Temporal trends and transmission patterns during the emergence of multidrug-resistant tuberculosis in New York City: a molecular epidemiologic assessment.
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.
Shafer
R W
RW
Center for AIDS Research, Stanford University, California.
Small
P M
PM
Larkin
C
C
Singh
S P
SP
Kelly
P
P
Sierra
M F
MF
Schoolnik
G
G
Chirgwin
K D
KD
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
D000995:Antitubercular Agents; D004269:DNA, Bacterial