MOLECULAR EPIDEMIOLOGY OF TUBERCULOSIS IN SAN FRANCISCO

描述：（改编自申请人摘要）。 的假设 这项研究是，由于感染了人类免疫缺陷病毒， 艾滋病毒（艾滋病毒）、无家可归和各种其他社会和医疗问题 因素，增加比例的结核病病例在圣 弗朗西斯科是最近感染分枝杆菌的结果 结核 据推测，这些感染是从 社区内可识别的来源，其中的网站， 传播M.肺结核的发生可以确定。 这 一项提案描述了一项基于社区的研究，其中限制性片段 长度多态性（RFLP）模式分析将用于 结合密集的流行病学调查， 城市结核病的分布和动态。 本研究将 利用限制性片段长度多态性（RFLP）来识别由以下原因引起的结核病病例群： 相同的菌株，假设聚类表明最近 迅速发展为疾病的感染。 因此，确定 集群中的病例比例将是一个指标， 社区内的传染源。 所寻求的问题 答案如下：什么是相对比例 弗朗西斯科的肺结核病例有多少怎么 聚集性病例的特征与非聚集性病例不同？ 可能未知的地点，也许，传播模式的M。 肺结核可以确诊吗？健康的相对贡献是什么 照料设施、教养机构以及向 弗朗西斯科结核病发病率 Can RFLP模式分析 是否有助于评估结核病控制项目的充分性？ 这项研究是一项前瞻性的，以社区为基础的检查， 描述性和比较性成分。 其目的是包括所有 弗朗西斯科新诊断的肺结核患者。 分离株 分枝 所有新诊断为结核病的患者 结核病，以及任何分离获得四个月或更长时间后， 诊断后，将进行RFLP分析。 模式匹配将是 使用自动扫描系统搜索。 采集后 流行病学数据是完整的，RFLP数据文件将被链接到 流行病学和临床数据将保存在相同的 电脑 分析将针对分析群集中的更改 随着时间的推移，数量和分布， 传播者和不同变量的比较， 不成簇，并确定RFLP对评估的益处 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.