Pathogenesis of Mycobacterium avium subspecies paratuberculosis infections in ruminants: still more questions than answers

Mycobacterium avium subspecies paratuberculosis is the etiologic agent of paratuberculosis (Johnes disease), a chronic enteritis in ruminants, which is one of the most widespread bacterial diseases of domestic animals, causing enormous economic losses worldwide. Though the disease was first described more than a century ago, the biology of the infecting organism and the mechanisms of its interactions with the host still remain a mystery. In this review, recent advances made on pathogenesis of paratuberculosis are summarized and future challenges are discussed.