvement with a case described as by local authorities as 'atypical tuberculosis from a non-bovine source' which we reported here. We post Mr. Denny's experiences with the authorities, in full.
In 2005 there was a cluster of young children near Newport, Powys - a bTB hotspot - who had swollen lymph glands in the neck and head glands. These are classical ‘scrofula’ symptoms of TB. Some of the glands were suppurating- leaking pus. Because some failed to respond to antibiotic treatment, their glands were surgically removed. Although Mycobacterium bacilli were isolated it is apparent that the unique media essential to grow bTB was not used.

One child a dairy farmer’s daughter developed enlarged glands, which burst. Months later a consultant paediatrician diagnosed “atypical TB”. The authorities allowed the child to go to school, provided the glands were covered up! Although the farm had a history of some bTB in the cattle, no one would tell her Mother where the TB had come from - there was a ‘wall of silence’ from the authorities. Unlike most of the parents who were probably too embarrassed to cause a fuss, one mother was so frustrated that she had front page coverage in the Powys County Times 24 March 2006. The National Public Health Service said “there is no such thing as atypical TB, it is a Mycobacterium infection which can cause a whole range of infections some of which are TB, which are usually acquired from the environment, but transmission can occur from animals to humans”.

In the local school playing area a moribund badger was found. The local Veterinary Surgeon had the carcase sent to the VLA at Aberystwyth. The VS attempted to establish from the VLA the result of the PM. They would not tell him, “they were not allowed to”. Having been at College with the DVM at Shrewsbury he contacted him. “I am unable to tell you”. He eventually established, off the record that the badger did in fact have lesions typical of TB. Later it turned out that on instructions from above the lesions “must not be cultured. We don’t want a TB badger to be found in a school play area”!.

Tuberculosis is a very slow growing organism, and although it is considered to be a disease primarily involving the lungs it can establish itself in any organ or multiple organs of the body be it brain or bone etc. Thus a negative lung X’ray in no way indicates freedom from TB. Medical authorities may also, because of the very real risk of over exposure, be very reluctant to X’ray young children. The usual first line of screening is the Mantoux skin test, which is said to show exposure to TB bacteria. But increasingly, PCR sputum tests are also used as non invasive and arguably more specific screens.

Mr. Denny continues:
Whilst the aerosol route of infection is the accepted way, it is certainly not the only way TB can enter the body; it can enter through any orifice or even a wound. The main route of infection for cattle would be by them eating/ drinking contaminated food which badgers have contaminated, when each teaspoonful of their urine can contain 1,500,000 TB bacilli. [ And it only needs 70 cfu bacteria to provoke a skin reaction, or cause infection in cattle. - ed]..

As the figures of bTB spill back are slowly released, it seems that camelids (alpacas) and cats are the most vulnerable. Mr. Denny describes bTB infection in cats thus:
Because cats are so fastidious and are always licking themselves any bacilli in their hair or on their feet are ingested. Cat wounds can become infected as a result of being licked. It results in a non healing grossly thickened wound which does not respond to treatment.

And many of these cats, 'not responding to treatment' will have been 'fastidiously' grooming themselves on the lap of their owner. And that is not 'academic' at all. It appears to us that it presents a real and present danger.


Anonymous said...

Good idea screening human 'contacts'.

Are all those who work with cattle screened - particularly those that come into contact with animals from more than one herd?


Unknown said...

yes, we may be reassured now, after 8months, however i have certainly had one gp tell me (off the record) that tb is such a chronic, slow to develop illness that even being asymptomatic for 8mos is no guarantee.

it would also have been nice not to have had to wait 8months for this relative degree of certainty; i can tell you that it has not been an easy time for any of us. given that defra stressed to us the urgency with which we needed to procure tests, and the utter refusal of the health authorities to allow said tests, we have felt very confused and helpless.

and no, farmers/those who work regularly with cattle (even infected cattle) are not screened, and that is another big issue in our area.

what a mess.

Matthew said...

Kira Lily,
The whole damn thing is a mess. And an avoidable one. We hope that Dr. Fink is right, but your 'off the record' GP is also quite correct that TB can be a very slow developing disease. So, if exposure is small, or the immune system of those exposed is up to scratch, it may be decades later, when the perpetrators of this debacle have long gone to other jobs, that the fruits of this exposure may come home to roost.


Unknown said...

and they will all go to other jobs, and possibly be just as ignorant in future endeavours as they are now.

no expertise, no accountability needed these days. no caring needed these days, it would seem.

my son is begging me to let us get a kitten. it would of course be a house cat this time around, but still. i wish i had never heard of bovine tb; i really do.