Notes from the field: outbreak of tuberculosis associated with a newly identified Mycobacterium tuberculosis genotype--New York City, 2010-2013.

In January 2010, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) identified a tuberculosis (TB) case caused by Mycobacterium tuberculosis with a genotype not reported previously in the United States. The patient was evaluated for TB while incarcerated but was released before the diagnosis was confirmed and before beginning TB treatment. The patient, who had a history of homelessness and clinical characteristics suggesting infectiousness, could not be located by DOHMH for 13 months. Numerous efforts were made to locate the patient, including queries to shelters, jails, and infection-control staff members at local hospitals. The patient was located after he had an abnormal chest radiograph result following referral by a local jail to a hospital emergency department (ED) for symptoms of alcohol withdrawal; he died from complications of liver cirrhosis 5 days later, without having started TB treatment. During February 2012-May 2013, DOHMH identified four additional patients with the same TB genotype. All five patients were U.S.-born black men aged 52-57 years. Four had a history of substance abuse; three had a history of homelessness; and two had a history of incarceration. All patients had drug-susceptible TB and were negative for human immunodeficiency virus. Three patients completed TB treatment. One patient, who was homeless at the time of diagnosis, began TB treatment but was lost to follow-up by DOHMH.