Díaz R, Gómez R I, García N, Valdivia J A, van Soolingen D
National Reference Laboratory on Tuberculosis and Mycobacteria, Institute Pedro Kourí, Marianao 13, Havana, Cuba.
J Hosp Infect. 2001 Sep;49(1):30-6. doi: 10.1053/jhin.2001.1015.
The IS 6110 restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis isolates has revolutionized the description of the epidemiology of tuberculosis. This technique has been used to confirm suspected cases of transmission in several institutional settings. In this study, we analysed by conventional and molecular epidemiological methods the unexpectedly high number of tuberculosis cases which occurred among 14 mentally handicapped patients and a healthcare worker in Havana's Psychiatric Hospital in the period from 1995 to 1998. Twelve M. tuberculosis isolates of the respective patients showed the same DNA fingerprint, consisting of nine bands. Three other different IS 6110 RFLP patterns with 10, eight, and 10 bands were observed. The results of RFLP analysis and of an additional epidemiological investigation allowed the identification of the probable source of this chain of transmission in the healthcare facility. This would not have been possible without the aid of DNA fingerprinting. Delays in diagnosis of the source patient and of the secondary cases, a tardy and deficient tuberculin skin test and the difficulties of management of mentally handicapped patients probably contributed to spread the M. tuberculosis strain in Havana's Psychiatric Hospital.
结核分枝杆菌分离株的IS 6110限制性片段长度多态性（RFLP）分析彻底改变了结核病流行病学的描述方式。这项技术已被用于确认多个机构环境中疑似传播病例。在本研究中，我们采用传统和分子流行病学方法，分析了1995年至1998年期间哈瓦那精神病院14名智障患者和一名医护人员中意外出现的大量结核病例。各患者的12株结核分枝杆菌分离株显示出相同的DNA指纹图谱，由九条带组成。还观察到另外三种不同的IS 6110 RFLP模式，分别有10条、8条和10条带。RFLP分析结果以及进一步的流行病学调查使得能够确定该医疗机构中这一传播链的可能源头。如果没有DNA指纹图谱技术的帮助，这是不可能实现的。源头患者和继发病例诊断的延迟、结核菌素皮肤试验的迟缓与不足以及智障患者管理的困难，可能都促使结核分枝杆菌菌株在哈瓦那精神病院传播。
