Frieden T R, Woodley C L, Crawford J T, Lew D, Dooley S M
National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Tuber Lung Dis. 1996 Oct;77(5):407-13. doi: 10.1016/s0962-8479(96)90112-4.
During the 1980s, New York City experienced a rapid increase of tuberculosis cases, more than 40% of which were human immunodeficiency virus (HIV)-associated.
To better define the molecular epidemiology of tuberculosis in New York City.
We collected an isolate from every patient in New York City with a positive culture for Mycobacterium tuberculosis, including both incident and prevalent cases, in April 1991. Restriction fragment length polymorphism (RFLP) analysis using IS6110 was performed and the clinical, demographic, epidemiologic, and drug susceptibility patterns of patients were correlated with RFLP results.
Of 441 patients, 12 (3%) had laboratory, clinical, and RFLP evidence of falsely positive cultures. The remaining 429 patients had 252 distinct RFLP patterns. Patients with clustered 1-3 band isolates did not share demographic or drug susceptibility patterns. Eliminating these patients from the analysis, 344 patients remained, of whom 126 (37%) belonged to one of 31 clusters ranging in size from 2-17 patients (median cluster size = 3). Clustering was more common among patients with multidrug-resistant isolates (53%), African Americans (44%), and the homeless (49%), but was not associated with HIV infection or acquired immune deficiency syndrome (AIDS), Multidrug-resistance, being African American, and homelessness remained independently associated with clustering in multivariate analysis. Of 79 patients in clusters of > or = 4 patients, 25 (32%) had identifiable epidemiologic linkages; 17 (74%) of these patients, and 6% of all cases, were documented to have been nosocomially associated.
A small but non-negligible proportion (3%) of New York City patients had falsely positive cultures for M. tuberculosis as a result of laboratory error. More than one third of all patients and most patients with multidrug-resistance in April 1991 had clustered RFLP patterns, suggesting recent transmission of M. tuberculosis. Homelessness, multidrug-resistance, and being African American independently increased the risk of clustering. Most of the identified epidemiologic linkages and 6% of all cases resulted from transmission in hospitals.
在20世纪80年代，纽约市结核病病例迅速增加，其中超过40%与人类免疫缺陷病毒（HIV）相关。
更好地界定纽约市结核病的分子流行病学特征。
1991年4月，我们收集了纽约市每例结核分枝杆菌培养阳性患者的分离株，包括新发病例和现患病例。采用IS6110进行限制性片段长度多态性（RFLP）分析，并将患者的临床、人口统计学、流行病学及药物敏感性模式与RFLP结果进行关联分析。
441例患者中，12例（3%）的培养结果存在实验室、临床及RFLP证据证实为假阳性。其余429例患者有252种不同的RFLP模式。1 - 3条带分离株聚集的患者在人口统计学或药物敏感性模式上无共性。排除这些患者后，剩余344例患者，其中126例（37%）属于31个簇之一，簇的大小从2至17例患者不等（簇大小中位数 = 3）。聚集现象在耐多药分离株患者（53%）、非裔美国人（44%）及无家可归者（49%）中更为常见，但与HIV感染或获得性免疫缺陷综合征（AIDS）无关。在多变量分析中，耐多药、非裔美国人身份及无家可归状态仍与聚集独立相关。在≥4例患者的簇中的79例患者中，25例（32%）有可识别的流行病学关联；其中17例（74%）以及所有病例的6%被记录为与医院感染相关。
由于实验室误差，纽约市一小部分但不可忽视比例（3%）的患者结核分枝杆菌培养结果为假阳性。1991年4月，超过三分之一的患者以及大多数耐多药患者具有聚集性RFLP模式，提示结核分枝杆菌近期传播。无家可归状态、耐多药及非裔美国人身份独立增加聚集风险。大多数已识别的流行病学关联以及所有病例的6%是由医院内传播所致。
