title: Unsuspected recent transmission of tuberculosis among high-risk groups: implications of universal tuberculosis genotyping in its detection.
abstract: BACKGROUND
  The initiation of universal genotyping revealed 3 clusters of 19 patients with tuberculosis (TB) in Wisconsin, with no apparent epidemiologic links among most of them. An epidemiologic investigation was conducted to determine whether genotype clustering resulted from recent transmission.
  
  
  METHODS
  We conducted additional interviews with patients and reviewed medical records. Places frequented by the patients while they were infectious were visited to identify contacts.
  
  
  RESULTS
  Our investigation revealed several previously unrecognized possible sites of TB transmission: a single-room occupancy hotel, 2 homeless shelters, 1 bar, and 2 crack houses. Seven patients with previously diagnosed TB were added to the clusters. Of 26 patients, we identified epidemiologic links for all but 1. Common risk factors among patients included alcohol abuse, crack cocaine use, homelessness, and unemployment. Additionally, 98 contacts missed during routine contact investigation were identified.
  
  
  CONCLUSIONS
  Transmission of TB, particularly among high-risk groups, may go undetected for years. Our investigation demonstrated the value of universal genotyping in revealing unsuspected recent TB transmission and previously unrecognized sites of transmission, which can be targeted for specific TB interventions.
authors.affiliation: Division of Applied Public Health Training, Epidemiology Program Office, National Center for HIV, STD and TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. nailemlk@yahoo.com
authors.forename: Naile
authors.initials: N
authors.lastname: Malakmadze
authors.forename: Idalia M
authors.initials: IM
authors.lastname: González
authors.forename: Tanya
authors.initials: T
authors.lastname: Oemig
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Isiadinso
authors.forename: Desiree
authors.initials: D
authors.lastname: Rembert
authors.forename: Mary M
authors.initials: MM
authors.lastname: McCauley
authors.forename: Philip
authors.initials: P
authors.lastname: Wand
authors.forename: Lois
authors.initials: L
authors.lastname: Diem
authors.forename: Lauren
authors.initials: L
authors.lastname: Cowan
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Palumbo
authors.forename: Michael
authors.initials: M
authors.lastname: Fraser
authors.forename: Kashef
authors.initials: K
authors.lastname: Ijaz
mesh_terms: D000328:Adult; D000368:Aged; D016358:Contact Tracing; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification*; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission*