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Dirlikov E, Thomas D, Yost D, Tejada-Vera B, Bermudez M, Joglar O, Chorba T. Tuberculosis Surveillance and Control, Puerto Rico, 1898-2015. Emerg Infect Dis 2019; 25:538-546. [PMID: 37933081 PMCID: PMC6390739 DOI: 10.3201/eid2503.181157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The World Health Organization recognizes Puerto Rico as an area of low tuberculosis (TB) incidence, where TB elimination is possible by 2035. To describe the current low incidence of reported cases, provide key lessons learned, and detect areas that may affect progress, we systematically reviewed the literature about the history of TB surveillance and control in Puerto Rico and supplemented this information with additional references and epidemiologic data. We reviewed 3 periods: 1898-1946 (public health efforts before the advent of TB chemotherapy); 1947-1992 (control and surveillance after the introduction of TB chemotherapy); and 1993-2015 (expanded TB control and surveillance). Although sustained surveillance, continued care, and use of newly developed strategies occurred concomitantly with decreased incidence of reported TB cases and mortality rates, factors that may affect progress remain poorly understood and include potential delayed diagnosis and underreporting, the effects of government debt and Hurricane Maria, and poverty.
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Affiliation(s)
| | | | - David Yost
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dirlikov, D. Thomas, D. Yost, O. Joglar, T. Chorba)
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA (D. Thomas, D. Yost)
- National Center for Health Statistics, Hyattsville, Maryland, USA (B. Tejada-Vera)
- Puerto Rico Department of Health, San Juan, Puerto Rico (M. Bermudez, O. Joglar)
| | - Betzaida Tejada-Vera
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dirlikov, D. Thomas, D. Yost, O. Joglar, T. Chorba)
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA (D. Thomas, D. Yost)
- National Center for Health Statistics, Hyattsville, Maryland, USA (B. Tejada-Vera)
- Puerto Rico Department of Health, San Juan, Puerto Rico (M. Bermudez, O. Joglar)
| | - Maria Bermudez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dirlikov, D. Thomas, D. Yost, O. Joglar, T. Chorba)
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA (D. Thomas, D. Yost)
- National Center for Health Statistics, Hyattsville, Maryland, USA (B. Tejada-Vera)
- Puerto Rico Department of Health, San Juan, Puerto Rico (M. Bermudez, O. Joglar)
| | - Olga Joglar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dirlikov, D. Thomas, D. Yost, O. Joglar, T. Chorba)
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA (D. Thomas, D. Yost)
- National Center for Health Statistics, Hyattsville, Maryland, USA (B. Tejada-Vera)
- Puerto Rico Department of Health, San Juan, Puerto Rico (M. Bermudez, O. Joglar)
| | - Terence Chorba
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Dirlikov, D. Thomas, D. Yost, O. Joglar, T. Chorba)
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA (D. Thomas, D. Yost)
- National Center for Health Statistics, Hyattsville, Maryland, USA (B. Tejada-Vera)
- Puerto Rico Department of Health, San Juan, Puerto Rico (M. Bermudez, O. Joglar)
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Séraphin MN, Didelot X, Nolan DJ, May JR, Khan MSR, Murray ER, Salemi M, Morris JG, Lauzardo M. Genomic Investigation of a Mycobacterium tuberculosis Outbreak Involving Prison and Community Cases in Florida, United States. Am J Trop Med Hyg 2018; 99:867-874. [PMID: 29987998 PMCID: PMC6159577 DOI: 10.4269/ajtmh.17-0700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 05/18/2018] [Indexed: 01/10/2023] Open
Abstract
We used whole-genome sequencing to investigate a tuberculosis outbreak involving U.S.-born persons in the prison system and both U.S.- and foreign-born persons in the community in Florida over a 7-year period (2009-2015). Genotyping by spacer oligonucleotide typing and 24-locus mycobacterial interspersed repetitive unit-variable number tandem repeat suggested that the outbreak might be clonal in origin. However, contact tracing could not link the two populations. Through a multidisciplinary approach, we showed that the cluster involved distinct bacterial transmission networks segregated by country of birth. The source strain is of foreign origin and circulated in the local Florida community for more than 20 years before introduction into the prison system. We also identified novel transmission links involving foreign and U.S.-born cases not discovered during contact investigation. Our data highlight the potential for spread of strains originating from outside the United States into U.S. "high-risk" populations, such as prisoners, with subsequent movement back to the general community.
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Affiliation(s)
- Marie Nancy Séraphin
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Xavier Didelot
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - David J. Nolan
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
- Bioinfoexperts, LLC, Thibodaux, Louisiana
| | - Justin R. May
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Md Siddiqur Rahman Khan
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Ellen R. Murray
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - J. Glenn Morris
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
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France AM, Grant J, Kammerer JS, Navin TR. A field-validated approach using surveillance and genotyping data to estimate tuberculosis attributable to recent transmission in the United States. Am J Epidemiol 2015; 182:799-807. [PMID: 26464470 DOI: 10.1093/aje/kwv121] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/27/2015] [Indexed: 01/20/2023] Open
Abstract
Tuberculosis genotyping data are frequently used to estimate the proportion of tuberculosis cases in a population that are attributable to recent transmission (RT). Multiple factors influence genotype-based estimates of RT and limit the comparison of estimates over time and across geographic units. Additionally, methods used for these estimates have not been validated against field-based epidemiologic assessments of RT. Here we describe a novel genotype-based approach to estimation of RT based on the identification of plausible-source cases, which facilitates systematic comparisons over time and across geographic areas. We compared this and other genotype-based RT estimation approaches with the gold standard of field-based assessment of RT based on epidemiologic investigation in Arkansas, Maryland, and Massachusetts during 1996-2000. We calculated the sensitivity and specificity of each approach for epidemiologic evidence of RT and calculated the accuracy of each approach across a range of hypothetical RT prevalence rates plausible for the United States. The sensitivity, specificity, and accuracy of genotype-based RT estimates varied by approach. At an RT prevalence of 10%, accuracy ranged from 88.5% for state-based clustering to 94.4% with our novel approach. Our novel, field-validated approach allows for systematic assessments over time and across public health jurisdictions of varying geographic size, with an established level of accuracy.
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4
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Is the Beijing strain of Mycobacterium tuberculosis associated with cavitary lung disease? INFECTION GENETICS AND EVOLUTION 2015; 33:1-5. [PMID: 25891279 DOI: 10.1016/j.meegid.2015.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 11/24/2022]
Abstract
We conducted a cross-sectional study to describe clinical characteristics of patients with pulmonary tuberculosis with and without evidence of pulmonary cavitation on chest radiography and assess whether cavitation is associated with infection with Mycobacterium tuberculosis Beijing strain. Cases were selected from the Tuberculosis Registry (January 1, 2008-November 1, 2011) of the Florida Department of Health (FDOH). Molecular characterization was performed by spoligotyping and MIRU-VNTR. We analyzed 975 cases, where 144 (14.8%) were infected with the Beijing strain. Cavitation was not associated with disease caused by the Beijing strain. Alcohol use (OR = 1.7; 95%CI: 1.249-2.313) was associated with increased risk of cavitation in the unadjusted analyses. Multivariable analyses showed that older age (⩾ 65 years) (OR = 0.5; 95%CI: 0.233-0.871), Hispanic ethnicity (OR = 0.6; 95%CI: 0.312-0.962), and co-infection with HIV (OR = 0.1; 95%CI: 0.068-0.295) demonstrated protective effects to cavitation. Understanding the factors associated with cavitation among pulmonary cases is essential toward improved tuberculosis management and control.
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Moonan PK, Quitugua TN, Pogoda JM, Woo G, Drewyer G, Sahbazian B, Dunbar D, Jost KC, Wallace C, Weis SE. Does directly observed therapy (DOT) reduce drug resistant tuberculosis? BMC Public Health 2011; 11:19. [PMID: 21214913 PMCID: PMC3032680 DOI: 10.1186/1471-2458-11-19] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 01/07/2011] [Indexed: 11/29/2022] Open
Abstract
Background Directly observed therapy (DOT) is a widely recommended and promoted strategy to manage tuberculosis (TB), however, there is still disagreement about the role of DOT in TB control and the impact it has on reducing the acquisition and transmission of drug resistant TB. This study compares the portion of drug resistant genotype clusters, representing recent transmission, within and between communities implementing programs differing only in their directly observed therapy (DOT) practices. Methods Genotype clusters were defined as 2 or more patient members with matching IS6110 restriction fragment length polymorphism (RFLP) and spoligotype patterns from all culture-positive tuberculosis cases diagnosed between January 1, 1995 and December 31, 2001. Logistic regression was used to compute maximum-likelihood estimates of odds ratios (ORs) and 95% confidence intervals (CIs) comparing cluster members with and without drug resistant isolates. In the universal DOT county, all patients received doses under direct observation of health department staff; whereas in selective DOT county, the majority of received patients doses under direct observation of health department staff, while some were able to self-administer doses. Results Isolates from 1,706 persons collected during 1,721 episodes of tuberculosis were genotyped. Cluster members from the selective DOT county were more than twice as likely than cluster members from the universal DOT county to have at least one isolate resistant to isoniazid, rifampin, and/or ethambutol (OR = 2.3, 95% CI: 1.7, 3.1). Selective DOT county isolates were nearly 5 times more likely than universal DOT county isolates to belong to clusters with at least 2 resistant isolates having identical resistance patterns (OR = 4.7, 95% CI: 2.9, 7.6). Conclusions Universal DOT for tuberculosis is associated with a decrease in the acquisition and transmission of resistant tuberculosis.
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Affiliation(s)
- Patrick K Moonan
- University of North Texas Health Science Center at Fort Worth, Department of Medicine, USA
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6
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Viader-Salvadó JM, Flores-Gracia J, Vega-Alonso AS, Treviño-Alvarado VM, Molina-Torres CA, Vera-Cabrera L, Guerrero-Olazarán M. Simplified amplified-fragment length polymorphism method for genotyping Mycobacterium tuberculosis isolates. J Microbiol Methods 2009; 78:331-8. [DOI: 10.1016/j.mimet.2009.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/14/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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Guernier V, Sola C, Brudey K, Guégan JF, Rastogi N. Use of cluster-graphs from spoligotyping data to study genotype similarities and a comparison of three indices to quantify recent tuberculosis transmission among culture positive cases in French Guiana during a eight year period. BMC Infect Dis 2008; 8:46. [PMID: 18410681 PMCID: PMC2375894 DOI: 10.1186/1471-2334-8-46] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 04/14/2008] [Indexed: 11/30/2022] Open
Abstract
Background French Guiana has the highest tuberculosis (TB) burden among all French departments, with a strong increase in the TB incidence over the last few years. It is now uncertain how best to explain this incidence. The objective of this study was to compare three different methods evaluating the extent of recent TB transmission in French Guiana. Methods We conducted a population-based molecular epidemiology study of tuberculosis in French Guiana based on culture-positive TB strains (1996 to 2003, n = 344) to define molecular relatedness between isolates, i.e. potential transmission events. Phylogenetic relationships were inferred by comparing two methods: a "cluster-graph" method based on spoligotyping results, and a minimum spanning tree method based on both spoligotyping and variable number of tandem DNA repeats (VNTR). Furthermore, three indices attempting to reflect the extent of recent TB transmission (RTIn, RTIn-1 and TMI) were compared. Results Molecular analyses showed a total amount of 120 different spoligotyping patterns and 273 clinical isolates (79.4%) that were grouped in 49 clusters. The comparison of spoligotypes from French Guiana with an international spoligotype database (SpolDB4) showed that the majority of isolates belonged to major clades of M. tuberculosis (Haarlem, 22.6%; Latin American-Mediterranean, 23.3%; and T, 32.6%). Indices designed to quantify transmission of tuberculosis gave the following values: RTIn = 0.794, RTIn-1 = 0.651, and TMI = 0.146. Conclusion Our data showed a high number of Mycobacterium tuberculosis clusters, suggesting a high level of recent TB transmission, nonetheless an estimation of transmission rate taking into account cluster size and mutation rate of genetic markers showed a low ongoing transmission rate (14.6%). Our results indicate an endemic mode of TB transmission in French Guiana, with both resurgence of old spatially restricted genotypes, and a significant importation of new TB genotypes by migration of TB infected persons from neighgouring high-incidence countries.
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Affiliation(s)
- Vanina Guernier
- UMR 2724 IRD-CNRS, Génétique et Evolution des Maladies Infectieuses, Equipe Dynamique des Systèmes & Maladies Infectieuses, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 05, France.
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Oppong JR, Denton CJ, Moonan PK, Weis SE. Foreign-Born Status and Geographic Patterns of Tuberculosis Genotypes in Tarrant County, Texas. THE PROFESSIONAL GEOGRAPHER : THE JOURNAL OF THE ASSOCIATION OF AMERICAN GEOGRAPHERS 2007; 59:478-491. [PMID: 26504253 PMCID: PMC4618290 DOI: 10.1111/j.1467-9272.2007.00636.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Regardless of destination, immigrants arrive with health profiles typical of people in their previous surroundings. Thus, immigrants change the epidemiological profile of destination communities, and immigrant neighborhoods may represent islands of infectious disease. Genotyping has emerged as a useful surveillance tool to track the spread of disease at the molecular level. Yet the spatial distribution of infectious disease at the molecular level associated with migration and immigrant neighborhoods has received little attention. Using molecular genotyping to characterize M. tuberculosis isolated from tuberculosis cases, this article analyzes spatial variations of unique molecular M. tuberculosis strains by zip code in Tarrant County, Texas. The results suggest that immigrant neighborhoods have higher rates of unique isolates of tuberculosis (suggestive of remote transmission) compared to neighborhoods occupied by the native-born. Neighborhoods dominated by the native-born have higher rates of clustered isolates (suggestive of recent transmission). Therefore, in addition to being culturally distinct, immigrant neighborhoods may also be pathogenically distinct from surrounding neighborhoods.
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Affiliation(s)
| | | | - Patrick K Moonan
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination; School of Public Health, University of North Texas Health Science Center of Fort Worth
| | - Stephen E Weis
- Department of Medicine, University of North Texas Health Science Center at Fort Worth; Tarrant County Public Health Department, Fort Worth; Bureau of Tuberculosis Elimination, Texas Department of Health and Human Services, Austin
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9
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Jain R, Schriever CA, Danziger LH, Cho SH, Rubinstein I. The IS6110 repetitive DNA element of Mycobacterium tuberculosis is not detected in exhaled breath condensate of patients with active pulmonary tuberculosis. Respiration 2007; 74:329-33. [PMID: 17534131 DOI: 10.1159/000101786] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 01/25/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A large tertiary referral hospital in inner-city Chicago. OBJECTIVES To determine whether the IS6110 repetitive DNA element of Mycobacterium tuberculosis is detected in exhaled breath condensate of patients with newly diagnosed active pulmonary tuberculosis. METHODS Ten hospitalized patients with positive Ziehl-Neelson-stained sputum smears were studied. Concurrent sputum cultures for mycobacteria were performed as well. Exhaled breath condensate was collected from each patient within 6 days of initiating antituberculosis chemotherapy (median 1.5 days). These samples were analyzed by polymerase chain reaction (PCR) using primers designed to amplify the IS6110 DNA fragment of M. tuberculosis. Exogenous M. tuberculosis DNA was added to exhaled breath condensate samples to detect PCR inhibitors. Concurrent cultures of exhaled breath condensate for mycobacteria were performed. RESULTS M. tuberculosis was identified in 9 of 10 sputum cultures. One isolate was identified as Mycobacterium kansasii. The IS6110 repetitive DNA element of M. tuberculosis was not detected in any of the 10 exhaled breath condensate samples. Exogenous M. tuberculosis DNA added to these samples elicited the characteristic band pattern of M. tuberculosis on agarose gel electrophoresis. No PCR inhibitors were detected. Cultures of exhaled breath condensate showed no growth of mycobacteria. CONCLUSIONS The IS6110 repetitive DNA element of M. tuberculosis is not detected in exhaled breath condensate of patients with newly diagnosed active pulmonary tuberculosis.
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Affiliation(s)
- Rupali Jain
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612-4325, USA
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10
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Bakowska-Zywicka K, Twardowski T. Correlation of the structure and conformational changes of selected fragments of plant small ribosomal RNA within the steps of polypeptide chain elongation. Emerg Infect Dis 2007; 164:496-504. [PMID: 16704887 DOI: 10.3201/eid1204.050264] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 03/07/2006] [Indexed: 05/09/2023] Open
Abstract
The interaction and conformational relationships between rRNAs and ribosomal proteins are responsible for ribosome activity. We tested seven different deoxyoligonucleotides complementary to the selected, highly conserved sequences of 18S rRNAs important in protein biosynthesis. We carried out a reaction of binding Phe-tRNA to A site on the ribosomes converted either to pre- or to post-translocational states (with or without pre-hybridized oligonucleotides). We found a correlation between the level of oligomer hybridization and the inhibition of AA-tRNA binding. We observed well-defined structural changes of ribosome's conformation during different steps of the elongation cycle of protein biosynthesis.
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MESH Headings
- Base Sequence
- Lupinus/genetics
- Lupinus/metabolism
- Models, Molecular
- Nucleic Acid Conformation
- Peptide Chain Elongation, Translational
- RNA, Plant/chemistry
- RNA, Plant/genetics
- RNA, Plant/metabolism
- RNA, Ribosomal, 18S/chemistry
- RNA, Ribosomal, 18S/genetics
- RNA, Ribosomal, 18S/metabolism
- RNA, Transfer, Phe/metabolism
- Ribosomes/chemistry
- Ribosomes/metabolism
- Glycine max/genetics
- Glycine max/metabolism
- Thermodynamics
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Affiliation(s)
- Kamilla Bakowska-Zywicka
- Insitute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
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Lutze-Wallace C, Turcotte C, Glover G, Cousins D, Bell J, Berlie-Surujballi G, Barbeau Y, Randall G. Isolation of a Mycobacterium microti-like organism from a rock hyrax (Procavia capensis) in a Canadian zoo. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2006; 47:1011-3. [PMID: 17078252 PMCID: PMC1571125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A Mycobacterium tuberculosis complex organism was isolated from a zoo resident rock hyrax (Procavia capensis) imported into Canada from South Africa. The strain was identified biochemically as Mycobacterium microti. The spoligotype pattern obtained for this isolate was found to be rare. This represents the first report of isolation and spoligotyping of M. microti in North America.
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Affiliation(s)
- Cyril Lutze-Wallace
- Canadian Food Inspection Agency, Mycobacterial Diseases Centre of Expertise, Ottawa Laboratory Fallowfield, 3851 Fallowfield Road, Ottawa, Ontario.
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12
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Clark CM, Driver CR, Munsiff SS, Driscoll JR, Kreiswirth BN, Zhao B, Ebrahimzadeh A, Salfinger M, Piatek AS, Abdelwahab J. Universal genotyping in tuberculosis control program, New York City, 2001-2003. Emerg Infect Dis 2006; 12:719-24. [PMID: 16704826 PMCID: PMC3374450 DOI: 10.3201/eid1205.050446] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Real-time universal genotyping decreased unnecessary treatment. In 2001, New York City implemented genotyping to its tuberculosis (TB) control activities by using IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping to type isolates from culture-positive TB patients. Results are used to identify previously unknown links among genotypically clustered patients, unidentified sites of transmission, and potential false-positive cultures. From 2001 to 2003, spoligotype and IS6110-based RFLP results were obtained for 90.7% of eligible and 93.7% of submitted isolates. Fifty-nine (2.4%) of 2,437 patient isolates had false-positive culture results, and 205 genotype clusters were identified, with 2–81 cases per cluster. Cluster investigations yielded 57 additional links and 17 additional sites of transmission. Four additional TB cases were identified as a result of case finding initiated through cluster investigations. Length of unnecessary treatment decreased among patients with false-positive cultures.
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Affiliation(s)
- Carla M Clark
- Tuberculosis Control Program, New York City Department of Health and Mental Hygiene, 225 Broadway, New York, NY 10007, USA.
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13
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Yokoyama E, Kishida K, Uchimura M, Ichinohe S. Comparison between agarose gel electrophoresis and capillary electrophoresis for variable numbers of tandem repeat typing of Mycobacterium tuberculosis. J Microbiol Methods 2006; 65:425-31. [PMID: 16219376 DOI: 10.1016/j.mimet.2005.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 08/25/2005] [Accepted: 08/31/2005] [Indexed: 11/30/2022]
Abstract
Variable numbers of tandem repeat (VNTR) typing of Mycobacterium tuberculosis was performed on 54 strains including 23 strains derived from 9 outbreaks. PCR amplicon sizes of 12 mycobacterial interspersed repetitive unit tandem repeat loci were measured using both agarose gel electrophoresis and capillary electrophoresis. Similarities using agarose gel electrophoresis of Euclidian distances among the 23 strains derived from the 9 outbreaks were significantly lower than that using capillary electrophoresis (Wilcoxon signed ranks test, P < 0.01). By clustering analysis using unweighted pair group method using arithmetic averages, all of the 23 strains derived from the 9 outbreaks were each clustered with more than 90% similarities based on the distance using capillary electrophoresis. In contrast, differential clusters with more than 90% similarity were observed with only 7 strains derived from 3 outbreaks when analyzed by agarose gel electrophoresis. These results indicated that measurement of PCR amplicon size of tandem repeat loci should be carried out using capillary electrophoresis and that agarose gel electrophoresis is not suitable for clustering analysis of M. tuberculosis VNTR typing.
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Affiliation(s)
- Eiji Yokoyama
- Division of Bacteriology, Chiba Prefectural Institute of Public Health, Chuo, Japan.
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14
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Torgersen J, Dorman SE, Baruch N, Hooper N, Cronin W. Molecular epidemiology of pleural and other extrapulmonary tuberculosis: a Maryland state review. Clin Infect Dis 2006; 42:1375-82. [PMID: 16619148 DOI: 10.1086/503421] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Accepted: 01/21/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Limited information exists about the current epidemiological characteristics of extrapulmonary tuberculosis. However, pleural tuberculosis is usually considered to be a manifestation of primary tuberculosis. Our objective was to use molecular epidemiological techniques to describe the occurrence of pleural and other extrapulmonary tuberculosis in Maryland, a state with moderate tuberculosis incidence. METHODS We surveyed tuberculosis cases reported with a single site of disease in Maryland from 1996 through 2001. Genotyping of Mycobacterium tuberculosis isolates was performed with an IS6110-based restriction fragment-length polymorphism analysis. DNA clustering of strains with >5 IS6110 bands, with supporting epidemiologic information on patients, served as a proxy for recent transmission. RESULTS A total of 1811 patients with tuberculosis were reported (incidence, 5.9 cases per 100,000 population). Of 1411 patients (77.9%) with cultures positive for M. tuberculosis, 1246 (88.3%) had a single site of disease, with 934 (75.0%) of these isolates having >5 IS6110 bands. Of the 934 patients included in the analyses, 729 (78.0%) had pulmonary tuberculosis, and 205 (22.0%) had extrapulmonary tuberculosis; of the latter group, 46 patients had pleural disease, and 159 patients had nonrespiratory disease. In multivariate analyses, patients with pleural tuberculosis were not significantly associated with clustered strains, compared with patients with nonrespiratory or pulmonary tuberculosis disease. Having a DNA-clustered strain was negatively associated with nonrespiratory tuberculosis, compared with pulmonary disease (adjusted odds ratio, 0.48; P = .003). CONCLUSIONS Nonrespiratory extrapulmonary tuberculosis is less likely than pulmonary tuberculosis to be a result of recent infection. Pleural tuberculosis is not an appropriate indicator for recent transmission among our population.
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Affiliation(s)
- Jessie Torgersen
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland 21201, USA
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15
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Liu W, Fontanet A, Zhang PH, Zhan L, Xin ZT, Tang F, Baril L, Cao WC. Pulmonary tuberculosis and SARS, China. Emerg Infect Dis 2006; 12:707-9. [PMID: 16715587 PMCID: PMC3294680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Affiliation(s)
- Wei Liu
- Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | | | - Pan-He Zhang
- Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Lin Zhan
- Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Zhong-Tao Xin
- Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Fang Tang
- Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | | | - Wu-Chun Cao
- Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
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16
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Prodinger WM, Brandstätter A, Naumann L, Pacciarini M, Kubica T, Boschiroli ML, Aranaz A, Nagy G, Cvetnic Z, Ocepek M, Skrypnyk A, Erler W, Niemann S, Pavlik I, Moser I. Characterization of Mycobacterium caprae isolates from Europe by mycobacterial interspersed repetitive unit genotyping. J Clin Microbiol 2005; 43:4984-92. [PMID: 16207952 PMCID: PMC1248478 DOI: 10.1128/jcm.43.10.4984-4992.2005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium caprae, a recently defined member of the Mycobacterium tuberculosis complex, causes tuberculosis among animals and, to a limited extent, in humans in several European countries. To characterize M. caprae in comparison with other Mycobacterium tuberculosis complex members and to evaluate genotyping methods for this species, we analyzed 232 M. caprae isolates by mycobacterial interspersed repetitive unit (MIRU) genotyping and by spoligotyping. The isolates originated from 128 distinct epidemiological settings in 10 countries, spanning a period of 25 years. We found 78 different MIRU patterns (53 unique types and 25 clusters with group sizes from 2 to 9) but only 17 spoligotypes, giving Hunter-Gaston discriminatory indices of 0.941 (MIRU typing) and 0.665 (spoligotyping). For a subset of 103 M. caprae isolates derived from outbreaks or endemic foci, MIRU genotyping and IS 6110 restriction fragment length polymorphism were compared and shown to provide similar results. MIRU loci 4, 26, and 31 were most discriminant in M. caprae, followed by loci 10 and 16, a combination which is different than those reported to discriminate M. bovis best. M. caprae MIRU patterns together with published data were used for phylogenetic inference analysis employing the neighbor-joining method. M. caprae isolates were grouped together, closely related to the branches of classical M. bovis, M. pinnipedii, M. microti, and ancestral M. tuberculosis, but apart from modern M. tuberculosis. The analysis did not reflect geographic patterns indicative of origin or spread of M. caprae. Altogether, our data confirm M. caprae as a distinct phylogenetic lineage within the Mycobacterium tuberculosis complex.
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Affiliation(s)
- Wolfgang M Prodinger
- Department of Hygiene, Microbiology, and Social Medicine, Innsbruck Medical University, Fritz Pregl-Strasse 3, A-6020 Innsbruck, Austria.
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17
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García-Pachón E, Rodríguez J. Epidemiología molecular de la tuberculosis: principales hallazgos y su aplicación en España. Arch Bronconeumol 2005. [DOI: 10.1157/13081251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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García-Pachón E, Rodríguez JC. Molecular Epidemiology of Tuberculosis: Main Findings and Their Application in Spain. ACTA ACUST UNITED AC 2005; 41:618-24. [PMID: 16324601 DOI: 10.1016/s1579-2129(06)60296-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- E García-Pachón
- Sección de Neumología, Hospital General Universitario, Elche, Alicante, Spain.
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19
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Cowan LS, Diem L, Monson T, Wand P, Temporado D, Oemig TV, Crawford JT. Evaluation of a two-step approach for large-scale, prospective genotyping of Mycobacterium tuberculosis isolates in the United States. J Clin Microbiol 2005; 43:688-95. [PMID: 15695665 PMCID: PMC548083 DOI: 10.1128/jcm.43.2.688-695.2005] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Genotyping of Mycobacterium tuberculosis isolates is useful in tuberculosis control for confirming suspected transmission links, identifying unsuspected transmission, and detecting or confirming possible false-positive cultures. The value is greatly increased by reducing the turnaround time from positive culture to genotyping result and by increasing the proportion of cases for which results are available. Although IS6110 fingerprinting provides the highest discrimination, amplification-based methods allow rapid, high-throughput processing and yield digital results that can be readily analyzed and thus are better suited for large-scale genotyping. M. tuberculosis isolates (n = 259) representing 99% of culture-positive cases of tuberculosis diagnosed in Wisconsin in the years 2000 to 2003 were genotyped by using spoligotyping, mycobacterial interspersed repetitive unit (MIRU) typing, and IS6110 fingerprinting. Spoligotyping clustered 64.1% of the isolates, MIRU typing clustered 46.7% of the isolates, and IS6110 fingerprinting clustered 29.7% of the isolates. The combination of spoligotyping and MIRU typing yielded 184 unique isolates and 26 clusters containing 75 isolates (29.0%). The addition of IS6110 fingerprinting reduced the number of clustered isolates to 30 (11.6%) if an exact pattern match was required or to 44 (17.0%) if the definition of a matching IS6110 fingerprint was expanded to include patterns that differed by the addition of a single band. Regardless of the genotyping method chosen, the addition of a second or third method decreased clustering. Our results indicate that using spoligotyping and MIRU typing together provides adequate discrimination in most cases. IS6110 fingerprinting can then be used as a secondary typing method to type the clustered isolates when additional discrimination is needed.
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Affiliation(s)
- Lauren S Cowan
- Division of TB Elimination, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Abstract
After decades of decline, an unprecedented resurgence in tuberculosis occurred in the late 1980s and early 1990s. Deterioration of tuberculosis program infrastructure, the HIV/AIDS epidemic, drug-resistant tuberculosis, and tuberculosis among foreign-born persons contributed to the resurgence. Since then, tuberculosis case numbers have declined, but the decline in 2003 was the smallest since the resurgence. Key challenges remain, and efforts must focus on identifying and targeting interventions for high-risk populations, active involvement in the global effort against tuberculosis, developing new tools, and maintaining adequate resources.
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Affiliation(s)
- Eileen Schneider
- Division of Tuberculosis and Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-10, Atlanta, GA 30333, USA.
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21
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Lutze-Wallace C, Turcotte C, Sabourin M, Berlie-Surujballi G, Barbeau Y, Watchorn D, Bell J. Spoligotyping of Mycobacterium bovis isolates found in Manitoba. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2005; 69:143-5. [PMID: 15971679 PMCID: PMC1142182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Spoligotyping was applied to 44 isolates of Mycobacterium bovis obtained from the Canadian province of Manitoba. Isolates were obtained from submissions of elk (n = 16), deer (n = 1), and cattle (n = 27) tissues spanning the period of 1990 to early 2003. Two spoligotype profiles were obtained differing only in the reaction with oligonucleotide number 12. Forty of the 44 isolates (90.9%) hybridized with oligonucleotide 12 (MB-1 type), while the remaining 4 of 44 (9.1%) did not show a signal at position 12 (MB-2 type). Octal codes for these 2 types are 656573377603600 and 656473377603600, respectively. These spoligotypes have not been reported as occurring elsewhere worldwide.
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Affiliation(s)
- Cyril Lutze-Wallace
- Mycobacterial Diseases Centre of Expertise, Canadian Food Inspection Agency, 3851 Fallowfield Road, Ottawa, Ontario.
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22
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Shin SS, Naroditskaya V, Sloutsky A, Werner B, Timperi R, Bayona J, Farmer PE, Becerra MC. rpoBGene Mutations in Clinical Isolates of Multidrug-Resistant Mycobacterium tuberculosisin Northern Lima, Peru. Microb Drug Resist 2005; 11:26-30. [PMID: 15770091 DOI: 10.1089/mdr.2005.11.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In many developing countries and outside hospital settings, the characteristics of endemic Mycobacterium tuberculosis strains resistant to multiple drugs remain unknown. In a community-based referral and therapy program in northern Lima, Peru, beginning in 1996, patients found to be failures on standard regimens were referred for drug-susceptibility testing of their isolates, and those found to be infected with M. tuberculosis isolates resistant to at least rifampin were treated with individualized regimens based on their infecting strains. Isolates from 42 of these patients were subjected to DNA sequencing of the rpoB gene region responsible for rifampin resistance. We determined the frequency of types of mutations in the rpoB gene among these Peruvian isolates.
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Affiliation(s)
- S S Shin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, MA 02120-1613, USA.
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23
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Kammerer JS, McNabb SJN, Becerra JE, Rosenblum L, Shang N, Iademarco MF, Navin TR. Tuberculosis transmission in nontraditional settings: a decision-tree approach. Am J Prev Med 2005; 28:201-7. [PMID: 15710276 DOI: 10.1016/j.amepre.2004.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tuberculosis (TB) transmission in nontraditional settings and relationships (non-TSR) often eludes detection by conventional contact investigation and is increasingly common. The U.S.-based National Tuberculosis Genotyping and Surveillance Network collected epidemiologic data and genotyping results of Mycobacterium tuberculosis isolates from 1996 to 2000. METHODS In 2003-2004, we determined the number and characteristics of TB patients in non-TSR that were involved in recent transmission, generated a decision tree to profile those patients, and performed a case-control study to identify predictors of being in non-TSR. RESULTS Of 10,844 culture-positive reported TB cases that were genotyped, 4724 (43.6%) M. tuberculosis isolates were clustered with at least one other isolate. Among these, 520 (11%) had epidemiologic linkages discovered during conventional contact investigation or cluster investigation and confirmed by genotyping results. The decision tree identified race/ethnicity (non-Hispanic white or black) as having the greatest predictive ability to determine patients in non-TSR, followed by being aged 15 to 24 years and having positive or unknown HIV infection status. From the 520, 85 (16.4%) had non-TSR, and 435 (83.6%) had traditional settings and relationships (TSR). In multivariate analyses, patients in non-TSR were significantly more likely than those in TSR to be non-Hispanic white (adjusted odds ratio [aOR]=6.1; 95% confidence interval [CI]=1.7-21.1]) or to have an M. tuberculosis isolate resistant to rifampin (aOR=5.2; 95% CI=1.5-17.7). CONCLUSIONS Decision-tree analyses can be used to enhance both the efficiency and effectiveness of TB prevention and control activities in identifying patients in non-TSR.
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Affiliation(s)
- J Steve Kammerer
- Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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24
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Moonan PK, Bayona M, Quitugua TN, Oppong J, Dunbar D, Jost KC, Burgess G, Singh KP, Weis SE. Using GIS technology to identify areas of tuberculosis transmission and incidence. Int J Health Geogr 2004; 3:23. [PMID: 15479478 PMCID: PMC529461 DOI: 10.1186/1476-072x-3-23] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 10/13/2004] [Indexed: 12/02/2022] Open
Abstract
Background Currently in the U.S. it is recommended that tuberculosis screening and treatment programs be targeted at high-risk populations. While a strategy of targeted testing and treatment of persons most likely to develop tuberculosis is attractive, it is uncertain how best to accomplish this goal. In this study we seek to identify geographical areas where on-going tuberculosis transmission is occurring by linking Geographic Information Systems (GIS) technology with molecular surveillance. Methods This cross-sectional analysis was performed on data collected on persons newly diagnosed with culture positive tuberculosis at the Tarrant County Health Department (TCHD) between January 1, 1993 and December 31, 2000. Clinical isolates were molecularly characterized using IS6110-based RFLP analysis and spoligotyping methods to identify patients infected with the same strain. Residential addresses at the time of diagnosis of tuberculosis were geocoded and mapped according to strain characterization. Generalized estimating equations (GEE) analysis models were used to identify risk factors involved in clustering. Results Evaluation of the spatial distribution of cases within zip-code boundaries identified distinct areas of geographical distribution of same strain disease. We identified these geographical areas as having increased likelihood of on-going transmission. Based on this evidence we plan to perform geographically based screening and treatment programs. Conclusion Using GIS analysis combined with molecular epidemiological surveillance may be an effective method for identifying instances of local transmission. These methods can be used to enhance targeted screening and control efforts, with the goal of interruption of disease transmission and ultimately incidence reduction.
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Affiliation(s)
- Patrick K Moonan
- Department of Medicine, 3500 Camp Bowie Blvd. University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA
- School of Public Health, 3500 Camp Bowie Blvd. University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA
| | - Manuel Bayona
- School of Public Health, 3500 Camp Bowie Blvd. University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA
| | - Teresa N Quitugua
- Department of Microbiology and Immunology, 15355 Lambda Drive. University of Texas Health Science Center at San Antonio South Texas Center for Biology in Medicine Bldg, Room 2.100.04, San Antonio, TX 78245, USA
| | - Joseph Oppong
- Department of Geography, 1704 W. Mulberry. University of North Texas, P.O. Box 305279 Denton, Texas 76203, USA
| | - Denise Dunbar
- Bureau of Laboratories, Texas Department of Health Austin, Texas 78756, USA
| | - Kenneth C Jost
- Bureau of Laboratories, Texas Department of Health Austin, Texas 78756, USA
| | - Gerry Burgess
- Tarrant County Public Health Department, 1101 S. Main St. Fort Worth, Texas 76104, Suite 1600, USA
| | - Karan P Singh
- School of Public Health, 3500 Camp Bowie Blvd. University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA
| | - Stephen E Weis
- Department of Medicine, 3500 Camp Bowie Blvd. University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA
- School of Public Health, 3500 Camp Bowie Blvd. University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA
- Tarrant County Public Health Department, 1101 S. Main St. Fort Worth, Texas 76104, Suite 1600, USA
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25
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Milan SJ, Hauge KA, Kurepina NE, Lofy KH, Goldberg SV, Narita M, Nolan CM, McElroy PD, Kreiswirth BN, Cangelosi GA. Expanded geographical distribution of the N family of Mycobacterium tuberculosis strains within the United States. J Clin Microbiol 2004; 42:1064-8. [PMID: 15004054 PMCID: PMC356885 DOI: 10.1128/jcm.42.3.1064-1068.2004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The N and W-Beijing families of Mycobacterium tuberculosis are phylogenetically closely related. The ability of the W-Beijing family to rapidly cause widespread disease is well described; however, few outbreaks involving the N family have been reported outside the New York City, N.Y., area. During 2002 to 2003, Seattle, Wash., experienced a rapidly expanding tuberculosis outbreak involving 38 persons in a 23-month period. The outbreak strain, SBRI9, exhibited the genotypic properties of the N family. Its IS6110 restriction fragment length polymorphism pattern was identical or nearly identical to those of two N family strains that were responsible for clusters of tuberculosis cases, including a large nosocomial outbreak, in New York City and New Jersey from 1989 to 1990. It was also identical to strains involved in late 1990s tuberculosis cases in Michigan, Maryland, and Arkansas. Further monitoring of the N family may show that it shares with the W-Beijing family the propensity to spread rapidly, suggesting that this characteristic evolved prior to the divergence of the two genetic lineages.
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Affiliation(s)
- S Joy Milan
- Seattle Biomedical Research Institute, Seattle, Washington 98107-1651, USA
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26
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27
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Malone JL, Ijaz K, Lambert L, Rosencrans L, Phillips L, Tomlinson V, Arbise M, Moolenaar RL, Dworkin MS, Simoes EJ. Investigation of healthcare-associated transmission ofMycobacterium tuberculosis among patients with malignancies at three hospitals and at a residential facility. Cancer 2004; 101:2713-21. [PMID: 15547933 DOI: 10.1002/cncr.20698] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Immunocompromised patients have an increased risk of experiencing progression of latent Mycobacterium tuberculosis infection (LTBI) to active tuberculosis (TB) disease. In January 2002, 2 patients with leukemia (Patients 1 and 2) developed pulmonary TB after recent exposure at 3 hospitals (Hospital A, Hospital B, and Hospital C) and at a residential facility for patients with cancer. Neither was known to have LTBI. Within 1 year, 3 other patients with malignancy and TB disease had been identified at these facilities, prompting an investigation of healthcare facility-associated transmission of M. tuberculosis. METHODS The authors performed genotypic analysis of the five available M. tuberculosis isolates from patients with malignancies at these facilities, reviewed medical records, interviewed individuals who had identical M. tuberculosis genotypic patterns, and performed tuberculin skin testing (TST) and case finding for possible exposed contacts. RESULTS Only Patients 1 and 2 had identical genotypic patterns. Neither patient had baseline TST results available. Patient 1 had clinical evidence of infectiousness 3 months before the diagnosis of TB was ascertained. Among employee contacts of Patient 1, TST conversions occurred in 1 of 59 (2%), 2 of 34 (6%), 2 of 32 (6%), and 0 of 8 who were tested at Hospitals A, B, and C and at the residential facility, respectively. Among the others who were exposed to Patient 1, 1 of 31 (3%), 1 of 30 (3%), 0 of 40 (0%), and 12 of 136 (9%) who were tested had positive TSTs at Hospitals A, B, and C and at the residential facility, respectively. CONCLUSIONS Delayed TB diagnosis in 2 patients with leukemia resulted in the transmission of M. tuberculosis to 19 patients and staff at 3 hospitals and a residential facility. Baseline TB screening and earlier clinical recognition of active disease could reduce healthcare facility-associated transmission of M. tuberculosis among patients with malignancy.
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Affiliation(s)
- Joseph L Malone
- Epidemic Intelligence Service-State Branch, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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28
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Gold BD, Westra SJ, Graeme-Cook FM. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-2003. A 14-month-old boy with recurrent abdominal distention and diarrhea. N Engl J Med 2003; 349:2541-9. [PMID: 14695415 DOI: 10.1056/nejmcpc030030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Abdominal Pain/etiology
- Adult
- Colitis, Ulcerative/complications
- Colitis, Ulcerative/drug therapy
- Diagnosis, Differential
- Diarrhea, Infantile/etiology
- Enterocolitis/complications
- Enterocolitis/microbiology
- Enterocolitis/pathology
- Enterocolitis, Necrotizing/diagnosis
- Female
- Gastrointestinal Diseases/diagnosis
- Humans
- Infant
- Infections/diagnosis
- Infectious Disease Transmission, Vertical
- Intestine, Small/diagnostic imaging
- Intestine, Small/pathology
- Intestine, Small/surgery
- Lung/diagnostic imaging
- Male
- Mycobacterium tuberculosis/isolation & purification
- Sarcoidosis/diagnosis
- Tomography, X-Ray Computed
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/pathology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnostic imaging
- Tuberculosis, Pulmonary/transmission
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29
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Hawkey PM, Smith EG, Evans JT, Monk P, Bryan G, Mohamed HH, Bardhan M, Pugh RN. Mycobacterial interspersed repetitive unit typing of Mycobacterium tuberculosis compared to IS6110-based restriction fragment length polymorphism analysis for investigation of apparently clustered cases of tuberculosis. J Clin Microbiol 2003; 41:3514-20. [PMID: 12904348 PMCID: PMC179797 DOI: 10.1128/jcm.41.8.3514-3520.2003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An evaluation of the utility of IS6110-based restriction fragment length polymorphism (RFLP) typing compared to a combination of variable number tandem repeat (VNTR) typing and mycobacterial interspersed repetitive unit (MIRU) typing was undertaken. A total of 53 patient isolates of Mycobacterium tuberculosis from four presumed episodes of cross-infection were examined. Genomic DNA was extracted from the isolates by a cetyl trimethylammonium bromide method. The number of copies of tandem repeats of the five loci ETR(A) to ETR(E) and 12 MIRU loci was determined by PCR amplification and agarose gel electrophoresis of the amplicons. VNTR typing identified the major clusters of strains in the three investigations in which they occurred (each representing a different evolutionary clade: 32333, 42235, and 32433). The majority of unrelated isolates (by epidemiology and RFLP typing) were also identified by VNTR typing. The concordance between the RFLP and MIRU typing was complete, with the exception of two isolates with RFLP patterns that differed by one band each from the rest of the major epidemiologically linked groups of isolates in investigation A. All of these isolates had identical MIRU and VNTR types. A further pair of isolates differed in the number of tandem repeat copies at two MIRU alleles but had identical RFLP patterns. The speed of the combined VNTR and MIRU typing approach enabled results for some of the investigations to be supplied in "real time," influencing choices in contact tracing. The ease of comparison of results of MIRU and VNTR typing, which are recorded as single multidigit numbers, was also found to greatly facilitate investigation management and the communication of results to health care professionals.
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Affiliation(s)
- Peter M Hawkey
- Public Health Laboratory, Heartlands Hospital, Birmingham B9 5SS, United Kingdom.
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30
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Sun SJ, Bennett DE, Flood J, Loeffler AM, Kammerer S, Ellis BA. Identifying the sources of tuberculosis in young children: a multistate investigation. Emerg Infect Dis 2002; 8:1216-23. [PMID: 12453345 PMCID: PMC2738551 DOI: 10.3201/eid0811.020419] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To better understand the molecular epidemiology of tuberculosis (TB) transmission for culture-confirmed patients <5 years of age, data were analyzed from a population-based study conducted in seven U.S. sites from 1996 to 2000. Mycobacterium tuberculosis isolates were genotyped with IS6110-based restriction fragment length polymorphism analysis and spoligotyping. Case-patient data were obtained from the Centers for Disease Control and Prevention s national tuberculosis registry and health department records. Routine public health investigations conducted by local health departments identified suspected source patients for 57 (51%) of 111 culture-confirmed patients <5 years of age. For 8 (15%) of 52 culture-confirmed patients <5 years of age and their suspected source patients with complete genotyping results, genotypes suggested infection with different TB strains. Potential differences between sources for patients <5 years of age and source patients that transmitted TB to adolescent and adult patients were identified.
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Affiliation(s)
- Sumi J Sun
- California Department of Health Services, Berkley, CA, USA.
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31
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Miller AC, Sharnprapai S, Suruki R, Corkren E, Nardell EA, Driscoll JR, McGarry M, Taber H, Etkind S. Impact of genotyping of Mycobacterium tuberculosis on public health practice in Massachusetts. Emerg Infect Dis 2002; 8:1285-9. [PMID: 12453357 PMCID: PMC2738536 DOI: 10.3201/eid0811.020316] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Massachusetts was one of seven sentinel surveillance sites in the National Tuberculosis Genotyping and Surveillance Network. From 1996 through 2000, isolates from new patients with tuberculosis (TB) underwent genotyping. We describe the impact that genotyping had on public health practice in Massachusetts and some limitations of the technique. Through genotyping, we explored the dynamics of TB outbreaks, investigated laboratory cross-contamination, and identified Mycobacterium tuberculosis strains, transmission sites, and accurate epidemiologic links. Genotyping should be used with epidemiologic follow-up to identify how resources can best be allocated to investigate genotypic findings.
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Affiliation(s)
- Ann C. Miller
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Sharon Sharnprapai
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Robert Suruki
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Edward Corkren
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Edward A. Nardell
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
- Harvard University, Boston, Massachusetts, USA
| | | | | | - Harry Taber
- New York State Department of Health, Albany, New York, USA
| | - Sue Etkind
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
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32
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McNabb SJN, Braden CR, Navin TR. DNA fngerprinting of Mycobacterium tuberculosis: lessons learned and implications for the future. Emerg Infect Dis 2002; 8:1314-9. [PMID: 12453363 PMCID: PMC2738558 DOI: 10.3201/eid0811.020402] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
DNA fingerprinting of Mycobacterium tuberculosis--a relatively new laboratory technique--offers promise as a powerful aid in the prevention and control of tuberculosis (TB). Established in 1996 by the Centers for Disease Control and Prevention (CDC), the National Tuberculosis Genotyping and Surveillance Network was a 5-year prospective, population-based study of DNA fingerprinting conducted from 1996 to 2000. The data from this study suggest multiple molecular epidemiologic and program management uses for DNA fingerprinting in TB public health practice. From these data, we also gain a clearer understanding of the overall diversity of M. tuberculosis strains as well as the presence of endemic strains in the United States. We summarize the key findings and the impact that DNA fingerprinting may have on future approaches to TB control. Although challenges and limitations to the use of DNA fingerprinting exist, the widespread implementation of the technique into routine TB prevention and control practices appears scientifically justified.
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Affiliation(s)
- Scott J N McNabb
- Centers for Disesase Control and Prevention, Atlanta, GA 30333, USA.
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33
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Ellis BA, Crawford JT, Braden CR, McNabb SJN, Moore M, Kammerer S. Molecular epidemiology of tuberculosis in a sentinel surveillance population. Emerg Infect Dis 2002; 8:1197-209. [PMID: 12453343 PMCID: PMC2738559 DOI: 10.3201/eid0811.020403] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a population-based study to assess demographic and risk-factor correlates for the most frequently occurring Mycobacterium tuberculosis genotypes from tuberculosis (TB) patients. The study included all incident, culture-positive TB patients from seven sentinel surveillance sites in the United States from 1996 to 2000. M. tuberculosis isolates were genotyped by IS6110-based restriction fragment length polymorphism and spoligotyping. Genotyping was available for 90% of 11923 TB patients. Overall, 48% of cases had isolates that matched those from another patient, including 64% of U.S.-born and 35% of foreign-born patients. By logistic regression analysis, risk factors for clustering of genotypes were being male, U.S.-born, black, homeless, and infected with HIV; having pulmonary disease with cavitations on chest radiograph and a sputum smear with acid-fast bacilli; and excessive drug or alcohol use. Molecular characterization of TB isolates permitted risk correlates for clusters and specific genotypes to be described and provided information regarding cluster dynamics over time.
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Affiliation(s)
- Barbara A Ellis
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Braden CR, Crawford JT, Schable BA. Quality assessment of Mycobacterium tuberculosis genotyping in a large laboratory network. Emerg Infect Dis 2002; 8:1210-5. [PMID: 12453344 PMCID: PMC2738535 DOI: 10.3201/eid0811.020401] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Quality assessment exercises were conducted to evaluate the reproducibility of IS6110 DNA fingerprinting performed by eight laboratories in the National Tuberculosis Genotyping and Surveillance Network. Three panels, each with 8 to 16 isolates, were typed at all laboratories, resulting in 280 images. When the pattern obtained by the majority for each isolate was used as the standard, exact matches were obtained for 73% of patterns; 90% and 97% of patterns matched within one- and two-band differences, respectively. A second approach involved retyping of randomly selected isolates at the Centers for Disease Control and Prevention. Retyping was done for 8-19 isolates per laboratory (76 total). Paired images matched exactly for 54% of isolates and within one and two band differences, 78% and 93%, respectively. We evaluated reasons for mismatching. We also evaluated the reproducibility of spoligotyping using a test panel of 13 isolates; a discrepancy of 1 in 91 results was noted.
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Bennett DE, Onorato IM, Ellis BA, Crawford JT, Schable B, Byers R, Kammerer JS, Braden CR. DNA fingerprinting of Mycobacterium tuberculosis isolates from epidemiologically linked case pairs. Emerg Infect Dis 2002; 8:1224-9. [PMID: 12453346 PMCID: PMC2738550 DOI: 10.3201/eid0811.020420] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
DNA fingerprinting was used to evaluate epidemiologically linked case pairs found during routine tuberculosis (TB) contact investigations in seven sentinel sites from 1996 to 2000. Transmission was confirmed when the DNA fingerprints of source and secondary cases matched. Of 538 case pairs identified, 156 (29%) did not have matching fingerprints. Case pairs from the same household were no more likely to have confirmed transmission than those linked elsewhere. Case pairs with unconfirmed transmission were more likely to include a smear-negative source case (odds ratio [OR] 2.0) or a foreign-born secondary case (OR 3.4) and less likely to include a secondary case <15 years old (OR 0.3). Our study suggests that contact investigations should focus not only on the household but also on all settings frequented by an index case. Foreign-born persons with TB may have been infected previously in high-prevalence countries; screening and preventive measures recommended by the Institute of Medicine could prevent TB reactivation in these cases.
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Affiliation(s)
- Diane E Bennett
- Centers for Disease control and Prevention, Atlanta, GA 30333, USA.
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Cowan LS, Crawford JT. Genotype analysis of Mycobacterium tuberculosis isolates from a sentinel surveillance population. Emerg Infect Dis 2002; 8:1294-302. [PMID: 12453359 PMCID: PMC2738546 DOI: 10.3201/eid0811.020313] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As part of the National Tuberculosis and Genotyping Surveillance Network, isolates obtained from all new cases of tuberculosis occurring in seven geographically separate surveillance sites from 1996 through 2000 were genotyped. A total of 10883 isolates were fingerprinted by the IS6110-restriction fragment length polymorphism method, yielding 6128 distinct patterns. Low-copy isolates (those with six or fewer bands) were also spoligotyped. The distribution of specific genotype clusters was examined. Databases were also examined for families of related genotypes. Analysis of IS6110 patterns showed 497 patterns related to the W-Beijing family; these patterns represent 946 (9%) of all isolates in the study. Six new sets of related fingerprint patterns were also proposed for isolates containing 6-15 copies of IS6110. These fingerprint sets contain up to 251 patterns and 414 isolates; together, they contain 21% of isolates in this copy number range. These sets of fingerprints may represent endemic strains distributed across the United States.
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Affiliation(s)
- Lauren S. Cowan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jack T. Crawford
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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