| Autor: |
Bifani, Pablo J., Mathema, Barun, Liu, Zhiyuan, Moghazeh, Soraya L., Shopsin, Bo, Tempalski, Barbara, Driscoll, Jeffrey, Frothingham, Richard, Musser, James M., Alcabes, Philip, Kreiswirth, Barry N., Bifani, P J, Mathema, B, Liu, Z, Moghazeh, S L, Shopsin, B, Tempalski, B, Driscol, J, Frothingham, R, Musser, J M |
| Předmět: |
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| Zdroj: |
JAMA: Journal of the American Medical Association; 12/22/99, Vol. 282 Issue 24, p2321-2327, 7p, 2 Charts, 1 Graph, 1 Map |
| Abstrakt: |
Context: Typing of Mycobacterium tuberculosis could provide a more sensitive means of identifying outbreaks than use of conventional surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey.Objective: To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance data.Design: Population-based cross-sectional study.Setting and Subjects: All incident culture-positive tuberculosis cases reported in New Jersey from January 1996 to September 1998, for which the W family was defined by insertion sequence (IS) IS6110 DNA fingerprinting, polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping (spoligotyping), and variable number tandem repeat (VNTR) analysis.Main Outcome Measure: Identification and characterization of W family clones supplemented by surveillance data.Results: Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged to the W family based on IS6110 and spoligotype hybridization patterns. The IS6110 hybridization patterns or fingerprints revealed that43 patients (designated group A) shared a unique banding motif not present in other W family isolates. Strains collected from the remaining 25 patients (designated group B), while related to W, displayed a variety of IS6110 patterns and did not share this motif. The PGRS and VNTR typing confirmed the division of the W family into groups A and B and again showed group A strains to be closely related and group B strains to be more diverse. The demographic characteristics of individuals from groups A and B were specific and defined. Group A patients were more likely than group B patients to be US born (91 % vs 24%, P<.001), black (76% vs 16%, P<.001), human immunodeficiency virus positive (40% vs 0%, P = .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born, of Asian descent, and more dispersed throughout New Jersey. No outbreak had been detected using conventional surveillance alone.Conclusions: The implementation of multiple molecular techniques in conjunction with surveillance data enabled us to identify a previously undetected outbreak in a defined geographical setting. The outbreak isolates comprise members of a distinct branch of the W family phylogenetic lineage. The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigations. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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