Stauffer F, Makristathis A, Rumetshofer R, Barousch W, Hasenberger P, Wewalka G, Rotter M, Wolf K
Bundesstaatliche bakteriologisch-serologische Untersuchungsanstalt Wien, Austria.
Wien Klin Wochenschr. 2000 Sep 29;112(18):791-7.
Tuberculosis continues to be one of the predominant infectious diseases. Effective control of its spread requires that sources of infection and routes of transmission be disclosed as quickly as possible. At present such investigations are still performed by conventional epidemiological methods. In the recent past, however, molecular typing systems were added to the spectrum of epidemiological tools. Unfortunately, they were applied to retrospective investigations rather than used as an aid in the health care system. In this study, 515 Mycobacterium tuberculosis strains isolated during 1997 and 1998 in Vienna were analysed by spoligotyping, a molecular technique requiring no further cultivation of mycobacteria. The study was aimed to assess the suitability of the method as a quick means of disclosing new cases. Thus, clusters obtained by spoligotyping were analysed along with demographic and epidemiological data and compared with clusters obtained by conventional epidemiological techniques alone. In addition, spoligotype-forming clusters were matched with an international database containing spoligotypes from four different studies. Of 515 isolates, 107 showed an unique pattern. The remaining 408 isolates were distributed into two large clusters of 82 and 73 isolates and into 49 smaller ones consisting of 2 to 33 isolates each. The two spoligotypes forming the large clusters were identical with the most prevalent spoligotypes in the world. Therefore, for the tuberculosis authorities, information was only gained by excluding rather than tracing possible ways of transmission. Twenty-two of the 49 spoligotypes forming smaller clusters were identical with strains found in other parts of the world. Seventeen of 22 infection chains assumed by conventional investigations were confirmed by spoligotyping. In small clusters, an additional 24 infections were assumed due to similarities such as living conditions or socioeconomic status. In 27 clusters, all patients sharing the same strain belong to the same country or geographical area. In conclusion, spoligotyping proved suitable as an early guide in conventional investigations to trace routes of M. tuberculosis transmission in a community. However, when a strain isolated from a patient belongs to a spoligotype shared by many isolates, a second molecular typing method is required.
结核病仍然是主要的传染病之一。有效控制其传播需要尽快查明感染源和传播途径。目前此类调查仍采用传统流行病学方法。然而，最近分子分型系统已被纳入流行病学工具范畴。不幸的是，它们被用于回顾性调查，而非作为医疗保健系统的辅助手段。在本研究中，对1997年和1998年在维也纳分离出的515株结核分枝杆菌菌株进行了间隔寡核苷酸分型（spoligotyping）分析，这是一种无需对分枝杆菌进行进一步培养的分子技术。该研究旨在评估该方法作为快速查明新病例手段的适用性。因此，对通过间隔寡核苷酸分型获得的聚类与人口统计学和流行病学数据进行了分析，并与仅通过传统流行病学技术获得的聚类进行了比较。此外，将形成间隔寡核苷酸分型的聚类与一个包含来自四项不同研究的间隔寡核苷酸分型的国际数据库进行了匹配。在515株分离株中，107株显示出独特的模式。其余408株分离株被分为两个大聚类（分别为82株和73株）以及49个较小的聚类（每个聚类由2至33株组成）。形成大聚类的两种间隔寡核苷酸分型与世界上最常见的间隔寡核苷酸分型相同。因此，对于结核病管理部门而言，仅通过排除而非追踪可能的传播途径获取了信息。在形成较小聚类的49种间隔寡核苷酸分型中，有22种与世界其他地区发现的菌株相同型。通过传统调查假定的22条感染链中有17条通过间隔寡核苷酸分型得到了证实。在小聚类中，由于生活条件或社会经济地位等相似性，又假定了另外24例感染。在27个聚类中，所有携带相同菌株的患者都属于同一个国家或地理区域。总之，间隔寡核苷酸分型被证明适合作为传统调查中的早期指导，以追踪社区中结核分枝杆菌的传播途径。然而，当从患者分离出的菌株属于许多分离株共有的间隔寡核苷酸分型时，则需要第二种分子分型方法。
