title: Complex transmission dynamics of clonally related virulent Mycobacterium tuberculosis associated with barhopping by predominantly human immunodeficiency virus-positive gay men.
abstract: Limited data suggest that measures to reduce tuberculosis transmission should be based on locations rather than on personal contacts. Molecular epidemiologic methods (analysis of IS6110 patterns, spoligotypes, variable numbers of tandem DNA repeats, and automated DNA sequence data) identified a cohort of 48 persons who were infected with progeny of the same Mycobacterium tuberculosis strain. Epidemiologic investigation documented that a large proportion of the patients were gay white human immunodeficiency virus-positive men. Most practiced barhopping, an activity that involved patronizing many bars in the same neighborhood each night. Few subjects were directly linked to more than 1 or 2 other persons by conventional investigation methods, which shows that the transmission dynamics were unusually complex compared with most previously described episodes of strain spread. The data support the concept that identification of locations where pathogen dissemination likely occurs may provide additional strategies for targeted tuberculosis control.
authors.affiliation: Institute for the Study of Human Bacterial Pathogenesis, Baylor College of Medicine, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Yaganehdoost
authors.forename: E A
authors.initials: EA
authors.lastname: Graviss
authors.forename: M W
authors.initials: MW
authors.lastname: Ross
authors.forename: G J
authors.initials: GJ
authors.lastname: Adams
authors.forename: S
authors.initials: S
authors.lastname: Ramaswamy
authors.forename: A
authors.initials: A
authors.lastname: Wanger
authors.forename: R
authors.initials: R
authors.lastname: Frothingham
authors.forename: H
authors.initials: H
authors.lastname: Soini
authors.forename: J M
authors.initials: JM
authors.lastname: Musser
mesh_terms: D000428:Alcohol Drinking; D000704:Analysis of Variance; D001727:Bisexuality; D015897:Comorbidity; D004251:DNA Transposable Elements; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000472:pathogenicity*; D044469:Racial Groups; D012309:Risk-Taking; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D014774:Virulence
chemical_list: D004251:DNA Transposable Elements