title: Clustering of Mycobacterium tuberculosis cases in Acapulco: Spoligotyping and risk factors.
abstract: Recurrence and reinfection of tuberculosis have quite different implications for prevention. We identified 267 spoligotypes of Mycobacterium tuberculosis from consecutive tuberculosis patients in Acapulco, Mexico, to assess the level of clustering and risk factors for clustered strains. Point cluster analysis examined spatial clustering. Risk analysis relied on the Mantel Haenszel procedure to examine bivariate associations, then to develop risk profiles of combinations of risk factors. Supplementary analysis of the spoligotyping data used SpolTools. Spoligotyping identified 85 types, 50 of them previously unreported. The five most common spoligotypes accounted for 55% of tuberculosis cases. One cluster of 70 patients (26% of the series) produced a single spoligotype from the Manila Family (Clade EAI2). The high proportion (78%) of patients infected with cluster strains is compatible with recent transmission of TB in Acapulco. Geomatic analysis showed no spatial clustering; clustering was associated with a risk profile of uneducated cases who lived in single-room dwellings. The Manila emerging strain accounted for one in every four cases, confirming that one strain can predominate in a hyperendemic area.
authors.affiliation: Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Calle Pino S/N, Colonia El Roble, 39640 Acapulco, Guerrero, Mexico. enava@ciet.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nava-Aguilera
authors.forename: Yolanda
authors.initials: Y
authors.lastname: López-Vidal
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
authors.forename: Arcadio
authors.initials: A
authors.lastname: Morales-Pérez
authors.forename: Steven
authors.initials: S
authors.lastname: Mitchell
authors.forename: Miguel
authors.initials: M
authors.lastname: Flores-Moreno
authors.forename: Ascencio
authors.initials: A
authors.lastname: Villegas-Arrizón
authors.forename: José
authors.initials: J
authors.lastname: Legorreta-Soberanis
authors.forename: Robert
authors.initials: R
authors.lastname: Ledogar
authors.forename: Neil
authors.initials: N
authors.lastname: Andersson
mesh_terms: D000328:Adult; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000235:genetics; D058974:Phylogeography; D011110:Polymorphism, Genetic; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology / Q000635:transmission