title: Relationship between Mycobacterium tuberculosis phylogenetic lineage and clinical site of tuberculosis.
abstract: BACKGROUND
  Genotyping of Mycobacterium tuberculosis has revealed 4 major phylogenetic lineages with differential distribution worldwide. It is not clear whether different lineages are associated with different sites of infection (eg, pulmonary tuberculosis versus extrapulmonary tuberculosis). We sought to determine whether M. tuberculosis lineage is associated with the site of tuberculosis disease.
  
  
  METHODS
  We conducted a cross-sectional analysis of all culture-confirmed cases of tuberculosis with routinely determined M. tuberculosis spoligotype-defined lineage reported to the US National Tuberculosis Surveillance System from 2004 through 2008. Odds ratios (ORs) were used to assess the relation between disease site and M. tuberculosis lineage, after adjustment for age, sex, human immunodeficiency virus infection status, region of birth, and race/ethnicity.
  
  
  RESULTS
  Of 53972 reported culture-positive tuberculosis cases, 32000 (59.3%) were cases of M. tuberculosis that included complete spoligotype-based data on lineage. Of these, 23844 (74.5%) were exclusively pulmonary, 5085 (15.9%) were exclusively extrapulmonary, and 3071 (9.6%) were combined pulmonary and extrapulmonary. The percentages of tuberculosis cases that were exclusively extrapulmonary differed by lineage: East Asian, 13.0%; Euro-American, 13.8%; Indo-Oceanic, 22.6%; and East-African Indian, 34.3%. Compared with East Asian lineage, the odds of exclusively extrapulmonary tuberculosis relative to exclusively pulmonary tuberculosis were greater for Euro-American (adjusted OR, 1.3; 95% confidence interval [CI], 1.1-1.4), Indo-Oceanic (adjusted OR, 1.7; 95% CI, 1.5-1.9), and East-African Indian (adjusted OR, 1.6; 95% CI, 1.4-1.9) lineages.
  
  
  CONCLUSIONS
  Phylogenetic lineage of M. tuberculosis is associated with the site of tuberculosis disease.
authors.affiliation: Epidemic Intelligence Service , Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. eoc9@cdc.gov
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: Click
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.forename: Carla A
authors.initials: CA
authors.lastname: Winston
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Cowan
authors.forename: John E
authors.initials: JE
authors.lastname: Oeltmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D016017:Odds Ratio; D044469:Racial Groups; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology*; D014481:United States / Q000453:epidemiology