TRANSMISSION OF TUBERCULOSIS IN NEW-YORK-CITY - AN ANALYSIS BY DNA-FINGERPRINTING AND CONVENTIONAL EPIDEMIOLOGIC METHODS
TRANSMISSION OF TUBERCULOSIS IN NEW-YORK-CITY - AN ANALYSIS BY DNA-FINGERPRINTING AND CONVENTIONAL EPIDEMIOLOGIC METHODS
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DOI：
10.1056/nejm199406163302403
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发表时间：
1994-06-16
影响因子：
158.5
通讯作者：
BLOOM, BR
中科院分区：
文献类型：
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作者：
ALLAND, D;KALKUT, GE;BLOOM, BR
背景。在美国，结核病和耐药性的发病率正在增加，但尚不清楚增加的多少是由于潜伏感染的重新激活，多少是由于最近的传播。我们使用限制性片段长度多态性（RFLP）对1989年12月1日至1992年12月31日期间在纽约布朗克斯区一家大医院确诊的每位结核病患者的至少一株分离物进行了DNA指纹分析。对医疗记录和人口普查数据进行了相关的临床、社会和人口统计数据的审查。在130名结核病患者中，104名成年人（80%）有完整的医疗记录和可评估DNA指纹的分离株。来自65名患者（62.5%）的分离株具有独特的RFLP模式，而来自39名患者（37.5%）的分离株的RFLP模式与来自至少1名其他研究患者的分离株的RFLP模式相同；后一组分离物可分为12个聚类。其分离株被包括在其中一个聚集群中的患者被推断为最近传播了疾病。聚集性分离物的独立危险因素包括人类免疫缺陷病毒（HIV）血清阳性（西班牙裔患者的优势比为4.31,P = 0.02；非西班牙裔患者的优势比为3.12,P = 0.07）、西班牙裔合并HIV血清阴性（优势比为5.13,P = 0.05）、耐药结核感染（优势比为4.52,P = 0.005）和年龄较小（优势比为1.59,P = 0.02）。居住在布朗克斯区家庭收入中位数低于20,000美元的部分地区也与聚集性孤立相关（优势比为3.22;P = 0.04）。在我们研究的市中心社区，最近传播的结核病约占事件病例的40%，几乎占耐药病例的三分之二。最近结核病的传播，不仅仅是潜伏疾病的重新激活，大大促进了结核病的增加。
Background. The incidence of tuberculosis and drug resistance is increasing in the United States, but it is not clear how much of the increase is due to reactivation of latent infection and how much to recent transmission.Methods. We performed DNA fingerprinting using restriction-fragment-length polymorphism (RFLP) analysis of at least one isolate from every patient with confirmed tuberculosis at a major hospital in the Bronx, New York, from December 1, 1989, through December 31, 1992. Medical records and census-tract data were reviewed for relevant clinical, social, and demographic data.Results. Of 130 patients with tuberculosis, 104 adults (80 percent) had complete medical records and isolates whose DNA fingerprints could be evaluated. Isolates from 65 patients (62.5 percent) had unique RFLP patterns, whereas isolates from 39 patients (37.5 percent) had RFLP patterns that were identical to those of an isolate from at least 1 other study patient; the isolates in the latter group were classified into 12 clusters. Patients whose isolates were included in one of the clusters were inferred to have recently transmitted disease. Independent risk factors for having a clustered isolate included seropositivity for the human immunodeficiency virus (HIV) (odds ratio for Hispanic patients, 4.31; P = 0.02; for non-Hispanic patients, 3.12; P = 0.07), Hispanic ethnicity combined with HIV seronegativity (odds ratio, 5.13; P = 0.05), infection with drug-resistant tuberculosis (odds ratio, 4.52; P = 0.005), and younger age (odds ratio, 1.59; P = 0.02). Residence in sections of the Bronx with a median household income below $20,000 was also associated with having a clustered isolate (odds ratio, 3.22; P = 0.04).Conclusions. In the inner-city community we studied, recently transmitted tuberculosis accounts for approximately 40 percent of the incident cases and almost two thirds of drug-resistant cases. Recent transmission of tuberculosis, and not only reactivation of latent disease, contributes substantially to the increase in tuberculosis.