Background The incidence of tuberculosis and drug resistanceis increasing in the United States, but it is not clear howmuch of the increase is due to reactivation of latent infectionand how much to recent transmission.
Methods We performed DNA fingerprinting using restriction-fragment-lengthpolymorphism (RFLP) analysis of at least one isolate from everypatient with confirmed tuberculosis at a major hospital in theBronx, New York, from December 1, 1989, through December 31,1992. Medical records and census-tract data were reviewed forrelevant clinical, social, and demographic data.
Results Of 130 patients with tuberculosis, 104 adults (80 percent)had complete medical records and isolates whose DNA fingerprintscould be evaluated. Isolates from 65 patients (62.5 percent)had unique RFLP patterns, whereas isolates from 39 patients(37.5 percent) had RFLP patterns that were identical to thoseof an isolate from at least 1 other study patient; the isolatesin the latter group were classified into 12 clusters. Patientswhose isolates were included in one of the clusters were inferredto have recently transmitted disease. Independent risk factorsfor having a clustered isolate included seropositivity for thehuman immunodeficiency virus (HIV) (odds ratio for Hispanicpatients, 4.31; P = 0.02; for non-Hispanic patients, 3.12; P= 0.07), Hispanic ethnicity combined with HIV seronegativity(odds ratio, 5.13; P = 0.05), infection with drug-resistanttuberculosis (odds ratio, 4.52; P = 0.005), and younger age(odds ratio, 1.59; P = 0.02). Residence in sections of the Bronxwith a median household income below $20,000 was also associatedwith having a clustered isolate (odds ratio, 3.22; P = 0.04).
Conclusions In the inner-city community we studied, recentlytransmitted tuberculosis accounts for approximately 40 percentof the incident cases and almost two thirds of drug-resistantcases. Recent transmission of tuberculosis, and not only reactivationof latent disease, contributes substantially to the increasein tuberculosis. .
Source Information
From the Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center-North Central Bronx Hospital (D.A., G.E.K.), the Department of Epidemiology and Social Medicine, Montefiore Medical Center (E.D.), and the Department of Microbiology and Immunology and the Howard Hughes Medical Institute (R.A.M., B.R.B.), Albert Einstein College of Medicine, Bronx, N.Y.; the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Division of Epidemiology and Medicine, San Francisco General Hospital, San Francisco (A.R.M., J.A.H.); and the Department of Political Science, Lehman College, City University of New York, Bronx, N.Y. (W.B.).
Address reprint requests to Dr. Alland at the Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, 111 East 210 St., Bronx, NY 10467.
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