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Journal of Clinical Microbiology, February 2005, p. 870-878, Vol. 43, No. 2
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.2.870-878.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Long-Term Molecular Analysis of Tuberculosis Strains in Alabama, a State Characterized by a Largely Indigenous, Low-Risk Population{dagger}

Mirjam-Colette Kempf,1* Nancy E. Dunlap,1,2 Kerry H. Lok,1 William H. Benjamin Jr.,2,3 Nancy B. Keenan,4 and Michael E. Kimerling5,6

Division of Pulmonary and Critical Care Medicine,1 Department of Microbiology,2 Department of Pathology,3 Division of General Internal Medicine,6 Department of Epidemiology, University of Alabama at Birmingham,5 Alabama Department of Public Health, Montgomery, Alabama4

Received 14 May 2004/ Returned for modification 4 August 2004/ Accepted 10 September 2004

With a tuberculosis case detection rate of 5.9 per 100,000 population in 2001, Alabama ranked twelfth highest in the United States. However, cases among foreign-born and human immunodeficiency virus-infected individuals remain low in Alabama. To understand the endemic statewide disease pattern, tuberculosis strains were studied for clustering in a long-term population-based study from January 1994 to May 2000. IS6110 restriction fragment length polymorphism analysis was performed for 1,834 strains. Spoligotyping was used as a secondary typing method for the 37% of isolates displaying a restriction fragment length polymorphism pattern with <6 IS6110 copies. A total of 721 (41%) patients provided isolates that composed 114 clusters, each containing isolates from 2 to 136 patients, suggesting that recent transmission accounted for 35% of tuberculosis cases. Demographic, behavioral, and clinical characteristics of patients with clustered versus nonclustered isolates stratified by low-copy-number strains (<6 IS6110 copies) versus high-copy-number strains (≥6 IS6110 copies) were evaluated. Younger age, black race, a history of alcohol abuse, and homelessness were predictors of clustering of low-copy-number, strains and younger age, urban residency, alcohol abuse, homelessness, noninjection drug use, and a history of incarceration and/or cavitary disease were predictors of clustering of high-copy-number strains. By identifying local characteristics of tuberculosis clustering through molecular fingerprinting, control programs can distribute their limited resources to impact the transmission of tuberculosis in high-risk populations and evaluate strain distribution across geographical areas.

* Corresponding author. Mailing address: Department of Epidemiology, RPHB 217G, 1530 3rd Ave. South, Birmingham, AL 35294-0022. Phone: (205) 934-7186. Fax: (205) 975-3329. E-mail: Mkempf{at}uab.edu.

{dagger} Present address: Genetic Core Facility, Biochemistry and Molecular Division, Department of Nutrition Science School of Health-Related Professions, University of Alabama at Birmingham, Birmingham, AL 35294.

Journal of Clinical Microbiology, February 2005, p. 870-878, Vol. 43, No. 2
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.2.870-878.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • France, A. M., Cave, M. D., Bates, J. H., Foxman, B., Chu, T., Yang, Z. (2007). What's Driving the Decline in Tuberculosis in Arkansas? A Molecular Epidemiologic Analysis of Tuberculosis Trends in a Rural, Low-Incidence Population, 1997 2003. Am J Epidemiol 166: 662-671 [Abstract] [Full Text]  


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