title: Temporal trends and transmission patterns during the emergence of multidrug-resistant tuberculosis in New York City: a molecular epidemiologic assessment.
abstract: To ascertain the role of human immunodeficiency virus (HIV) and Mycobacterium tuberculosis transmission on multidrug-resistant (MDR) tuberculosis (TB) emergence in New York City, medical records, drug susceptibilities, and restriction fragment length polymorphisms (RFLPs) of TB cases at a city hospital between two 9-month periods (1987-1988 and 1990-1991) were reviewed. The proportion of TB patients with MDRTB increased from 10% (27/267) to 17% (38/222; P = .03). Among MDRTB patients of known HIV status, the proportion with HIV increased from 16% (3/19) to 58% (22/38; P = .006). HIV-infected MDRTB patients were more likely than the seronegative ones to have initial MDRTB (88% vs. 56%; P = .03). Among 56 MDR cases with RFLP results, 12 had unique patterns; 44 belonged to one of six clusters. During 1990-1991, 27 (75%) of 36 MDRTB patients were infected with strains isolated from HIV-seronegative patients during 1987-1988. The increase in MDRTB caused by transmission from immunocompetent to immunocompromised persons underscores the urgency of TB control in populations with increasing HIV prevalence.
authors.affiliation: Center for AIDS Research, Stanford University, California.
authors.forename: R W
authors.initials: RW
authors.lastname: Shafer
authors.forename: P M
authors.initials: PM
authors.lastname: Small
authors.forename: C
authors.initials: C
authors.lastname: Larkin
authors.forename: S P
authors.initials: SP
authors.lastname: Singh
authors.forename: P
authors.initials: P
authors.lastname: Kelly
authors.forename: M F
authors.initials: MF
authors.lastname: Sierra
authors.forename: G
authors.initials: G
authors.lastname: Schoolnik
authors.forename: K D
authors.initials: KD
authors.lastname: Chirgwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000235:genetics; D018432:Drug Resistance, Multiple; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D009519:New York City / Q000453:epidemiology; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial