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Journal of Clinical Microbiology, December 2004, p. 5931-5934, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5931-5934.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Conventional and Molecular Epidemiology of Tuberculosis in Homeless Patients in Budapest, Hungary

Judit Lukács,1,{dagger} Vilmos Tubak,2,{dagger} Judit Mester,3 Sándor Dávid,3 Zoltán Bártfai,1 Tanja Kubica,4 Stefan Niemann,4 and Ákos Somoskövi1*

Department of Respiratory Medicine, School of Medicine, Semmelweis University,1 Korányi National Institute for Tuberculosis and Respiratory Medicine, Budapest,3 Creative Laboratory Ltd., Szeged, Hungary,2 National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany4

Received 9 April 2004/ Returned for modification 8 June 2004/ Accepted 11 August 2004

In Hungary the incidence of tuberculosis among the homeless population was 676 per 100,000 in 2002. Sixty-nine percent (140 patients) of all homeless tuberculosis patients were notified in Budapest (the capital). Therefore, a retrospective study that included 66 homeless tuberculosis patients notified in Budapest in 2002 was conducted to determine the rate of recent transmission of the disease and medical risk factors and to identify transmission pathways by means of conventional and molecular epidemiologic methods. IS6110 DNA fingerprinting revealed that 71.2% of the isolates could be clustered. Thirty-four (51.5%) patients belonged to five major clusters (size, from 4 to 11 individuals), and 13 (19.7%) belonged to six smaller clusters. Additional analysis of patient records found that 2 (18%) of the 11 patients in cluster A, 3 (37.5%) of the 8 patients in cluster B, and 2 (33%) of the 6 patients in cluster C were residents of the same three homeless shelters during the diagnosis of tuberculosis. Review of the database of the National Tuberculosis Surveillance Center (NTSC) revealed that 21.2% of the cases have not been reported to the NTSC. These findings indicate that the screening and treatment of tuberculosis among the homeless need to be strengthened and also warrant the review of environmental control steps in public shelters. Improvement of adherence of clinicians to surveillance reporting regulations is also necessary.

* Corresponding author. Mailing address: Department of Respiratory Medicine, School of Medicine, Semmelweis University, Budapest, Hungary. Phone: 36-1-355-8682. Fax: 36-1-214-2498. E-mail: akos{at}pulm.sote.hu.

{dagger} J.L. and V.T. contributed equally to this work.

Journal of Clinical Microbiology, December 2004, p. 5931-5934, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5931-5934.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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