title: A molecular epidemiological assessment of extrapulmonary tuberculosis in San Francisco.
abstract: The epidemiology of extrapulmonary tuberculosis (TB) is not well understood. We studied all cases of extrapulmonary TB reported in San Francisco during 1991-2000 to determine risk factors for extrapulmonary TB and the proportion caused by recent infection. Isolates were analyzed by IS6110-based restriction fragment-length polymorphisms analysis. There were 480 cases of extrapulmonary TB, of which 363 (76%) were culture positive; isolates were genotyped for 301 cases (83%). Multivariate analysis identified young age, female sex, and HIV infection as independent risk factors for nonrespiratory TB (excluding pulmonary, pleural, and disseminated TB). Pleural TB was less common in HIV-seropositive persons and women than were nonrespiratory forms of extrapulmonary TB. Pleural TB is different from other forms of extrapulmonary TB and is associated with the highest clustering rate (35% of cases) of all forms of TB. This high rate of clustering occurs because pleural TB is often an early manifestation of recent infection.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital Department of Medicine, University of California, San Francisco, California 94143, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ong
authors.forename: Jennifer
authors.initials: J
authors.lastname: Creasman
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hopewell
authors.forename: Leah C
authors.initials: LC
authors.lastname: Gonzalez
authors.forename: Maida
authors.initials: M
authors.lastname: Wong
authors.forename: Robert M
authors.initials: RM
authors.lastname: Jasmer
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D012495:San Francisco / Q000453:epidemiology; D014396:Tuberculosis, Pleural / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*