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Issue Cover for Volume 8, Number 11—November 2002

Volume 8, Number 11—November 2002

[PDF - 23.47 MB - 186 pages]

THEME ISSUE
Tuberculosis Genotyping
Tuberculosis Genotyping Network, United States

The Continued Threat of Tuberculosis [PDF - 158 KB - 1 page]
T. Navin et al.
EID Navin T, McNabb S, Crawford JT. The Continued Threat of Tuberculosis. Emerg Infect Dis. 2002;8(11):1187. https://doi.org/10.3201/eid0811.020468
AMA Navin T, McNabb S, Crawford JT. The Continued Threat of Tuberculosis. Emerging Infectious Diseases. 2002;8(11):1187. doi:10.3201/eid0811.020468.
APA Navin, T., McNabb, S., & Crawford, J. T. (2002). The Continued Threat of Tuberculosis. Emerging Infectious Diseases, 8(11), 1187. https://doi.org/10.3201/eid0811.020468.

Rationale and Methods for the National Tuberculosis Genotyping and Surveillance Network [PDF - 437 KB - 4 pages]
K. G. Castro and H. W. Jaffe

Our understanding of tuberculosis (TB) transmission dynamics has been refined by genotyping of Mycobacterium tuberculosis strains. The National Tuberculosis Genotyping and Surveillance Network was designed and implemented to systematically evaluate the role of genotyping technology in improving TB prevention and control activities. Genotyping proved a useful adjunct to investigations of outbreaks, unusual clusters, and laboratory cross-contamination.

EID Castro KG, Jaffe HW. Rationale and Methods for the National Tuberculosis Genotyping and Surveillance Network. Emerg Infect Dis. 2002;8(11):1188-1191. https://doi.org/10.3201/eid0811.020408
AMA Castro KG, Jaffe HW. Rationale and Methods for the National Tuberculosis Genotyping and Surveillance Network. Emerging Infectious Diseases. 2002;8(11):1188-1191. doi:10.3201/eid0811.020408.
APA Castro, K. G., & Jaffe, H. W. (2002). Rationale and Methods for the National Tuberculosis Genotyping and Surveillance Network. Emerging Infectious Diseases, 8(11), 1188-1191. https://doi.org/10.3201/eid0811.020408.

National Tuberculosis Genotyping and Surveillance Network: Design and Methods [PDF - 268 KB - 5 pages]
J. T. Crawford et al.

The National Tuberculosis Genotyping and Surveillance Network was established in 1996 to perform a 5-year, prospective study of the usefulness of genotyping Mycobacterium tuberculosis isolates to tuberculosis control programs. Seven sentinel sites identified all new cases of tuberculosis, collected information on patients and contacts, and obtained patient isolates. Seven genotyping laboratories performed DNA fingerprinting analysis by the international standard IS6110 method. BioImage Whole Band Analyzer software was used to analyze patterns, and distinct patterns were assigned unique designations. Isolates with six or fewer bands on IS6110 patterns were also spoligotyped. Patient data and genotyping designations were entered in a relational database and merged with selected variables from the national surveillance database. In two related databases, we compiled the results of routine contact investigations and the results of investigations of the relationships of patients who had isolates with matching genotypes. We describe the methods used in the study.

EID Crawford JT, Braden CR, Schable BA, Onorato IM. National Tuberculosis Genotyping and Surveillance Network: Design and Methods. Emerg Infect Dis. 2002;8(11):1192-1196. https://doi.org/10.3201/eid0811.020296
AMA Crawford JT, Braden CR, Schable BA, et al. National Tuberculosis Genotyping and Surveillance Network: Design and Methods. Emerging Infectious Diseases. 2002;8(11):1192-1196. doi:10.3201/eid0811.020296.
APA Crawford, J. T., Braden, C. R., Schable, B. A., & Onorato, I. M. (2002). National Tuberculosis Genotyping and Surveillance Network: Design and Methods. Emerging Infectious Diseases, 8(11), 1192-1196. https://doi.org/10.3201/eid0811.020296.

Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population [PDF - 365 KB - 18 pages]
B. A. Ellis et al.

We conducted a population-based study to assess demographic and risk-factor correlates for the most frequently occurring Mycobacterium tuberculosis genotypes from tuberculosis (TB) patients. The study included all incident, culture-positive TB patients from seven sentinel surveillance sites in the United States from 1996 to 2000. M. tuberculosis isolates were genotyped by IS6110-based restriction fragment length polymorphism and spoligotyping. Genotyping was available for 90% of 11,923 TB patients. Overall, 48% of cases had isolates that matched those from another patient, including 64% of U.S.-born and 35% of foreign-born patients. By logistic regression analysis, risk factors for clustering of genotypes were being male, U.S.-born, black, homeless, and infected with HIV; having pulmonary disease with cavitations on chest radiograph and a sputum smear with acid-fast bacilli; and excessive drug or alcohol use. Molecular characterization of TB isolates permitted risk correlates for clusters and specific genotypes to be described and provided information regarding cluster dynamics over time.

EID Ellis BA, Crawford JT, Braden CR, McNabb SJ, Moore M, Kammerer S. Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population. Emerg Infect Dis. 2002;8(11):1197-1209. https://doi.org/10.3201/eid0811.020403
AMA Ellis BA, Crawford JT, Braden CR, et al. Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population. Emerging Infectious Diseases. 2002;8(11):1197-1209. doi:10.3201/eid0811.020403.
APA Ellis, B. A., Crawford, J. T., Braden, C. R., McNabb, S. J., Moore, M., & Kammerer, S. (2002). Molecular Epidemiology of Tuberculosis in a Sentinel Surveillance Population. Emerging Infectious Diseases, 8(11), 1197-1209. https://doi.org/10.3201/eid0811.020403.

Quality Assessment of Mycobacterium tuberculosis Genotyping in a Large Laboratory Network [PDF - 342 KB - 6 pages]
C. R. Braden et al.

Quality assessment exercises were conducted to evaluate the reproducibility of IS6110 DNA fingerprinting performed by eight laboratories in the National Tuberculosis Genotyping and Surveillance Network. Three panels, each with 8 to 16 isolates, were typed at all laboratories, resulting in 280 images. When the pattern obtained by the majority for each isolate was used as the standard, exact matches were obtained for 73% of patterns; 90% and 97% of patterns matched within one- and two-band differences, respectively. A second approach involved retyping of randomly selected isolates at the Centers for Disease Control and Prevention. Retyping was done for 8–19 isolates per laboratory (76 total). Paired images matched exactly for 54% of isolates and within one and two band differences, 78% and 93%, respectively. We evaluated reasons for mismatching. We also evaluated the reproducibility of spoligotyping using a test panel of 13 isolates; a discrepancy of 1 in 91 results was noted.

EID Braden CR, Crawford JT, Schable BA. Quality Assessment of Mycobacterium tuberculosis Genotyping in a Large Laboratory Network. Emerg Infect Dis. 2002;8(11):1210-1215. https://doi.org/10.3201/eid0811.020401
AMA Braden CR, Crawford JT, Schable BA. Quality Assessment of Mycobacterium tuberculosis Genotyping in a Large Laboratory Network. Emerging Infectious Diseases. 2002;8(11):1210-1215. doi:10.3201/eid0811.020401.
APA Braden, C. R., Crawford, J. T., & Schable, B. A. (2002). Quality Assessment of Mycobacterium tuberculosis Genotyping in a Large Laboratory Network. Emerging Infectious Diseases, 8(11), 1210-1215. https://doi.org/10.3201/eid0811.020401.

Identifying the Sources of Tuberculosis in Young Children: A Multistate Investigation [PDF - 256 KB - 8 pages]
S. J. Sun et al.

To better understand the molecular epidemiology of tuberculosis (TB) transmission for culture-confirmed patients <5 years of age, data were analyzed from a population-based study conducted in seven U.S. sites from 1996 to 2000. Mycobacterium tuberculosis isolates were genotyped with IS6110-based restriction fragment length polymorphism analysis and spoligotyping. Case-patient data were obtained from the Centers for Disease Control and Prevention’s national tuberculosis registry and health department records. Routine public health investigations conducted by local health departments identified suspected source patients for 57 (51%) of 111 culture-confirmed patients <5 years of age. For 8 (15%) of 52 culture-confirmed patients <5 years of age and their suspected source patients with complete genotyping results, genotypes suggested infection with different TB strains. Potential differences between sources for patients <5 years of age and source patients that transmitted TB to adolescent and adult patients were identified.

EID Sun SJ, Bennett DE, Flood J, Loeffler AM, Kammerer S, Ellis BA. Identifying the Sources of Tuberculosis in Young Children: A Multistate Investigation. Emerg Infect Dis. 2002;8(11):1216-1223. https://doi.org/10.3201/eid0811.020419
AMA Sun SJ, Bennett DE, Flood J, et al. Identifying the Sources of Tuberculosis in Young Children: A Multistate Investigation. Emerging Infectious Diseases. 2002;8(11):1216-1223. doi:10.3201/eid0811.020419.
APA Sun, S. J., Bennett, D. E., Flood, J., Loeffler, A. M., Kammerer, S., & Ellis, B. A. (2002). Identifying the Sources of Tuberculosis in Young Children: A Multistate Investigation. Emerging Infectious Diseases, 8(11), 1216-1223. https://doi.org/10.3201/eid0811.020419.

DNA Fingerprinting of Mycobacterium tuberculosis Isolates from Epidemiologically Linked Case Pairs [PDF - 241 KB - 6 pages]
D. E. Bennett et al.

DNA fingerprinting was used to evaluate epidemiologically linked case pairs found during routine tuberculosis (TB) contact investigations in seven sentinel sites from 1996 to 2000. Transmission was confirmed when the DNA fingerprints of source and secondary cases matched. Of 538 case pairs identified, 156 (29%) did not have matching fingerprints. Case pairs from the same household were no more likely to have confirmed transmission than those linked elsewhere. Case pairs with unconfirmed transmission were more likely to include a smear-negative source case (odds ratio [OR] 2.0) or a foreign-born secondary case (OR 3.4) and less likely to include a secondary case <15 years old (OR 0.3). Our study suggests that contact investigations should focus not only on the household but also on all settings frequented by an index case. Foreign-born persons with TB may have been infected previously in high-prevalence countries; screening and preventive measures recommended by the Institute of Medicine could prevent TB reactivation in these cases.

EID Bennett DE, Onorato IM, Ellis BA, Crawford JT, Schable B, Byers R, et al. DNA Fingerprinting of Mycobacterium tuberculosis Isolates from Epidemiologically Linked Case Pairs. Emerg Infect Dis. 2002;8(11):1124-1129. https://doi.org/10.3201/eid0811.020420
AMA Bennett DE, Onorato IM, Ellis BA, et al. DNA Fingerprinting of Mycobacterium tuberculosis Isolates from Epidemiologically Linked Case Pairs. Emerging Infectious Diseases. 2002;8(11):1124-1129. doi:10.3201/eid0811.020420.
APA Bennett, D. E., Onorato, I. M., Ellis, B. A., Crawford, J. T., Schable, B., Byers, R....Braden, C. R. (2002). DNA Fingerprinting of Mycobacterium tuberculosis Isolates from Epidemiologically Linked Case Pairs. Emerging Infectious Diseases, 8(11), 1124-1129. https://doi.org/10.3201/eid0811.020420.

Molecular Epidemiology of Multidrug-Resistant Tuberculosis, New York City, 1995–1997 [PDF - 1.35 MB - 9 pages]
S. S. Munsiff et al.

From January 1, 1995, to December 31, 1997, we reviewed records of all New York City patients who had multidrug-resistant tuberculosis (MDRTB); we performed insertion sequence (IS) 6110-based DNA genotyping on the isolates. Secondary genotyping was performed for low IS6110 copy band strains. Patients with identical DNA pattern strains were considered clustered. From 1995 through 1997, MDRTB was diagnosed in 241 patients; 217 (90%) had no prior treatment history, and 166 (68.9%) were born in the United States or Puerto Rico. Compared with non-MDRTB patients, MDRTB patients were more likely to be born in the United States, have HIV infection, and work in health care. Genotyping results were available for 234 patients; 153 (65.4%) were clustered, 126 (82.3%) of them in eight clusters of >4 patients. Epidemiologic links were identified for 30 (12.8%) patients; most had been exposed to patients diagnosed before the study period. These strains were likely transmitted in the early 1990s when MDRTB outbreaks and tuberculosis transmission were widespread in New York.

EID Munsiff SS, Bassoff T, Nivin B, Li J, Sharma A, Bifani P, et al. Molecular Epidemiology of Multidrug-Resistant Tuberculosis, New York City, 1995–1997. Emerg Infect Dis. 2002;8(11):1230-1238. https://doi.org/10.3201/eid0811.020288
AMA Munsiff SS, Bassoff T, Nivin B, et al. Molecular Epidemiology of Multidrug-Resistant Tuberculosis, New York City, 1995–1997. Emerging Infectious Diseases. 2002;8(11):1230-1238. doi:10.3201/eid0811.020288.
APA Munsiff, S. S., Bassoff, T., Nivin, B., Li, J., Sharma, A., Bifani, P....Kreiswirth, B. N. (2002). Molecular Epidemiology of Multidrug-Resistant Tuberculosis, New York City, 1995–1997. Emerging Infectious Diseases, 8(11), 1230-1238. https://doi.org/10.3201/eid0811.020288.

Genotyping Analyses of Tuberculosis Cases in U.S.- and Foreign-Born Massachusetts Residents [PDF - 1.19 MB - 7 pages]
S. Sharnprapai et al.

We used molecular genotyping to further understand the epidemiology and transmission patterns of tuberculosis (TB) in Massachusetts. The study population included 983 TB patients whose cases were verified by the Massachusetts Department of Public Health between July 1, 1996, and December 31, 2000, and for whom genotyping results and information on country of origin were available. Two hundred seventy-two (28%) of TB patients were in genetic clusters, and isolates from U.S-born were twice as likely to cluster as those of foreign-born (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.69, 3.12). Our results suggest that restriction fragment length polymorphism analysis has limited capacity to differentiate TB strains when the isolate contains six or fewer copies of IS6110, even with spoligotyping. Clusters of TB patients with more than six copies of IS6110 were more likely to have epidemiologic connections than were clusters of TB patients with isolates with few copies of IS6110 (OR 8.01, 95%; CI 3.45,18.93).

EID Sharnprapai S, Miller AC, Suruki R, Corkren E, Etkind S, Driscoll J, et al. Genotyping Analyses of Tuberculosis Cases in U.S.- and Foreign-Born Massachusetts Residents. Emerg Infect Dis. 2002;8(11):1239-1245. https://doi.org/10.3201/eid0811.020370
AMA Sharnprapai S, Miller AC, Suruki R, et al. Genotyping Analyses of Tuberculosis Cases in U.S.- and Foreign-Born Massachusetts Residents. Emerging Infectious Diseases. 2002;8(11):1239-1245. doi:10.3201/eid0811.020370.
APA Sharnprapai, S., Miller, A. C., Suruki, R., Corkren, E., Etkind, S., Driscoll, J....Nardell, E. (2002). Genotyping Analyses of Tuberculosis Cases in U.S.- and Foreign-Born Massachusetts Residents. Emerging Infectious Diseases, 8(11), 1239-1245. https://doi.org/10.3201/eid0811.020370.

Transmission of Mycobacterium tuberculosis in a Rural Community, Arkansas, 1945–2000 [PDF - 424 KB - 3 pages]
J. A. Dillaha et al.

A cluster of tuberculosis cases in a rural community in Arkansas persisted from 1991 to 1999. The cluster had 13 members, 11 linked epidemiologically. Old records identified 24 additional patients for 40 linked case-patients during a 54-year period. Residents of this neighborhood represent a population at high risk who should be considered for tuberculin testing and treatment for latent tuberculosis infection.

EID Dillaha JA, Yang Z, Ijaz K, Eisenach KD, Cave MD, Wilson FJ, et al. Transmission of Mycobacterium tuberculosis in a Rural Community, Arkansas, 1945–2000. Emerg Infect Dis. 2002;8(11):1246-1248. https://doi.org/10.3201/eid0811.020299
AMA Dillaha JA, Yang Z, Ijaz K, et al. Transmission of Mycobacterium tuberculosis in a Rural Community, Arkansas, 1945–2000. Emerging Infectious Diseases. 2002;8(11):1246-1248. doi:10.3201/eid0811.020299.
APA Dillaha, J. A., Yang, Z., Ijaz, K., Eisenach, K. D., Cave, M. D., Wilson, F. J....Bates, J. H. (2002). Transmission of Mycobacterium tuberculosis in a Rural Community, Arkansas, 1945–2000. Emerging Infectious Diseases, 8(11), 1246-1248. https://doi.org/10.3201/eid0811.020299.

Cross-Jurisdictional Transmission of Mycobacterium tuberculosis in Maryland and Washington, D.C., 1996–2000, Linked to the Homeless [PDF - 202 KB - 3 pages]
M. Lathan et al.

From 1996 to 2000, 23 Maryland and Washington, D.C., tuberculosis cases were identified in one six-band DNA cluster. Cases were clustered on the basis of their Mycobacterium tuberculosis isolates. Medical record reviews and interviews were conducted to identify epidemiologic linkages. Eighteen (78%) of the 23 case-patients with identical restriction fragment length polymorphism patterns were linked to another member; half the patients were associated with a Washington, D.C., homeless shelter. Molecular epidemiology defined the extent of this large, cross-jurisdictional outbreak.

EID Lathan M, Mukasa LN, Hooper N, Golub J, Baruch N, Mulcahy D, et al. Cross-Jurisdictional Transmission of Mycobacterium tuberculosis in Maryland and Washington, D.C., 1996–2000, Linked to the Homeless. Emerg Infect Dis. 2002;8(11):1249-1251. https://doi.org/10.3201/eid0811.020245
AMA Lathan M, Mukasa LN, Hooper N, et al. Cross-Jurisdictional Transmission of Mycobacterium tuberculosis in Maryland and Washington, D.C., 1996–2000, Linked to the Homeless. Emerging Infectious Diseases. 2002;8(11):1249-1251. doi:10.3201/eid0811.020245.
APA Lathan, M., Mukasa, L. N., Hooper, N., Golub, J., Baruch, N., Mulcahy, D....Cronin, W. A. (2002). Cross-Jurisdictional Transmission of Mycobacterium tuberculosis in Maryland and Washington, D.C., 1996–2000, Linked to the Homeless. Emerging Infectious Diseases, 8(11), 1249-1251. https://doi.org/10.3201/eid0811.020245.

Use of DNA Fingerprinting To Investigate a Multiyear, Multistate Tuberculosis Outbreak [PDF - 236 KB - 5 pages]
P. D. McElroy et al.

In 1998–1999, the Baltimore TB control program detected a cluster of 21 tuberculosis (TB) cases. Patients reported frequent travel to various East Coast cities. An investigation was conducted to determine whether transmission of the same Mycobacterium tuberculosis strain was occurring in these other localities. A collaborative investigation among federal, state, and local TB controllers included TB record reviews, interviews of patients, and restriction fragment length polymorphism (RFLP) analysis of selected M. tuberculosis isolates from diagnosed TB patients in several cities in 1996–2001. A national TB genotyping database was searched for RFLP patterns that matched the outbreak pattern. Eighteen additional outbreak-related cases were detected outside of Baltimore—the earliest diagnosed in New Jersey in 1996, and the most recent in New York City in late 2001. The outbreak demonstrates the need for strategies to detect links among patients diagnosed with TB across multiple TB control jurisdictions.

EID McElroy PD, Sterling TR, Driver CR, Kreiswirth BN, Woodley CL, Cronin WA, et al. Use of DNA Fingerprinting To Investigate a Multiyear, Multistate Tuberculosis Outbreak. Emerg Infect Dis. 2002;8(11):1152-1156. https://doi.org/10.3201/eid0811.020424
AMA McElroy PD, Sterling TR, Driver CR, et al. Use of DNA Fingerprinting To Investigate a Multiyear, Multistate Tuberculosis Outbreak. Emerging Infectious Diseases. 2002;8(11):1152-1156. doi:10.3201/eid0811.020424.
APA McElroy, P. D., Sterling, T. R., Driver, C. R., Kreiswirth, B. N., Woodley, C. L., Cronin, W. A....Ridzon1, R. (2002). Use of DNA Fingerprinting To Investigate a Multiyear, Multistate Tuberculosis Outbreak. Emerging Infectious Diseases, 8(11), 1152-1156. https://doi.org/10.3201/eid0811.020424.

Mycobacterium tuberculosis Transmission between Cluster Members with Similar Fingerprint Patterns [PDF - 510 KB - 3 pages]
K. Ijaz et al.

Molecular epidemiologic studies provide evidence of transmission of Mycobacterium tuberculosis within clusters of patients whose isolates share identical IS6110-DNA fingerprint patterns. However, M. tuberculosis transmission among patients whose isolates have similar but not identical DNA fingerprint patterns (i.e., differing by a single band) has not been well documented. We used DNA fingerprinting, combined with conventional epidemiology, to show unsuspected patterns of tuberculosis transmission associated with three public bars in the same city. Among clustered TB cases, DNA fingerprinting analysis of isolates with similar and identical fingerprints helped us discover epidemiologic links missed during routine tuberculosis contact investigations.

EID Ijaz K, Yang Z, Matthews HS, Bates JH, Cave MD. Mycobacterium tuberculosis Transmission between Cluster Members with Similar Fingerprint Patterns. Emerg Infect Dis. 2002;8(11):1257-1259. https://doi.org/10.3201/eid0811.020284
AMA Ijaz K, Yang Z, Matthews HS, et al. Mycobacterium tuberculosis Transmission between Cluster Members with Similar Fingerprint Patterns. Emerging Infectious Diseases. 2002;8(11):1257-1259. doi:10.3201/eid0811.020284.
APA Ijaz, K., Yang, Z., Matthews, H. S., Bates, J. H., & Cave, M. D. (2002). Mycobacterium tuberculosis Transmission between Cluster Members with Similar Fingerprint Patterns. Emerging Infectious Diseases, 8(11), 1257-1259. https://doi.org/10.3201/eid0811.020284.

A Prospective, Multicenter Study of Laboratory Cross-Contamination of Mycobacterium tuberculosis Cultures [PDF - 201 KB - 4 pages]
R. M. Jasmer et al.

A prospective study of false-positive cultures of Mycobacterium tuberculosis that resulted from laboratory cross-contamination was conducted at three laboratories in California. Laboratory cross-contamination accounted for 2% of the positive cultures. Cross-contamination should be a concern when an isolate matches the genotype of another sample processed during the same period.

EID Jasmer RM, Roemer M, Hamilton J, Bunter J, Braden CR, Shinnick TM, et al. A Prospective, Multicenter Study of Laboratory Cross-Contamination of Mycobacterium tuberculosis Cultures. Emerg Infect Dis. 2002;8(11):1260-1263. https://doi.org/10.3201/eid0811.020298
AMA Jasmer RM, Roemer M, Hamilton J, et al. A Prospective, Multicenter Study of Laboratory Cross-Contamination of Mycobacterium tuberculosis Cultures. Emerging Infectious Diseases. 2002;8(11):1260-1263. doi:10.3201/eid0811.020298.
APA Jasmer, R. M., Roemer, M., Hamilton, J., Bunter, J., Braden, C. R., Shinnick, T. M....Desmond, E. P. (2002). A Prospective, Multicenter Study of Laboratory Cross-Contamination of Mycobacterium tuberculosis Cultures. Emerging Infectious Diseases, 8(11), 1260-1263. https://doi.org/10.3201/eid0811.020298.

Estimated Costs of False Laboratory Diagnoses of Tuberculosis in Three Patients [PDF - 338 KB - 7 pages]
J. M. Northrup et al.

We estimated direct medical and nonmedical costs associated with a false diagnosis of tuberculosis (TB) caused by laboratory cross-contamination of Mycobacterium tuberculosis cultures in Massachusetts in 1998 and 1999. For three patients who received misdiagnoses of active TB disease on the basis of laboratory cross-contamination, the costs totaled U.S.$32,618. Of the total, 97% was attributed to the public sector (local and state health departments, public health hospital and laboratory, and county and state correctional facilities); 3% to the private sector (physicians, hospitals, and laboratories); and <1% to the patient. Hospitalizations and inpatient tests, procedures, and TB medications accounted for 69% of costs, and outpatient TB medications accounted for 18%. The average cost per patient was $10,873 (range, $1,033-$21,306). Reducing laboratory cross-contamination and quickly identifying patients with cross-contaminated cultures can prevent unnecessary and potentially dangerous treatment regimens and anguish for the patient and financial burden to the health-care system.

EID Northrup JM, Miller AC, Nardell E, Sharnprapai S, Etkind S, Driscoll J, et al. Estimated Costs of False Laboratory Diagnoses of Tuberculosis in Three Patients. Emerg Infect Dis. 2002;8(11):1264-1270. https://doi.org/10.3201/eid0811.020387
AMA Northrup JM, Miller AC, Nardell E, et al. Estimated Costs of False Laboratory Diagnoses of Tuberculosis in Three Patients. Emerging Infectious Diseases. 2002;8(11):1264-1270. doi:10.3201/eid0811.020387.
APA Northrup, J. M., Miller, A. C., Nardell, E., Sharnprapai, S., Etkind, S., Driscoll, J....Braden, C. R. (2002). Estimated Costs of False Laboratory Diagnoses of Tuberculosis in Three Patients. Emerging Infectious Diseases, 8(11), 1264-1270. https://doi.org/10.3201/eid0811.020387.

Statewide Molecular Epidemiology of Mycobacterium tuberculosis Transmission in a Moderate- to Low-Incidence State: Are Contact Investigations Enough? [PDF - 307 KB - 9 pages]
W. A. Cronin et al.

To assess the circumstances of recent transmission of tuberculosis (TB) (progression to active disease <2 years after infection), we obtained DNA fingerprints for 1,172 (99%) of 1,179 Mycobacterium tuberculosis isolates collected from Maryland TB patients from 1996 to 2000. We also reviewed medical records and interviewed patients with genetically matching M. tuberculosis strains to identify epidemiologic links (cluster investigation). Traditional settings for transmission were defined as households or close relatives and friends; all other settings were considered nontraditional. Of 436 clustered patients, 114 had recently acquired TB. Cluster investigations were significantly more likely than contact investigations to identify patients who recently acquired TB in nontraditional settings (33/42 vs. 23/72, respectively; p<0.001). Transmission from a foreign-born person to a U.S.-born person was rare and occurred mainly in public settings. The time from symptom onset to diagnosis was twice as long for transmitters as for nontransmitters (16.8 vs. 8.5 weeks, respectively; p<0.01). Molecular epidemiologic studies showed that eliminating diagnostic delays can prevent TB transmission in nontraditional settings, which elude contact investigations.

EID Cronin WA, Golub JE, Lathan MJ, Mukasa LN, Hooper N, Razeq JH, et al. Statewide Molecular Epidemiology of Mycobacterium tuberculosis Transmission in a Moderate- to Low-Incidence State: Are Contact Investigations Enough?. Emerg Infect Dis. 2002;8(11):1271-1279. https://doi.org/10.3201/eid0811.020261
AMA Cronin WA, Golub JE, Lathan MJ, et al. Statewide Molecular Epidemiology of Mycobacterium tuberculosis Transmission in a Moderate- to Low-Incidence State: Are Contact Investigations Enough?. Emerging Infectious Diseases. 2002;8(11):1271-1279. doi:10.3201/eid0811.020261.
APA Cronin, W. A., Golub, J. E., Lathan, M. J., Mukasa, L. N., Hooper, N., Razeq, J. H....Bishai, W. R. (2002). Statewide Molecular Epidemiology of Mycobacterium tuberculosis Transmission in a Moderate- to Low-Incidence State: Are Contact Investigations Enough?. Emerging Infectious Diseases, 8(11), 1271-1279. https://doi.org/10.3201/eid0811.020261.

Skin-Test Screening and Tuberculosis Transmission among the Homeless [PDF - 197 KB - 5 pages]
P. Kong et al.

We describe the implementation of a mandatory tuberculosis (TB) screening program that uses symptom screening and tuberculin skin testing in homeless shelters. We used the results of DNA fingerprinting of Mycobacterium tuberculosis isolates to evaluate the effect of the program on TB incidence and transmission. After the program was implemented, the proportion of cases among homeless persons detected by screening activities increased, and the estimated TB incidence decreased from 510 to 121 cases per 100,000 population per year. Recent transmission, defined by DNA fingerprinting analysis as clustered patterns occurring within 2 years, decreased from 49% to 14% (p=0.03). Our results suggest that the shelter-based screening program decreased the incidence of TB by decreasing its transmission among the homeless.

EID Kong P, Tapy J, Calixto P, Burman WJ, Reves RR, Yang Z, et al. Skin-Test Screening and Tuberculosis Transmission among the Homeless. Emerg Infect Dis. 2002;8(11):1280-1284. https://doi.org/10.3201/eid0811.020306
AMA Kong P, Tapy J, Calixto P, et al. Skin-Test Screening and Tuberculosis Transmission among the Homeless. Emerging Infectious Diseases. 2002;8(11):1280-1284. doi:10.3201/eid0811.020306.
APA Kong, P., Tapy, J., Calixto, P., Burman, W. J., Reves, R. R., Yang, Z....Cave, M. D. (2002). Skin-Test Screening and Tuberculosis Transmission among the Homeless. Emerging Infectious Diseases, 8(11), 1280-1284. https://doi.org/10.3201/eid0811.020306.

Impact of Genotyping of Mycobacterium tuberculosis on Public Health Practice in Massachusetts [PDF - 211 KB - 5 pages]
A. C. Miller et al.

Massachusetts was one of seven sentinel surveillance sites in the National Tuberculosis Genotyping and Surveillance Network. From 1996 through 2000, isolates from new patients with tuberculosis (TB) underwent genotyping. We describe the impact that genotyping had on public health practice in Massachusetts and some limitations of the technique. Through genotyping, we explored the dynamics of TB outbreaks, investigated laboratory cross-contamination, and identified Mycobacterium tuberculosis strains, transmission sites, and accurate epidemiologic links. Genotyping should be used with epidemiologic follow-up to identify how resources can best be allocated to investigate genotypic findings.

EID Miller AC, Sharnprapai S, Suruki R, Corkren E, Nardell EA, Driscoll JR, et al. Impact of Genotyping of Mycobacterium tuberculosis on Public Health Practice in Massachusetts. Emerg Infect Dis. 2002;8(11):1285-1289. https://doi.org/10.3201/eid0811.020316
AMA Miller AC, Sharnprapai S, Suruki R, et al. Impact of Genotyping of Mycobacterium tuberculosis on Public Health Practice in Massachusetts. Emerging Infectious Diseases. 2002;8(11):1285-1289. doi:10.3201/eid0811.020316.
APA Miller, A. C., Sharnprapai, S., Suruki, R., Corkren, E., Nardell, E. A., Driscoll, J. R....Etkind, S. (2002). Impact of Genotyping of Mycobacterium tuberculosis on Public Health Practice in Massachusetts. Emerging Infectious Diseases, 8(11), 1285-1289. https://doi.org/10.3201/eid0811.020316.

Human Exposure following Mycobacterium tuberculosis Infection of Multiple Animal Species in a Metropolitan Zoo [PDF - 541 KB - 4 pages]
P. Oh et al.

From 1997 to 2000, Mycobacterium tuberculosis was diagnosed in two Asian elephants (Elephas maximus), three Rocky Mountain goats (Oreamnos americanus), and one black rhinoceros (Diceros bicornis) in the Los Angeles Zoo. DNA fingerprint patterns suggested recent transmission. An investigation found no active cases of tuberculosis in humans; however, tuberculin skin-test conversions in humans were associated with training elephants and attending an elephant necropsy.

EID Oh P, Granich R, Scott J, Sun B, Joseph M, Stringfield C, et al. Human Exposure following Mycobacterium tuberculosis Infection of Multiple Animal Species in a Metropolitan Zoo. Emerg Infect Dis. 2002;8(11):1290-1293. https://doi.org/10.3201/eid0811.020302
AMA Oh P, Granich R, Scott J, et al. Human Exposure following Mycobacterium tuberculosis Infection of Multiple Animal Species in a Metropolitan Zoo. Emerging Infectious Diseases. 2002;8(11):1290-1293. doi:10.3201/eid0811.020302.
APA Oh, P., Granich, R., Scott, J., Sun, B., Joseph, M., Stringfield, C....Flood, J. (2002). Human Exposure following Mycobacterium tuberculosis Infection of Multiple Animal Species in a Metropolitan Zoo. Emerging Infectious Diseases, 8(11), 1290-1293. https://doi.org/10.3201/eid0811.020302.

National Tuberculosis Genotyping and Surveillance Network: Analysis of the Genotype Database [PDF - 821 KB - 9 pages]
L. S. Cowan and J. T. Crawford

As part of the National Tuberculosis and Genotyping Surveillance Network, isolates obtained from all new cases of tuberculosis occurring in seven geographically separate surveillance sites from 1996 through 2000 were genotyped. A total of 10,883 isolates were fingerprinted by the IS6110-restriction fragment length polymorphism method, yielding 6,128 distinct patterns. Low-copy isolates (those with six or fewer bands) were also spoligotyped. The distribution of specific genotype clusters was examined. Databases were also examined for families of related genotypes. Analysis of IS6110 patterns showed 497 patterns related to the W-Beijing family; these pattens represent 946 (9%) of all isolates in the study. Six new sets of related fingerprint patterns were also proposed for isolates containing 6–15 copies of IS6110. These fingerprint sets contain up to 251 patterns and 414 isolates; together, they contain 21% of isolates in this copy number range. These sets of fingerprints may represent endemic strains distributed across the United States.

EID Cowan LS, Crawford JT. National Tuberculosis Genotyping and Surveillance Network: Analysis of the Genotype Database. Emerg Infect Dis. 2002;8(11):1294-1302. https://doi.org/10.3201/eid0811.020313
AMA Cowan LS, Crawford JT. National Tuberculosis Genotyping and Surveillance Network: Analysis of the Genotype Database. Emerging Infectious Diseases. 2002;8(11):1294-1302. doi:10.3201/eid0811.020313.
APA Cowan, L. S., & Crawford, J. T. (2002). National Tuberculosis Genotyping and Surveillance Network: Analysis of the Genotype Database. Emerging Infectious Diseases, 8(11), 1294-1302. https://doi.org/10.3201/eid0811.020313.

Molecular Typing of Mycobacterium tuberculosis Strains with a Common Two-Band IS6110 Pattern [PDF - 195 KB - 3 pages]
K. H. Lok et al.

We conducted a population-based molecular typing of all Mycobacterium tuberculosis isolates obtained in Alabama since 1994. Of 2,452 isolates, 1,013 (41%) had fewer than 6 bands of IS6110; 348 (14%) had a single two-band pattern (JH2). With conventional epidemiologic methods, we identified three groups of related patients with JH2 isolates. Spoligotyping and pattern of variable number of tandem repeats identified 10 molecular groups; two found by conventional methods were subdivided.

EID Lok KH, Benjamin WH, Kimerling ME, Pruitt V, Mulcahy D, Robinson N, et al. Molecular Typing of Mycobacterium tuberculosis Strains with a Common Two-Band IS6110 Pattern. Emerg Infect Dis. 2002;8(11):1303-1305. https://doi.org/10.3201/eid0811.020292
AMA Lok KH, Benjamin WH, Kimerling ME, et al. Molecular Typing of Mycobacterium tuberculosis Strains with a Common Two-Band IS6110 Pattern. Emerging Infectious Diseases. 2002;8(11):1303-1305. doi:10.3201/eid0811.020292.
APA Lok, K. H., Benjamin, W. H., Kimerling, M. E., Pruitt, V., Mulcahy, D., Robinson, N....Dunlap, N. E. (2002). Molecular Typing of Mycobacterium tuberculosis Strains with a Common Two-Band IS6110 Pattern. Emerging Infectious Diseases, 8(11), 1303-1305. https://doi.org/10.3201/eid0811.020292.

Spoligologos: A Bioinformatic Approach to Displaying and Analyzing Mycobacterium tuberculosis Data [PDF - 234 KB - 4 pages]
J. R. Driscoll et al.

Spacer oligonucleotide (spoligotyping) analysis is a rapid polymerase chain reaction–based method of DNA fingerprinting the Mycobacterium tuberculosis complex. We examined spoligotype data using a bioinformatic tool (sequence logo analysis) to elucidate undisclosed phylogenetic relationships and gain insights into the global dissemination of strains of tuberculosis. Logo analysis of spoligotyping data provides a simple way to describe a fingerprint signature and may be useful in categorizing unique spoligotypes patterns as they are discovered. Large databases of DNA fingerprint information, such as those from the U.S. National Tuberculosis Genotyping and Surveillance Network and the European Concerted Action on Tuberculosis, contain information on thousands of strains from diverse regions. The description of related spoligotypes has depended on exhaustive listings of the individual spoligotyping patterns. Logo analysis may become another useful graphic method of visualizing and presenting spoligotyping clusters from these databases.

EID Driscoll JR, Bifani PJ, Mathema B, McGarry MA, Zickas GM, Kreiswirth BN, et al. Spoligologos: A Bioinformatic Approach to Displaying and Analyzing Mycobacterium tuberculosis Data. Emerg Infect Dis. 2002;8(11):1306-1309. https://doi.org/10.3201/eid0811.020174
AMA Driscoll JR, Bifani PJ, Mathema B, et al. Spoligologos: A Bioinformatic Approach to Displaying and Analyzing Mycobacterium tuberculosis Data. Emerging Infectious Diseases. 2002;8(11):1306-1309. doi:10.3201/eid0811.020174.
APA Driscoll, J. R., Bifani, P. J., Mathema, B., McGarry, M. A., Zickas, G. M., Kreiswirth, B. N....Taber, H. W. (2002). Spoligologos: A Bioinformatic Approach to Displaying and Analyzing Mycobacterium tuberculosis Data. Emerging Infectious Diseases, 8(11), 1306-1309. https://doi.org/10.3201/eid0811.020174.

Molecular Differentiation of Mycobacterium tuberculosis Strains without IS6110 Insertions [PDF - 467 KB - 4 pages]
K. H. Lok et al.

By using standard restriction fragment length polymorphism, 6 zero-copy IS6110 Mycobacterium tuberculosis isolates were identified from 1,180 Maryland isolates as part of the National Tuberculosis Genotyping Surveillance Network Project. By using various genotyping methods, we demonstrated that this zero band cluster can be differentiated into six genotypes.

EID Lok KH, Benjamin WH, Kimerling ME, Pruitt V, Lathan M, Razeq J, et al. Molecular Differentiation of Mycobacterium tuberculosis Strains without IS6110 Insertions. Emerg Infect Dis. 2002;8(11):1310-1313. https://doi.org/10.3201/eid0811.020291
AMA Lok KH, Benjamin WH, Kimerling ME, et al. Molecular Differentiation of Mycobacterium tuberculosis Strains without IS6110 Insertions. Emerging Infectious Diseases. 2002;8(11):1310-1313. doi:10.3201/eid0811.020291.
APA Lok, K. H., Benjamin, W. H., Kimerling, M. E., Pruitt, V., Lathan, M., Razeq, J....Dunlap, N. E. (2002). Molecular Differentiation of Mycobacterium tuberculosis Strains without IS6110 Insertions. Emerging Infectious Diseases, 8(11), 1310-1313. https://doi.org/10.3201/eid0811.020291.

DNA Fingerprinting of Mycobacterium tuberculosis: Lessons Learned and Implications for the Future [PDF - 250 KB - 6 pages]
S. J. McNabb et al.

DNA fingerprinting of Mycobacterium tuberculosis—a relatively new laboratory technique—offers promise as a powerful aid in the prevention and control of tuberculosis (TB). Established in 1996 by the Centers for Disease Control and Prevention (CDC), the National Tuberculosis Genotyping Surveillance Network was a 5-year prospective, population-based study of DNA fingerprinting conducted from 1996 to 2000. The data from this study suggest multiple molecular epidemiologic and program management uses for DNA fingerprinting in TB public health practice. From these data, we also gain a clearer understanding of the overall diversity of M. tuberculosis strains as well as the presence of endemic strains in the United States. We summarize the key findings and the impact that DNA fingerprinting may have on future approaches to TB control. Although challenges and limitations to the use of DNA fingerprinting exist, the widespread implementation of the technique into routine TB prevention and control practices appears scientifically justified.

EID McNabb SJ, Braden CR, Navin TR. DNA Fingerprinting of Mycobacterium tuberculosis: Lessons Learned and Implications for the Future. Emerg Infect Dis. 2002;8(11):1314-1319. https://doi.org/10.3201/eid0811.020402
AMA McNabb SJ, Braden CR, Navin TR. DNA Fingerprinting of Mycobacterium tuberculosis: Lessons Learned and Implications for the Future. Emerging Infectious Diseases. 2002;8(11):1314-1319. doi:10.3201/eid0811.020402.
APA McNabb, S. J., Braden, C. R., & Navin, T. R. (2002). DNA Fingerprinting of Mycobacterium tuberculosis: Lessons Learned and Implications for the Future. Emerging Infectious Diseases, 8(11), 1314-1319. https://doi.org/10.3201/eid0811.020402.
Volume 8, Number 11—November 2002 - Continued

Research

Rifampin- and Multidrug-Resistant Tuberculosis in Russian Civilians and Prison Inmates: Dominance of the Beijing Strain Family [PDF - 691 KB - 7 pages]
F. Drobniewski et al.

Consecutive patient cultures (140) of Mycobacteriium tuberculosis were collected from five Russian civilian and prison tuberculosis laboratories and analyzed for rifampin (rpoB) and isoniazid resistance (inhA, katG, ahpC); transmission of Beijing family isolates; and the importance of prison and previous therapy in drug resistance. Rifampin, isoniazid, and multidrug resistance occurred in 58.2%, 51.6%, and 44.7% of cultures, respectively; 80% of prison cultures were rifampin resistant. Spoligotyping and variable number tandem repeat (VNTR) fingerprinting divided the isolates into 43 groups. Spoligotyping demonstrated that a high proportion (68.1%) of patients were infected with Beijing family strains and that most (69.1%) were rifampin resistant; the highest proportion (81.6%) occurred in prison. One VNTR subgroup (42435) comprised 68 (72.3%) of the Beijing isolates with a small number of IS6110 types; 50 (73.5%) were rifampin resistant. Rifampin-resistant Beijing isolates are dominant within the patient population, especially among prisoners, and threaten treatment programs.

EID Drobniewski F, Balabanova Y, Ruddy M, Weldon L, Jeltkova K, Brown T, et al. Rifampin- and Multidrug-Resistant Tuberculosis in Russian Civilians and Prison Inmates: Dominance of the Beijing Strain Family. Emerg Infect Dis. 2002;8(11):1320-1326. https://doi.org/10.3201/eid0811.020507
AMA Drobniewski F, Balabanova Y, Ruddy M, et al. Rifampin- and Multidrug-Resistant Tuberculosis in Russian Civilians and Prison Inmates: Dominance of the Beijing Strain Family. Emerging Infectious Diseases. 2002;8(11):1320-1326. doi:10.3201/eid0811.020507.
APA Drobniewski, F., Balabanova, Y., Ruddy, M., Weldon, L., Jeltkova, K., Brown, T....Fedorin, I. (2002). Rifampin- and Multidrug-Resistant Tuberculosis in Russian Civilians and Prison Inmates: Dominance of the Beijing Strain Family. Emerging Infectious Diseases, 8(11), 1320-1326. https://doi.org/10.3201/eid0811.020507.

Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program [PDF - 516 KB - 7 pages]
M. d. García-García et al.

To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates.

EID García-García Md, Ponce-de-León A, García-Sancho MC, Ferreyra-Reyes L, Palacios-Martínez M, Fuentes J, et al. Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program. Emerg Infect Dis. 2002;8(11):1327-1333. https://doi.org/10.3201/eid0811.020021
AMA García-García Md, Ponce-de-León A, García-Sancho MC, et al. Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program. Emerging Infectious Diseases. 2002;8(11):1327-1333. doi:10.3201/eid0811.020021.
APA García-García, M. d., Ponce-de-León, A., García-Sancho, M. C., Ferreyra-Reyes, L., Palacios-Martínez, M., Fuentes, J....Sifuentes-Osornio, J. (2002). Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program. Emerging Infectious Diseases, 8(11), 1327-1333. https://doi.org/10.3201/eid0811.020021.

Molecular Analysis of Sarcoidosis Tissues for Mycobacterium Species DNA [PDF - 356 KB - 13 pages]
W. P. Drake et al.

We performed polymerase chain reaction analysis, for Mycobacterium species 16S rRNA, rpoB, and IS6110 sequences, on 25 tissue specimens from patients with sarcoidosis and on 25 control tissue specimens consisting of mediastinal or cervical lymph nodes and lung biopsies. Mycobacterium species 16S rRNA sequences were amplified from 12 (48%) rpoB sequences from 6 (24%) of the sarcoidosis specimens. In total, 16S rRNA or rpoB sequences were amplified from 15 sarcoidosis specimens (60%) but were not detected in any of the control tissues (p=0.00002, Chi square). In three specimens, the sequences resembled Mycobacterium species other than M. tuberculosis. All specimens with sequences consistent with M. tuberculosis were negative for IS6110. We provide evidence that one of a variety of Mycobacterium species, especially organisms resembling M. tuberculosis, is found in most patients with sarcoidosis.

EID Drake WP, Pei Z, Pride DT, Collins RD, Cover TL, Blaser MJ. Molecular Analysis of Sarcoidosis Tissues for Mycobacterium Species DNA. Emerg Infect Dis. 2002;8(11):1334-1341. https://doi.org/10.3201/eid0811.020318
AMA Drake WP, Pei Z, Pride DT, et al. Molecular Analysis of Sarcoidosis Tissues for Mycobacterium Species DNA. Emerging Infectious Diseases. 2002;8(11):1334-1341. doi:10.3201/eid0811.020318.
APA Drake, W. P., Pei, Z., Pride, D. T., Collins, R. D., Cover, T. L., & Blaser, M. J. (2002). Molecular Analysis of Sarcoidosis Tissues for Mycobacterium Species DNA. Emerging Infectious Diseases, 8(11), 1334-1341. https://doi.org/10.3201/eid0811.020318.
Dispatches

Genomewide Pattern of Synonymous Nucleotide Substitution in Two Complete Genomes of Mycobacterium tuberculosis [PDF - 719 KB - 5 pages]
A. L. Hughes et al.

Comparison of the pattern of synonymous nucleotide substitution between two complete genomes of Mycobacterium tuberculosis at 3,298 putatively orthologous loci showed a mean percent difference per synonymous site of 0.000328 ± 0.000022. Although 80.5% of loci showed no synonymous or nonsynonymous nucleotide differences, the level of polymorphism observed at other loci was greater than suggested by previous studies of a small number of loci. This level of nucleotide difference leads to the conservative estimate that the common ancestor of these two genotypes occurred approximately 35,000 ago, which is twice as high as some recent estimates of the time of origin of this species. Our results suggest that a large number of loci should be examined for an accurate assessment of the level of nucleotide diversity in natural populations of pathogenic microorganisms.

EID Hughes AL, Friedman R, Murray MB. Genomewide Pattern of Synonymous Nucleotide Substitution in Two Complete Genomes of Mycobacterium tuberculosis. Emerg Infect Dis. 2002;8(11):1342-1346. https://doi.org/10.3201/eid0811.020064
AMA Hughes AL, Friedman R, Murray MB. Genomewide Pattern of Synonymous Nucleotide Substitution in Two Complete Genomes of Mycobacterium tuberculosis. Emerging Infectious Diseases. 2002;8(11):1342-1346. doi:10.3201/eid0811.020064.
APA Hughes, A. L., Friedman, R., & Murray, M. B. (2002). Genomewide Pattern of Synonymous Nucleotide Substitution in Two Complete Genomes of Mycobacterium tuberculosis. Emerging Infectious Diseases, 8(11), 1342-1346. https://doi.org/10.3201/eid0811.020064.

Global Distribution of Mycobacterium tuberculosis Spoligotypes [PDF - 179 KB - 3 pages]
I. Filliol et al.

We present a short summary of recent observations on the global distribution of the major clades of the Mycobacterium tuberculosis complex, the causative agent of tuberculosis. This global distribution was defined by data-mining of an international spoligotyping database, SpolDB3. This database contains 11,708 patterns from as many clinical isolates originating from more than 90 countries. The 11,708 spoligotypes were clustered into 813 shared types. A total of 1,300 orphan patterns (clinical isolates showing a unique spoligotype) were also detected.

EID Filliol I, Driscoll JR, van Soolingen D, Kreiswirth BN, Kremer K, Valétudie G, et al. Global Distribution of Mycobacterium tuberculosis Spoligotypes. Emerg Infect Dis. 2002;8(11):1347-1349. https://doi.org/10.3201/eid0811.020125
AMA Filliol I, Driscoll JR, van Soolingen D, et al. Global Distribution of Mycobacterium tuberculosis Spoligotypes. Emerging Infectious Diseases. 2002;8(11):1347-1349. doi:10.3201/eid0811.020125.
APA Filliol, I., Driscoll, J. R., van Soolingen, D., Kreiswirth, B. N., Kremer, K., Valétudie, G....Rastogi, N. (2002). Global Distribution of Mycobacterium tuberculosis Spoligotypes. Emerging Infectious Diseases, 8(11), 1347-1349. https://doi.org/10.3201/eid0811.020125.

Two Cases of Pulmonary Tuberculosis Caused by Mycobacterium tuberculosis subsp. canetti [PDF - 314 KB - 3 pages]
J. Miltgen et al.

We identified an unusual strain of mycobacteria from two patients with pulmonary tuberculosis by its smooth, glossy morphotype and, primarily, its genotypic characteristics. Spoligotyping and restriction fragment length polymorphism typing were carried out with the insertion sequence IS6110 patterns. All known cases of tuberculosis caused by Mycobacterium canetti have been contracted in the Horn of Africa.

EID Miltgen J, Morillon M, Koeck J, Varnerot A, Briant J, Nguyen G, et al. Two Cases of Pulmonary Tuberculosis Caused by Mycobacterium tuberculosis subsp. canetti. Emerg Infect Dis. 2002;8(11):1350-1352. https://doi.org/10.3201/eid0811.020017
AMA Miltgen J, Morillon M, Koeck J, et al. Two Cases of Pulmonary Tuberculosis Caused by Mycobacterium tuberculosis subsp. canetti. Emerging Infectious Diseases. 2002;8(11):1350-1352. doi:10.3201/eid0811.020017.
APA Miltgen, J., Morillon, M., Koeck, J., Varnerot, A., Briant, J., Nguyen, G....Vincent, V. (2002). Two Cases of Pulmonary Tuberculosis Caused by Mycobacterium tuberculosis subsp. canetti. Emerging Infectious Diseases, 8(11), 1350-1352. https://doi.org/10.3201/eid0811.020017.
Letters

Mycobacterium haemophilum: Emerging or Underdiagnosed in Brazil? [PDF - 165 KB - 2 pages]
J. Sampaio et al.
EID Sampaio J, Alves VA, Leão SC, Dolabela de Magalhães V, Martino MD, Mendes CM, et al. Mycobacterium haemophilum: Emerging or Underdiagnosed in Brazil?. Emerg Infect Dis. 2002;8(11):1359-1360. https://doi.org/10.3201/eid0811.020492
AMA Sampaio J, Alves VA, Leão SC, et al. Mycobacterium haemophilum: Emerging or Underdiagnosed in Brazil?. Emerging Infectious Diseases. 2002;8(11):1359-1360. doi:10.3201/eid0811.020492.
APA Sampaio, J., Alves, V. A., Leão, S. C., Dolabela de Magalhães, V., Martino, M. D., Mendes, C. M....Leite, J. P. (2002). Mycobacterium haemophilum: Emerging or Underdiagnosed in Brazil?. Emerging Infectious Diseases, 8(11), 1359-1360. https://doi.org/10.3201/eid0811.020492.

Children and Multidrug-Resistant Tuberculosis in Mumbai (Bombay), India [PDF - 159 KB - 2 pages]
S. Karande and S. B. Bavdekar
EID Karande S, Bavdekar SB. Children and Multidrug-Resistant Tuberculosis in Mumbai (Bombay), India. Emerg Infect Dis. 2002;8(11):1360-1361. https://doi.org/10.3201/eid0811.020513
AMA Karande S, Bavdekar SB. Children and Multidrug-Resistant Tuberculosis in Mumbai (Bombay), India. Emerging Infectious Diseases. 2002;8(11):1360-1361. doi:10.3201/eid0811.020513.
APA Karande, S., & Bavdekar, S. B. (2002). Children and Multidrug-Resistant Tuberculosis in Mumbai (Bombay), India. Emerging Infectious Diseases, 8(11), 1360-1361. https://doi.org/10.3201/eid0811.020513.
Another Dimension

At the Deathbed of Consumptive Art [PDF - 577 KB - 6 pages]
D. M. Morens
EID Morens DM. At the Deathbed of Consumptive Art. Emerg Infect Dis. 2002;8(11):1353-1358. https://doi.org/10.3201/eid0811.020549
AMA Morens DM. At the Deathbed of Consumptive Art. Emerging Infectious Diseases. 2002;8(11):1353-1358. doi:10.3201/eid0811.020549.
APA Morens, D. M. (2002). At the Deathbed of Consumptive Art. Emerging Infectious Diseases, 8(11), 1353-1358. https://doi.org/10.3201/eid0811.020549.
Books and Media

Cestode Zoonoses: Echinococcosis and Cysticercosis: An Emergent and Global Problem [PDF - 149 KB - 1 page]
F. O. Richards
EID Richards FO. Cestode Zoonoses: Echinococcosis and Cysticercosis: An Emergent and Global Problem. Emerg Infect Dis. 2002;8(11):1362. https://doi.org/10.3201/eid0811.020422
AMA Richards FO. Cestode Zoonoses: Echinococcosis and Cysticercosis: An Emergent and Global Problem. Emerging Infectious Diseases. 2002;8(11):1362. doi:10.3201/eid0811.020422.
APA Richards, F. O. (2002). Cestode Zoonoses: Echinococcosis and Cysticercosis: An Emergent and Global Problem. Emerging Infectious Diseases, 8(11), 1362. https://doi.org/10.3201/eid0811.020422.

Immunology of Infectious Diseases [PDF - 224 KB - 2 pages]
T. Lazar
EID Lazar T. Immunology of Infectious Diseases. Emerg Infect Dis. 2002;8(11):1362-1363. https://doi.org/10.3201/eid0811.020430
AMA Lazar T. Immunology of Infectious Diseases. Emerging Infectious Diseases. 2002;8(11):1362-1363. doi:10.3201/eid0811.020430.
APA Lazar, T. (2002). Immunology of Infectious Diseases. Emerging Infectious Diseases, 8(11), 1362-1363. https://doi.org/10.3201/eid0811.020430.
About the Cover

Amedeo Modigliani (1884-1920). Self-Portrait, 1919. [PDF - 2.87 MB - 1 page]
P. Potter
EID Potter P. Amedeo Modigliani (1884-1920). Self-Portrait, 1919.. Emerg Infect Dis. 2002;8(11):1364. https://doi.org/10.3201/eid0811.ac0811
AMA Potter P. Amedeo Modigliani (1884-1920). Self-Portrait, 1919.. Emerging Infectious Diseases. 2002;8(11):1364. doi:10.3201/eid0811.ac0811.
APA Potter, P. (2002). Amedeo Modigliani (1884-1920). Self-Portrait, 1919.. Emerging Infectious Diseases, 8(11), 1364. https://doi.org/10.3201/eid0811.ac0811.
Corrections

Correction, Vol. 8, No. 7 [PDF - 155 KB - 1 page]
EID Correction, Vol. 8, No. 7. Emerg Infect Dis. 2002;8(11):1363. https://doi.org/10.3201/eid0811.c10811
AMA Correction, Vol. 8, No. 7. Emerging Infectious Diseases. 2002;8(11):1363. doi:10.3201/eid0811.c10811.
APA (2002). Correction, Vol. 8, No. 7. Emerging Infectious Diseases, 8(11), 1363. https://doi.org/10.3201/eid0811.c10811.
Page created: April 19, 2012
Page updated: April 19, 2012
Page reviewed: April 19, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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