TUBERCULOSIS SPREAD IN DRUG USERS

近年来，结核病在美国急剧死灰复燃， 部分原因是艾滋病的流行。艾滋病毒阳性吸毒者在 感染活动性结核病并因此死亡的风险特别高 感染结核分枝杆菌在药物中的传播模式 用户，影响传播的行为因素，以及 菌株“溢出”到其他社会亚群在很大程度上是未知的， 并将在此进行研究。全面的、基于人群的流行病学 研究几乎所有的M。在休斯顿回收的结核病分离株 五年（700 - 800株/年）将由一大批 位于德克萨斯州医疗中心的协作医师。应变 将通过最先进的分子流行病学方法进行表征 技术，包括IS 6110指纹图谱和自动DNA测序。 有待检验的主要假设之一是， 吸毒者和其他人中数量有限的克隆人正在发生 休斯顿研究吸毒者社交网络的新战略 用户和其他人将被雇用，并（与 休斯顿结核病官员），分子和行为数据将用于 制定更合理、更有针对性的防控策略。 用于快速感染诊断的新的自动化DNA测序策略， 在原始标本中鉴定耐药结核菌株， 将产生痰。这项基于人群的研究将提供关键的 缺少关于应变共享的精确频率的信息， 以及吸毒者与其他人群之间的风险， 这些因素，有助于在吸毒者中采取有针对性的结核病预防方法， 并证明了快速分枝杆菌菌种鉴定的可行性， 鉴定赋予耐药性的突变，和 使用痰等原始标本进行分子流行病学研究。 将特别注意识别行为 结核微流行病患者和结核病患者之间的差异 由独特的MTB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.