title: Prospective use of molecular typing of Mycobacterium tuberculosis by use of restriction fragment-length polymorphism in a public tuberculosis-control program.
abstract: We performed a prospective, community-based evaluation of molecular typing of Mycobacterium tuberculosis isolates as a method for tuberculosis (TB) control. We performed restriction fragment-length polymorphism (RFLP) analysis of the insertion sequences IS6110 and pTBN12 for isolates recovered from 61 of 62 patients with culture-positive TB in St. Louis during 12 months. Twenty-four (39%) of the 61 patients were infected with an isolate with an RFLP pattern that was shared with >/=1 other isolate, and 11 (46%) also had epidemiologic links with patients in their cluster of cases. One case each of laboratory cross-contamination and occupational transmission were discovered. The patients in clusters were more likely to be younger, black, United States-born, to have substance abuse problems, and to live in poorer areas. A predictive algorithm for molecular identification of clusters had a sensitivity and a specificity of 75%. This study allowed the TB-control program in St. Louis to be redirected toward the affected subpopulations.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: McConkey
authors.forename: Michael
authors.initials: M
authors.lastname: Williams
authors.forename: Don
authors.initials: D
authors.lastname: Weiss
authors.forename: Hilda
authors.initials: H
authors.lastname: Adams
authors.forename: M Donald
authors.initials: MD
authors.lastname: Cave
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Yang
authors.forename: Tom
authors.initials: T
authors.lastname: Lindner
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bailey
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D011110:Polymorphism, Genetic; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission