Info sought- Crohn's Disease

Andre Hamel hamel at
Sun Feb 26 12:34:30 EST 1995

Dear Amy

Crohn's disease appears to be an autoimmune reaction (body's immune 
system attacks rest of its own body) triggered at least in part by 
infection by Mycobacterium avium paratuberculosis.

This stubborn organism (close cousin to tuberculosis causing agent) is 
difficult to treat because it grows intracellularly (WITHIN intestinal 
cells) ... also grows in mesenteric lymph nodes (likely site of trigger 
for autoimmune cascade).

Antibiotic treatment is likely but takes many weeks to several months 
before any changes can even begin to be detected (by routine biopsy).

The biopssy procedures should be quite trivial, involving use of 
gastroscopic device (narrow tube with fiber optic imaging system and 
biopsy sampling device akin to roto-rooter) ... slight discomfort but 
little or no pain should occur during such tests.

The devices should be exceptionally decontaminated after use by thorough 
washings in bleach, formaldehyde and alcohol, finally sterilized 
(autoclaved) while completely immersed/filled with water.

This will minimize risk of cross contaminating patients with one anothers 
infectious organisms ... even Helicobacter pylori can be transmitted 
through such devices ... M. paraTB is considerably more tough (some are 
resistant to high temperature).

There are reliable serological (simply requires serum drawn from patient) 
and PCR tests (requires biopsy, but no guarantee that negative result is not 
false negative because M. paraTB is intracellular and grows sooo slowly.

Lymph node biopsy might improve success of PCR and/or culturing ... I 
recommend your sister's doctor have serology performed in order to 
determine whether or not she has been exposed to M. paraTB ... if 
serologiccal results are positive, then there is a possibility (can't be 
ruled out) that her intestinal problems might be due to exposure to M. 
paraTB. ... calling for vigorous antibiotic therapy.

I'd also look at her lifestyle (is diet well balanced ... not undereating? 
... getting  sufficient rest, regular routines (regular eating, exercise 
& rest)? ... is she in any high risk category for aquiring such diseases 
(sexually promiscuous, IV drug user)? ... poor nutrition, etc lead to 
physical stress ... so on ... leading to such infections.

all best,

  Andre Hamel                      email: hamel at
  Manitoba Government                         tel: 204/945-7630
  Department of Agriculture                   FAX: 204/945-8062
  Veterinary Services Branch          
  Winnipeg, Manitoba, CANADA 

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