THE EPIDEMIOLOGY OF TUBERCULOSIS IN SAN-FRANCISCO - A POPULATION-BASED STUDY USING CONVENTIONAL AND MOLECULAR METHODS
THE EPIDEMIOLOGY OF TUBERCULOSIS IN SAN-FRANCISCO - A POPULATION-BASED STUDY USING CONVENTIONAL AND MOLECULAR METHODS
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DOI：
10.1056/nejm199406163302402
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发表时间：
1994-06-16
影响因子：
158.5
通讯作者：
SCHOOLNIK, GK
中科院分区：
文献类型：
--
作者：
SMALL, PM;HOPEWELL, PC;SCHOOLNIK, GK
背景结核病在城市人口中的流行病学正在发生变化。将传统的流行病学技术与结核分枝杆菌DNA指纹图谱相结合可以提高对结核病传播方式的认识。本研究采用限制性片段长度多态性（RFLP）分析方法对M.从1991年和1992年旧金山弗朗西斯科结核病登记处报告的所有患者中分离出结核病菌株。这些结果与临床、人口统计学和流行病学数据一起沿着解释。感染相同菌株的患者根据其RFLP模式进行鉴定，并将具有相同模式的患者分组。分析了聚集的危险因素。在研究的473名患者中，有191名似乎因近期感染而患有活动性结核病。使用传统方法追踪患者的接触者，发现这些患者中只有10%有联系。然而，DNA指纹鉴定确定了44个群体，其中20个群体只有2人，最大的群体有30人。在60岁以下的患者中，西班牙裔（比值比，3.3; P = 0.02），黑人（比值比，2.3; P = 0.02），在美国出生（比值比，5.8; P < 0.001），和获得性免疫缺陷综合征的诊断（比值比，1.8; P = 0.04）独立相关的集群。进一步的研究表明，结核病患者的依从性差对结核病的控制有很大的不利影响。尽管有一个有效的结核病控制计划，但在旧金山弗朗西斯科，近三分之一的结核病新病例是最近感染的结果。传统的接触者追踪方法很少发现这些传播病例。
Background. The epidemiology of tuberculosis in urban populations is changing. Combining conventional epidemiologic techniques with DNA fingerprinting of Mycobacterium tuberculosis can improve the understanding of how tuberculosis is transmitted.Methods. We used restriction-fragment-length polymorphism (RFLP) analysis to study M. tuberculosis isolates from all patients reported to the tuberculosis registry in San Francisco during 1991 and 1992. These results were interpreted along with clinical, demographic, and epidemiologic data. Patients infected with the same strains were identified according to their RFLP patterns, and patients with identical patterns were grouped in clusters. Risk factors for being in a cluster were analyzed.Results. Of 473 patients studied, 191 appeared to have active tuberculosis as a result of recent infection. Tracing of patients' contacts with the use of conventional methods identified links among only 10 percent of these patients. DNA fingerprinting, however, identified 44 clusters, 20 of which consisted of only 2 persons and the largest of which consisted of 30 persons. In patients under 60 years of age, Hispanic ethnicity (odds ratio, 3.3; P = 0.02), black race (odds ratio, 2.3; P = 0.02), birth in the United States (odds ratio, 5.8; P < 0.001), and a diagnosis of the acquired immunodeficiency syndrome (odds ratio, 1.8; P = 0.04) were independently associated with being in a cluster. Further study of patients in clusters confirmed that poorly compliant patients with infectious tuberculosis have a substantial adverse effect on the control of this disease.Conclusions. Despite an efficient tuberculosis-control program, nearly a third of new cases of tuberculosis in San Francisco are the result of recent infection. Few of these instances of transmission are identified by conventional contact tracing.