Ferrazoli L, Palaci M, Marques L R, Jamal L F, Afiune J B, Chimara E, Martins M C, Silva Telles M A, Oliveira C A, Palhares M C, Spada D T, Riley L W
Instituto Adolfo Lutz, Divisão de Biologia Médica, São Paulo, Brazil.
Int J Tuberc Lung Dis. 2000 Jan;4(1):18-25.
Two out-patient facilities in São Paulo, Brazil.
To study the transmission pattern of tuberculosis (TB) among human immunodeficiency virus (HIV) infected and uninfected persons in a setting endemic for TB.
A prospective study comparing HIV-seropositive and -seronegative TB patients identified consecutively between 1 March 1995 and 1 April 1997. The patients were stratified according to their Mycobacterium tuberculosis isolate IS6110 RFLP patterns. Risk factors were sought for infection with an RFLP cluster pattern strain, inferred to represent recent transmission.
Fifty-eight (38%) of 151 HIV-seropositive patients and 36 (25%) of 142 HIV-seronegative patients were infected with M. tuberculosis isolates that belonged to cluster patterns (OR 1.84, 95% CI 1.08-3.13). Multidrug-resistant (MDR) strains were isolated from 19 patients, all of whom were HIV seropositive; 12 (63%) of these, and 46 (35%) of 132 drug-susceptible isolates had cluster patterns (OR 3.20, 95% CI 1.08-9.77).
In a TB-endemic urban setting in Brazil, the proportion of cases resulting from recent transmission appears to be greater among HIV-seropositive than among HIV-seronegative patients. A large proportion of MDR-TB (63%) cases was caused by strains that had cluster RFLP patterns, suggesting recent transmission of already resistant organisms. This type of knowledge regarding TB transmission may help to improve locally appropriate TB control programs.
巴西圣保罗的两家门诊机构。
在结核病流行地区，研究人类免疫缺陷病毒（HIV）感染者和未感染者中结核病（TB）的传播模式。
一项前瞻性研究，比较1995年3月1日至1997年4月1日期间连续确定的HIV血清阳性和血清阴性结核病患者。患者根据其结核分枝杆菌分离株IS6110 RFLP模式进行分层。寻找感染RFLP簇模式菌株的危险因素，推断其代表近期传播。
151例HIV血清阳性患者中有58例（38%），142例HIV血清阴性患者中有36例（25%）感染了属于簇模式的结核分枝杆菌分离株（比值比1.84，95%可信区间1.08 - 3.13）。从19例患者中分离出耐多药（MDR）菌株，所有这些患者均为HIV血清阳性；其中12例（63%）以及132例药物敏感分离株中的46例（35%）具有簇模式（比值比3.20，95%可信区间1.08 - 9.77）。
在巴西结核病流行的城市环境中，近期传播导致的病例比例在HIV血清阳性患者中似乎高于HIV血清阴性患者。很大一部分耐多药结核病（63%）病例是由具有簇RFLP模式的菌株引起的，这表明已耐药的病原体近期发生了传播。这种关于结核病传播的知识可能有助于改进当地合适的结核病控制项目。
