title: A cluster of tuberculosis associated with use of a marijuana water pipe.
abstract: METHODS
  New cases of pulmonary tuberculosis (TB) were noted in a cluster of young Caucasian males, an unusual ethnic group for this disease in Queensland, Australia. It was noted that marijuana water pipe ('bong') smoking was common amongst cases and contacts.
  
  
  OBJECTIVE
  To report this cluster of TB and to investigate whether shared use of a marijuana water pipe was associated with transmission of TB.
  
  
  METHODS
  All contacts were identified and screened according to standard protocols. Cases were asked to list contacts with whom they had shared a marijuana water pipe.
  
  
  RESULTS
  Five cases of open pulmonary TB were identified clinically and on sputum culture, and all isolates of Mycobacterium tuberculosis were identical on typing. Of 149 contacts identified, 114 (77%) completed screening, and 57 (50%) had significant tuberculin skin test (TST) reactions on follow-up. Of 45 contacts who had shared a marijuana water pipe with a case, 29 (64%) had a significant TST reaction.
  
  
  CONCLUSIONS
  Sharing a marijuana water pipe with a case of pulmonary TB was associated with transmission of TB (OR 2.22, 95 % CI 0.96-5.17), although the most important risk factor for acquiring TB infection in this cluster was close household contact with a case (OR 4.91, 95% CI 1.13-20.70).
authors.affiliation: Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia. wendy_munckhof@health.qld.gov.au
authors.forename: W J
authors.initials: WJ
authors.lastname: Munckhof
authors.forename: A
authors.initials: A
authors.lastname: Konstantinos
authors.forename: M
authors.initials: M
authors.lastname: Wamsley
authors.forename: M
authors.initials: M
authors.lastname: Mortlock
authors.forename: C
authors.initials: C
authors.lastname: Gilpin
mesh_terms: D000328:Adult; D004196:Disease Outbreaks; D004866:Equipment Contamination; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000009:adverse effects*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification / Q000472:pathogenicity; D011793:Queensland / Q000453:epidemiology; D012919:Social Behavior; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000635:transmission*