Transmission of tuberculosis from smear negative patients: a molecular epidemiology study

E Hernández-Garduño, V Cook, D Kunimoto, R K Elwood, W A Black, J M FitzGerald, E Hernández-Garduño, V Cook, D Kunimoto, R K Elwood, W A Black, J M FitzGerald

Abstract

Background: While smear positive patients with tuberculosis (TB) are considered more infectious than smear negative patients, the latter can also transmit TB.

Methods: In a molecular epidemiology study of 791 patients in the Greater Vancouver regional district, the number of episodes of TB transmission from two groups of smear negative clustered patients by RFLP (assumed to be involved in recent transmission) was estimated after assessing for potential bias. Group 1 (n = 79) included patients with pulmonary TB or pulmonary + extrapulmonary disease (PTB or PTB+EPTB); group 2 (n = 129) included all patients in group 1 + extrapulmonary cases alone.

Results: In the total sample the mean (SD) age was 51 (21) years, 54.3% were male, and 17.0% of patients were clustered. Compared with smear negative patients, smear positive patients were more likely to be in a cluster (OR = 2.0, 95% CI 1.1 to 3.6) and to have had a history of ethanol abuse (OR = 2.7, 95% CI 1.0 to 6.7), diabetes mellitus (OR = 2.8, 95% CI 1.1 to 7.0), injection drug use (OR = 3.1, 95% CI 1.1 to 8.3), and to have had a previous hospital admission (OR = 8.5, 95% CI 5.1 to 14.0). The proportion of episodes of transmission from smear negative clustered patients ranged from 17.3% to 22.2% in group 1 and from 25% to 41% in group 2.

Conclusion: In Greater Vancouver, smear negative cases appear responsible for at least one sixth of culture positive episodes of TB transmission.

References

    1. Infect Control Hosp Epidemiol. 2001 Jan;22(1):10-2
    1. N Engl J Med. 1999 Nov 11;341(20):1491-5
    1. CMAJ. 2002 Aug 20;167(4):349-52
    1. Emerg Infect Dis. 2002 Nov;8(11):1260-3
    1. Am J Respir Crit Care Med. 2003 Mar 1;167(5):723-5
    1. Am Rev Respir Dis. 1967 Jun;95(6):998-1004
    1. Antimicrob Agents Chemother. 1973 Aug;4(2):94-104
    1. Bull Int Union Tuberc. 1975;50(1):107-21
    1. Bull Int Union Tuberc. 1975;50(1):90-106
    1. Am Rev Respir Dis. 1989 May;139(5):1082-5
    1. Tuber Lung Dis. 1993 Jun;74(3):191-4
    1. Tuber Lung Dis. 1994 Feb;75(1):25-32
    1. N Engl J Med. 1994 Jun 16;330(24):1703-9
    1. N Engl J Med. 1994 Jun 16;330(24):1710-6
    1. Chest. 1994 Sep;106(3):684-6
    1. Lancet. 2000 Jan 22;355(9200):275-80
    1. Trans R Soc Trop Med Hyg. 2000 Jul-Aug;94(4):395-8
    1. Med Clin (Barc). 1997 Mar 15;108(10):361-5
    1. Int J Tuberc Lung Dis. 1998 Apr;2(4):312-6
    1. Lancet. 1999 Feb 6;353(9151):444-9
    1. Chest. 1999 Feb;115(2):445-52
    1. Ann Intern Med. 1999 Jun 15;130(12):971-8
    1. J Intern Med. 2001 Jan;249(1):1-26

Source: PubMed

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