Golub J E, Cronin W A, Obasanjo O O, Coggin W, Moore K, Pope D S, Thompson D, Sterling T R, Harrington S, Bishai W R, Chaisson R E
Department of Epidemiology, The Johns Hopkins University, 424 N Bond St, Baltimore, MD 21231-1001, USA.
Arch Intern Med. 2001 Oct 8;161(18):2254-8. doi: 10.1001/archinte.161.18.2254.
An ongoing restriction fragment length polymorphism study of Mycobacterium tuberculosis isolates from tuberculosis cases showed an identical 12-band IS6110 pattern unique to 3 unrelated patients (Patients A-C) diagnosed as having tuberculosis within a 9-month period.
In an attempt to identify epidemiologic links between the 3 patients, we performed site visits to the retail business work site of patient A and conducted detailed interviews with all 3 patients and their contacts.
Patient B had visited patient A's work site 3 times during patient A's infectious period, spending no more than 15 minutes each time. Patient C visited patient A's work site on 6 to 10 occasions during this period for no more than 45 minutes at any one time. There were no other epidemiologic links between these 3 cases other than the contact at the store. Contact investigation identified 4 tuberculin skin test conversions among 8 (50%) of patient A's coworkers, 6 positive tests among 15 household contacts (40%), and 8 positive tests among 16 identified customers who were casual contacts (50%). Patient B and patient C were most likely infected by patient A during one of their brief visits to patient A's work site.
These data demonstrate that some tuberculosis is spread through casual contact not normally pursued in traditional contact investigations and that, in certain situations, M tuberculosis can be transmitted despite minimal duration of exposure. In addition, this outbreak emphasizes the importance of DNA fingerprinting data for identifying unusual transmission in unexpected settings.
一项正在进行的对肺结核病例中结核分枝杆菌分离株的限制性片段长度多态性研究显示，在9个月内被诊断为患有肺结核的3名无关联患者（患者A - C）具有相同的12带IS6110模式，此模式独一无二。
为了确定这3名患者之间的流行病学联系，我们走访了患者A的零售工作场所，并对所有3名患者及其接触者进行了详细访谈。
在患者A的传染期内，患者B曾3次前往患者A的工作场所，每次停留不超过15分钟。在此期间，患者C曾6至10次前往患者A的工作场所，每次停留不超过45分钟。除了在商店的接触外，这3例病例之间没有其他流行病学联系。接触者调查发现，患者A的8名同事中有4人（50%）结核菌素皮肤试验阳转，15名家庭接触者中有6人检测呈阳性（40%），16名确定的偶然接触顾客中有8人检测呈阳性（50%）。患者B和患者C很可能是在他们前往患者A工作场所的一次短暂接触中被患者A感染的。
这些数据表明，一些结核病是通过传统接触调查中通常不会追查的偶然接触传播的，并且在某些情况下，尽管接触时间很短，结核分枝杆菌仍可传播。此外，这次疫情强调了DNA指纹数据对于识别意外情况下异常传播的重要性。
