The etiology of Mycobacterium avium subspecies paratuberculosis in Crohn's disease

The etiology of Crohn's disease (CD) has drawn heated controversy in the literature. Compelling evidence in the literature has accumulated lately that could incriminate the Mycobacterium avium subspecies paratuberculosis (MAP), the well-known agent of John's disease in cattle. The evidence is isolation of the organism or its DNA and RNA, detection of the anti-MAP antibodies in Crohn's patients, increasing incidents of CD in areas close to the cattle pastures, and the possibility of treating the disease with the antibiotics. The group that favors the immune dysregulation theory considered this evidence circumstantial due to the variations in these reports. The treatment of CD with humanized anti-tumor necrosis factor-alpha antibodies is considered great endorsement to the immune dysregulation theory. The endless debate could jeopardize public health rather than bring a final solution. Reconciliation between the 2 theories appears inevitable in view of possible classification of this disease as a zoonotic.