Original Article

Factors Associated with Recently Transmitted Mycobacterium tuberculosis Strain MS0006 in Hinds County, Mississippi

Authors: Brian Temple, MD, MS, Awewura Kwara, MD, MPH, Imran Sunesara, MBBS, MPH, Leandro Mena, MD, MPH, Thomas Dobbs, MD, MPH, Harold Henderson, MD, Mike Holcomb, MPPA, Risa Webb, MD, DMTH

Abstract

Objective: The objective of this study was to investigate risk factors associated with tuberculosis (TB) transmission that was caused by Mycobacterium tuberculosis strain MS0006 from 2004 to 2009 in Hinds County, Mississippi.


Methods: DNA fingerprinting using spoligotyping, mycobacterial interspersed repetitive unit, and IS6110-based restriction fragment length polymorphism of culture-confirmed cases of TB was performed. Clinical and demographic factors associated with strain MS0006 were analyzed by univariate and multivariate analysis.


Results: Of the 144 cases of TB diagnosed during the study period, 117 were culture positive with fingerprints available. There were 48 different strains, of which 6 clustered strains were distributed among 74 patients. The MS0006 strain accounted for 46.2% of all culture-confirmed cases. Risk factors for having the MS0006 strain in a univariate analysis included homelessness, HIV co-infection, sputum smear negativity, tuberculin skin test negativity, and noninjectable drug use. Multivariate analysis identified homelessness (odds ratio 7.88, 95% confidence interval 2.90–21.35) and African American race (odds ratio 5.80, 95% confidence interval 1.37–24.55) as independent predictors of having TB caused by the MS0006 strain of M. tuberculosis.


Conclusions: Our findings suggest that a majority of recently transmitted TB in the studied county was caused by the MS0006 strain. African American race and homelessness were significant risk factors for inclusion in the cluster. Molecular epidemiology techniques continue to provide in-depth analysis of disease transmission and play a vital role in effective contact tracing and interruption of ongoing transmission.

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References

1. World Health Organization. Global Tuberculosis Control: WHO report 2010. Available at: http://whqlibdoc.who.int/publications/2010/9789241564069_eng.pdf. Accessed December 2010.
 
2. Centers for Disease Control and Prevention. Controlling tuberculosis in the United States. MMWR 2005;54:1–81.
 
3. Centers for Disease Control and Prevention. Trends in tuberculosis—United States, 2008. MMWR 2009;58:249–253.
 
4. Centers for Disease Control and Prevention. Decrease in reported tuberculosis cases—United States, 2009. MMWR 2010;59:289–294.
 
5. Buff AM, Moonan PK, Desai MA, et al. South Carolina tuberculosis genotype cluster investigation: a tale of substance abuse and recurrent disease. Int J Tuberc Lung Dis 2010;14:1347–1349.
 
6. Weis SE, Pogoda JM, Yang Z, et al. Transmission dynamics of tuberculosis in Tarrant County, Texas. Am J Respir Crit Care Med 2002; 166: 36–42.
 
7. Kempf MC, Dunlap NE, Lok KH, et al. Long term molecular analysis of tuberculosis strain in Alabama, a state characterized by a largely indigenous, low-risk population. J of Clin Micro 2005;43:870–878.
 
8. Webb RM, Penman A, Holcombe M, et al. TB case decline with nineteen years of universal directly observed therapy in a statewide comprehensive program. Int J Tuberc Lung Dis 2011;15:848–850.
 
9. Mississippi State Department of Health. Targeted tuberculosis screening in the Jackson, MS homeless population. Miss Morb Rep 2010;26:1–3.
 
10. US Census Bureau. Available at: http://www.census.gov/. Accessed November 2, 2010.
 
11. Mississippi State Department of Health. HIV Disease 2009 Annual Surveillance Summary. Available at: http://www.healthyms.com/std. Accessed October 2010.
 
12. World Health Organization. Global Tuberculosis Control: epidemiology, planning, financing WHO report 2009. Available at: http://whqlibdoc.who.int/publications/2009/9789241563802_eng.pdf. Accessed October 2010.
 
13. Barnes PF, Cave MD. Molecular epidemiology of tuberculosis. N Engl J Med 2003;349:1149–1156.
 
14. Barnes PF, Yang Z, Preston-Martin S, et al. Patterns of tuberculosis transmission in central Los Angeles. JAMA 1997;278:1159–1163.
 
15. Serpa JA, Teeter LD, Musser JM, et al. Tuberculosis disparity between US-born blacks and whites, Houston, Texas, USA. Emerg Infect Dis 2009;15:899–904.
 
16. EL Sahly HM, Adams GJ, Soini H, et al. Epidemiologic difference between United States and foreign born tuberculosis patients in Houston, Texas. J Infect Dis 2001;183:461–468.
 
17. Nava-Aguilera E, Andersson N, Harris E, et al. Risk factors associated with recent transmission of tuberculosis: systemic review and meta-analysis. Int J Tuberc Dis 2009;13:17–26.
 
18. Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2010.
 
19. World Health Organization. Global summary of the AIDS epidemic, December 2007. World Health Organization. Available at: http://www.who.int/hiv/data/2008_global_summary_AIDS_ep.png. Accessed October 2010.
 
20. Centers for Disease Control and Prevention. Recommendations for human immunodeficiency virus (HIV) screening in Tuberculosis (MTB) clinics. CDC April 2008. Available at: www.cdc.gov/MTB. Accessed October 15, 2011.
 
21. Mathema B, Kurepina NE, Bifani PJ, et al. Molecular epidemiology of tuberculosis: current insights. Clin Micro Rev 2006;19:658–685.
 
22. Hargreaves N, Kadzakumanja O, Phiri S, et al. What causes smear-negative pulmonary tuberculosis in Malawi an area of high HIV seroprevalence? Int J Tuberc Lung Dis 2001;5:113–122.
 
23. Kibiki G, Mulder B, van der Ven AJ, et al. Laboratory diagnosis of pulmonary tuberculosis in MTB and HIV endemic settings and the contribution of real time PCR for M. tuberculosis in bronchoalveolar lavage fluid. Trop Med Int Health 2007;12:1210–1217.
 
24. Behr MA, Warren SA, Salamon H, et al. Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli. Lancet 1999;353:444–449.
 
25. Hernandez-Garduono E, Cook V, Kunimoto D, et al. Transmission of tuberculosis from smear negative patients: a molecular epidemiology study. Thorax 2004;59:286–290.
 
26. Fok A, Numata Y, Schulzer M, et al. Risk factors for clustering of tuberculosis cases: a systemic review of population-based molecular epidemiology studies. Int J Tuberc Lung Dis 2008;12:480–492.
 
27. Wood R, Middelkoop K, Myer L, et al. Undiagnosed tuberculosis in a community with high HIV prevalence. Am J Respir Crit Care Med 2007;175:87–93.
 
28. Van Deutekom H, Hoijing SP, de Haas PE, et al. Clustered tuberculosis cases, do they represent recent transmission and can they be detected earlier. Am J Respir Crit Care Med 2004;169:806–810.
 
29. Solsona J, Caylà JA, Verdu E, et al. Molecular and conventional epidemiology of tuberculosis in an inner city district. Int J Tuberc Lung Dis 2001;5:724–731.
 
30. Nahid P, Bilven E, Kim EY, et al.. Influence of M. tuberculosis lineage variability within a clinical trial for pulmonary tuberculosis. PLoS One 2010;5:e10753.
 
31. Gagneux S, Small P. Global phylogeography of Mycobacterium tuberculosis and implications for tuberculosis product development. Lancet Infect Dis 2007;7:328–337.
 
32. Kato-Maeda M, Kim E, Flores L, et al. Differences among sublineages of the East-Asian lineage of Mycobacterium tuberculosis in genotypic clustering. Int J Tuberc Lung Dis 2010;14:538–544.