MOLECULAR EPIDEMIOLOGY OF TUBERCULOSIS IN SAN FRANCISCO

描述：(改编自申请人摘要)。的假说 这项研究认为，由于感染了人类免疫缺陷 艾滋病毒(HIV)、无家可归和各种其他社会和医疗问题 因素，增加了旧金山结核病病例的比例 弗朗西斯科是最近感染分枝杆菌的结果 肺结核。据推测，这些感染是从 社区内的可识别来源以及其中的站点 可以确定是否发生结核分枝杆菌的传播。这 Proposal描述了一项基于社区的研究，其中限制片段 长度多态(RFLP)模式分析将用于 结合密集的流行病学调查来描述 城市结核病的分布和动态。这项研究将 利用RFLP识别由以下原因引起的结核病聚集性 相同的菌株，假设聚集性表明最近 迅速发展为疾病的感染。因此，确定 聚集性病例的比例将是一项指标 社区中的感染源。所寻求的问题是 答案如下：这一比例是多少 旧金山的结核病病例总数是聚集性的吗？做什么 聚集性病例与非聚集性病例的特征有何不同？ 可能是未被怀疑的部位，也可能是M。 结核病是可以识别的吗？健康的相对贡献是什么？ 看护设施、教养机构和移民到 旧金山的结核病发病率是多少？CAN RFLP模式分析 在评估结核病控制计划的充分性方面是否有用？ 这项研究是一项前瞻性的、以社区为基础的考试，包括 描述性和可比性部分。其目的是将所有 旧金山新诊断的肺结核患者。分离物 从所有新诊断为结核分枝杆菌的患者中 结核病，以及在四个月或更长时间后获得的任何分离株 诊断结果，将进行RFLP分析。模式匹配将是 寻求使用自动扫描系统。在收集了 流行病学数据完整RFLP数据文件将链接到 流行病学和临床数据将保留在相同的 电脑。分析将定向到分析集群中的更改 随时间推移的数量和分布、要跟踪的集群检查 不同变量在人群中的传播者和比较 不在集群中，并确定RFLP在评价方面的益处 联系调查程序。

DESCRIPTION: (Adapted from Applicant's Abstract). The hypothesis of this study is that, because of infection with the human immunodeficiency virus (HIV), homelessness and a variety of other social and medical factors, increasing proportions of cases of tuberculosis in San Francisco are the result of recent infection with Mycobacterium tuberculosis. It is postulated that these infections are acquired from identifiable sources within the community and that the sites wherein transmission of M. tuberculosis takes place can be determined. This proposal describes a community-based study in which restriction fragment length polymorphisms (RFLP) pattern analysis will be utilized in combination with intensive epidemiologic investigation to describe the distribution and dynamics of urban tuberculosis. This Study will utilize RFLP to identify clusters of cases having tuberculosis caused by the same strain, the assumption being that clustering indicates recent infection with rapid progression to disease. Thus, determining the proportion of cases in clusters would be an indicator of the number of infectious sources in the community. The questions that are sought to be answered are as follows: What is the relative proportion of the total tuberculosis cases in San Francisco who are in clusters? How do the characteristics of cases in clusters differ from noncluster cases? Can unsuspected sites and, perhaps, patterns of transmission of M. tuberculosis be identified? What are the relative contributions of health care facilities, correctional institutions, and migration to the incidence of tuberculosis in San Francisco? Can RFLP pattern analysis be useful in evaluating the adequacy of a tuberculosis control program? This study is a prospective, community-based examination with both descriptive and comparative components. The intent is to include all patients in San Francisco with newly diagnosed tuberculosis. Isolates of M. tuberculosis from all patients who have new diagnosis of tuberculosis, as well as any isolates obtained four or more months after the diagnosis, will undergo RFLP analysis. Pattern matches will be sought using an automated scanning system. After collection of the epidemiologic data is complete the RFLP data files will be linked to the epidemiologic and clinical data that will be maintained in the same computer. Analyses will be directed toward analyzing changes in cluster numbers and distribution over time, examination of clusters to track disseminators and comparisons of different variables in persons in and not in clusters, and determination of the benefits of RFLP on evaluating contact investigation procedures.