title: Environmental mycobacteria in northern Malawi: implications for the epidemiology of tuberculosis and leprosy.
abstract: More than 36000 individuals living in rural Malawi were skin tested with antigens derived from 12 different species of environmental mycobacteria. Most were simultaneously tested with RT23 tuberculin, and all were followed up for both tuberculosis and leprosy incidence. Skin test results indicated widespread sensitivity to the environmental antigens, in particular to Mycobacterium scrofulaceum, M. intracellulare and one strain of M. fortuitum. Individuals with evidence of exposure to 'fast growers' (i.e. with induration to antigens from fast growers which exceeded their sensitivity to tuberculin), but not those exposed to 'slow growers', were at reduced risk of contracting both tuberculosis and leprosy, compared to individuals whose indurations to the environmental antigen were less than that to tuberculin. This evidence for cross protection from natural exposure to certain environmental mycobacteria may explain geographic distributions of mycobacterial disease and has important implications for the mechanisms and measurement of protection by mycobacterial vaccines.
authors.affiliation: Department of infectious at Tropical Diseases, London School of Hygiene and Tropical Medicine.
authors.forename: P E
authors.initials: PE
authors.lastname: Fine
authors.forename: S
authors.initials: S
authors.lastname: Floyd
authors.forename: J L
authors.initials: JL
authors.lastname: Stanford
authors.forename: P
authors.initials: P
authors.lastname: Nkhosa
authors.forename: A
authors.initials: A
authors.lastname: Kasunga
authors.forename: S
authors.initials: S
authors.lastname: Chaguluka
authors.forename: D K
authors.initials: DK
authors.lastname: Warndorff
authors.forename: P A
authors.initials: PA
authors.lastname: Jenkins
authors.forename: M
authors.initials: M
authors.lastname: Yates
authors.forename: J M
authors.initials: JM
authors.lastname: Ponnighaus
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000942:Antigens, Bacterial / Q000276:immunology*; D002648:Child; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007918:Leprosy / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009161:Mycobacterium / Q000145:classification / Q000254:growth & development* / Q000276:immunology* / Q000472:pathogenicity; D011159:Population Surveillance; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012867:Skin / Q000382:microbiology*; D012988:Soil Microbiology; D011795:Surveys and Questionnaires; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D014871:Water Microbiology
chemical_list: D000942:Antigens, Bacterial