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Journal of Clinical Microbiology, February 1998, p. 486-492, Vol. 36, No. 2
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Molecular Fingerprinting of Mycobacterium tuberculosis and Risk Factors for Tuberculosis Transmission in Paris, France, and Surrounding Area

M. C. Gutiérrez,1 V. Vincent,1,* D. Aubert,2 J. Bizet,3 O. Gaillot,4 L. Lebrun,5 C. Le Pendeven,6 M. P. Le Pennec,7 D. Mathieu,8 C. Offredo,9 B. Pangon,10 and C. Pierre-Audigier11

Centre National de Référence des Mycobactéries, Institut Pasteur, 75724 Paris,1 Service de Microbiologie, Hôpital Max Fourestier, 92000 Nanterre,2 Laboratoire de Microbiologie, Hôpital des Prisons de Fresnes, 94261 Fresnes,3 Service de Microbiologie, Hôpital Antoine Béclère, 92141 Clamart,5 Laboratoire Départemental de Seine Saint Denis, 93140 Bondy,6 Service de Microbiologie, Hôpital Robet Ballanger, 93602 Aulnay sur Bois,7 Service de Microbiologie, Hôpital Paul Brousse, 94800 Villejuif,8 Service de Microbiologie, Hôpital Laënnec, 75007 Paris,9 Centre Hospitalier de Versailles, 78000 Versailles,10 Service de Microbiologie, Hôpital Necker-Enfants-Malades, 75015 Paris,11 and Service de Microbiologie, Hôpital Boucicaut, 75015 Paris,4 France

Received 7 August 1997/Returned for modification 1 October 1997/Accepted 4 November 1997

Forty-three percent of the tuberculosis cases reported in France are from the Ile de France region. The incidence of tuberculosis in this region is 33 cases per 100,000 inhabitants, twice the national average. A restriction fragment length polymorphism (RFLP) analysis was performed with clinical isolates of Mycobacterium tuberculosis isolated during 1995 in 10 hospitals in Paris and surrounding areas to detect tuberculosis transmission and define the factors associated with clustering in this population. The molecular markers used were the insertion sequence IS6110 and the direct repeat (DR) sequence. Social, demographic, and clinical data were collected from the patients' medical files. Ten patients with isolates with a single copy of IS6110 were excluded from further analysis. Twenty-four patients with false-positive cultures due to laboratory contamination (based on RFLP analysis with IS6110 and examination of patient data) were also excluded. The study was then conducted with 272 strains isolated from 272 patients. Further fingerprinting was performed by using the DR element with strains with patterns by RFLP analysis with IS6110 that differed by one band only and strains with identical patterns by RFLP analysis with IS6110 and with low numbers of copies of IS6110. The combined use of both markers identified unique patterns for 177 strains and clustered 95 (35.7%) strains in 26 groups, each containing isolates from 2 to 12 patients. The clustering was strongly associated with homelessness and the male sex. It was not associated with age, birth in a foreign country, human immunodeficiency virus positivity, or residence in hostels or prison. Isolates from homeless people were often included in large clusters, and homeless people could be the source of tuberculosis transmission for more than 50% of the clustered patients. These results suggest that homeless people play a key role in the spread of M. tuberculosis in the community and that poor socioeconomic conditions are the main risk factors associated with active tuberculosis transmission.

* Corresponding author. Mailing address: Centre National de Référence des Mycobactéries, Institut Pasteur, 25 rue du Dr. Roux, 75724 Paris cedex 15, France. Phone: (33) (1) 45688360. Fax: (33) (1) 40613118. E-mail: vvincent{at}pasteur.fr.

Journal of Clinical Microbiology, February 1998, p. 486-492, Vol. 36, No. 2
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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