Transmission of multidrug-resistant tuberculosis in a large urban setting.

Abstract

Multidrug resistance has become an increasingly important problem in the control and prevention of tuberculosis in large urban centers. Although several small outbreaks of multidrug-resistant (MDR) tuberculosis in New York City have been reported, the increase in the number of cases is not fully explained by these recognized outbreaks, and the modes of transmission have not been clearly delineated. Transmission patterns of MDR tuberculosis in New York City, therefore, were studied by stratifying Mycobacterium tuberculosis isolates from 167 newly diagnosed tuberculosis patients according to their DNA restriction fragment length polymorphisms (RFLP). Forty-three (34%) of 127 drug-susceptible isolates and 19 (79%) of 24 multidrug-resistant isolates had RFLP patterns representing possible recent exogenous infection (primary tuberculosis). Patients who had such isolates were more likely to be seropositive for human immunodeficiency virus (58%; p < 0.05), non-Hispanic black (56%; p < 0.005), U.S.-born (57%; p < 0.001), and have MDR tuberculosis (79%; p < 0.0005). In a logistic regression model, primary tuberculosis remained significantly associated with MDR tuberculosis and black race. In contrast to previous reports, in New York City recent exogenous transmission accounts for most new cases of multidrug-resistant tuberculosis.

Molecular and Conventional Epidemiology of Tuberculosis in Hong Kong: a Population-Based Prospective Study

“…DNA fingerprinting of Mycobacterium tuberculosis has been used in population-based studies to determine the proportion of recently transmitted disease and to assess risk factors associated with recent transmission (1,4,5,6,7,8,10,13,14,17,19,20). These studies were carried out mostly in countries with a low prevalence of tuberculosis (1,4,5,6,7,10,14,17,20), while a few were done in countries with a high prevalence of tuberculosis and human immunodeficiency virus (HIV) infection (13,16,19).…”

The Changing Face of the Epidemiology of Tuberculosis due to Molecular Strain Typing: A Review

“…Importantly, transmission was not limited to these high risk groups as there was a "spill over" to the general population. Other studies on transmission of TB in large urban settings through cluster analysis (Alland et al 1994, Small et al 1994, Friedman et al 1995a, Sepkowitz et al 1995 demonstrated that besides drug resistance, young age, race, social status and being health care worker are risk factors.…”

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

“…19 These also spread by the airborne route. 20 Guidance for how to cure people sick with DR-TB and stop further spread has been available for nearly 20 years. [21][22][23][24] Low and middle income countries bear the greatest burden of TB and DR-TB.…”