Evidence from molecular fingerprinting of limited spread of drug-resistant tuberculosis in Texas.
Evidence from molecular fingerprinting of limited spread of drug-resistant tuberculosis in Texas.
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德克萨斯州耐药结核病有限传播的分子指纹证据。
DOI：
10.1128/jcm.37.10.3255-3259.1999
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发表时间：
1999
影响因子：
9.4
通讯作者：
Barnes,PF
中科院分区：
文献类型：
--
作者：
Wilson,RW;Yang,Z;Kelley,M;Cave,MD;Pogoda,JM;WallaceJr,RJ;Cegielski,JP;Dunbar,DF;Bergmire-Sweat,D;Elliott,LB;Barnes,PF
为了确定近期传播对德克萨斯州耐药结核病传播的贡献，我们对结核分枝杆菌分离物进行了基于IS 6110和基于pTBN 12的限制性片段长度多态性（RFLP）分析。研究了1992年至1994年期间从德克萨斯州201例患者中收集的分离株。病例的分布具有明显的集中性。所有病例均来自德克萨斯州254个县中的35个县，74%（201个县中的148个）仅来自9个县。161例（80%）患者有M。41例（20%）患者分为20个簇，每个簇由2 ~ 3名患者组成。与墨西哥接壤的县报告的耐药结核病病例最多，但德克萨斯州东北部以及包括达拉斯、沃斯堡和休斯顿在内的县的聚集性病例比例最高。与非聚集性患者相比，聚集性患者更有可能是非洲裔美国人，并且出生在美国。分离的患者更有可能来自同一地理区域，而来自同一地理区域的聚集患者更有可能具有相同的药物敏感性模式，这表明它们通过最近的传播联系在一起。在20个集群中的11个中，集群患者来自地理上不同的地区，大多数分离株没有相同的药物敏感性模式，这表明结核病在遥远的过去是从一个共同的来源感染的。基于聚集性病例的低百分比和小的聚集规模，我们得出结论，没有证据表明德克萨斯州的耐药结核病广泛传播。
To determine the contribution of recent transmission to spread of drug-resistant tuberculosis in Texas, we performed IS6110-based and pTBN12-based restriction fragment length polymorphism (RFLP) analyses onMycobacterium tuberculosisisolates. Isolates collected from 201 patients in Texas between 1992 and 1994 were studied. The distribution of cases was strikingly focal. All cases were reported from 35 of the 254 counties in Texas, and 74% (148 of 201) were reported from only 9 counties. One hundred sixty-one (80%) of the patients hadM. tuberculosisisolates with unique RFLP patterns, and 41 (20%) patients were in 20 clusters, each comprising 2 to 3 patients. The largest number of cases of drug-resistant tuberculosis were reported in counties bordering Mexico, but the percentage of clustered cases was highest in northeast Texas and in counties that included the cities of Dallas, Fort Worth, and Houston. Compared to nonclustered patients, clustered patients were more likely to be African American and to have been born in the United States. Clustered patients were significantly more likely to be from the same geographic area, and clustered patients from the same geographic area were more likely to have isolates with identical drug susceptibility patterns, suggesting that they were linked by recent transmission. In 11 of 20 clusters, clustered patients were from geographically separate regions, and most isolates did not have identical drug susceptibility patterns, suggesting that tuberculosis was contracted from a common source in the remote past. Based on the low percentage of clustered cases and the small cluster size, we conclude that there is no evidence for the extensive transmission of drug-resistant tuberculosis in Texas.