Daley C L, Small P M, Schecter G F, Schoolnik G K, McAdam R A, Jacobs W R, Hopewell P C
Medical Service, San Francisco General Hospital Medical Center, Calif.
N Engl J Med. 1992 Jan 23;326(4):231-5. doi: 10.1056/NEJM199201233260404.
Tuberculosis typically develops from a reactivation of latent infection. Clinical tuberculosis may also arise from a primary infection, and this is thought to be more likely in persons infected with the human immunodeficiency virus (HIV). However, the relative importance of these two pathogenetic mechanisms in this population is unclear.
Between December 1990 and April 1991, tuberculosis was diagnosed in 12 residents of a housing facility for HIV-infected persons. In the preceding six months, two patients being treated for tuberculosis had been admitted to the facility. We investigated this outbreak using standard procedures plus analysis of the cultured organisms with restriction-fragment-length polymorphisms (RFLPs).
Organisms isolated from all 11 of the culture-positive residents had similar RFLP patterns, whereas the isolates from the 2 patients treated for tuberculosis in the previous six months were different strains. This implicated the first of the 12 patients with tuberculosis as the source of this outbreak. Among the 30 residents exposed to possible infection, active tuberculosis developed in 11 (37 percent), and 4 others (13 percent) had newly positive tuberculin skin tests. Of 28 staff members with possible exposure, at least 6 had positive tuberculin-test reactions, but none had tuberculosis.
Newly acquired tuberculous infection in HIV-infected patients can spread readily and progress rapidly to active disease. There should be heightened surveillance for tuberculosis in facilities where HIV-infected persons live, and investigation of contacts must be undertaken promptly and be focused more broadly than is usual.
结核病通常由潜伏感染的重新激活引起。临床结核病也可能源于原发性感染，而这在感染人类免疫缺陷病毒（HIV）的人群中被认为更有可能发生。然而，这两种致病机制在该人群中的相对重要性尚不清楚。
在1990年12月至1991年4月期间，一家收治HIV感染者的住房设施中有12名居民被诊断患有结核病。在之前的六个月里，有两名正在接受结核病治疗的患者被收治到该设施。我们使用标准程序并通过限制性片段长度多态性（RFLP）分析培养的生物体来调查此次疫情爆发。
从所有11名培养阳性居民中分离出的生物体具有相似的RFLP模式，而从之前六个月接受结核病治疗的2名患者中分离出的菌株不同。这表明12名结核病患者中的首例是此次疫情爆发的源头。在30名可能接触感染的居民中，11人（37%）患上了活动性结核病，另外4人（13%）结核菌素皮肤试验新转为阳性。在28名可能接触过的工作人员中，至少6人结核菌素试验反应呈阳性，但无人患结核病。
HIV感染患者新获得的结核感染很容易传播，并迅速发展为活动性疾病。对于HIV感染者居住的设施，应加强对结核病的监测，并且必须迅速对接触者进行调查，而且调查范围应比通常情况更广泛。
