TUBERCULOSIS SPREAD IN DRUG USERS

近年来，结核病在美国急剧卷土重来。 部分由于艾滋病的流行，一些国家受到了影响。艾滋病毒呈阳性的吸毒者在 感染活动性结核病并死于这种疾病的风险特别高 感染。结核分枝杆菌在药物间的传播模式 用户、影响传播的行为因素以及 毒株对其他社会亚群的“溢出”在很大程度上是未知的， 并将在此进行研究。全面、以人群为基础的流行病学 休斯敦几乎所有结核分枝杆菌分离株的研究 五年(700-800个菌株/年)将由一大群 位于德克萨斯医疗中心的合作调查人员。菌种 将通过最先进的分子流行病学来进行表征 技术，包括IS6110指纹和自动DNA测序。 需要检验的主要假设之一是，促进传播 在吸毒者和其他人中发生的有限数量的克隆 休斯敦。研究毒品间社会网络的新策略 将雇用用户和其他人员，并(与 休斯顿结核病官员)，分子和行为数据将用于 制定更加合理、更有针对性的防控策略。 新的自动DNA测序策略可用于快速感染诊断和 从原代标本中鉴定耐药结核分枝杆菌 痰将会被开发出来。这项以人口为基础的研究将提供关键的 缺少关于应变共享的准确频率的信息 以及在吸毒者和其他人群之间，确定可改变的风险 因素，有助于在吸毒者中采取有针对性的结核病预防方法， 并论证了快速分枝杆菌菌种分配的可行性， 鉴定导致抗生素耐药性的突变，以及 对原始标本进行分子流行病学研究，如痰。 将特别注意识别行为 结核病微流行吸毒者与吸毒者的差异 由独特的结核分枝杆菌菌株引起的疾病。

Tuberculosis (TB) has resurged dramatically in recent years in the United States due in part to the AIDS epidemic. HIV-positive drug users are at particularly high risk of contracting active TB and dying of this infection. The patterns of Mycobacterium tuberculosis spread among drug users, the behavioral factors influencing dissemination, and the amount of strain "spillover" to other societal subpopulations are largely unknown, and will be studied herein. COMPREHENSIVE, POPULATION-BASED EPIDEMIOLOGIC STUDY OF VIRTUALLY ALL M. TUBERCULOSIS ISOLATES RECOVERED IN HOUSTON OVER FIVE YEARS (700 - 800 STRAINS/YEAR) WILL BE CONDUCTED BY A LARGE GROUP OF COLLABORATING INVESTIGATORS LOCATED IN THE TEXAS MEDICAL CENTER. Strain characterization will be done by state-of-the-art molecular epidemiologic techniques, including IS6110 fingerprinting, and automated DNA sequencing. One of the major hypotheses to be tested is that facilitated transmission of a limited number of clones among drug users and others is occurring in Houston. Newly-formulated strategies to study social networks among drug users and others will be employed, and (in close collaboration with Houston TB officers), the molecular and behavioral data will be used to formulate more rational and targeted prevention and control strategies. New automated DNA sequencing strategies for rapid infection diagnosis and identification of drug-resistant TB strains in primary specimens such as sputum will be developed. This population-based study will supply crucial missing information about the precise frequency of strain sharing among and between drug users and other populations, identify modifiable risk factors, facilitate a targeted approach to TB prevention among drug users, and demonstrate the feasibility of rapid mycobacterial species assignment, identification of mutations conferring antibiotic-resistance, and molecular epidemiologic studies with primary specimens such as sputum. Special attention will be devoted to identification of behavioral differences among drug users involved in TB microepidemics and those with disease caused by unique MTB strains.