How molecular epidemiology has changed what we know about tuberculosis.

摘要: By the mid-1980s, US public health community considered tuberculosis to be under control, and a plan was established for its elimination by 2010. Between 1989 1992, however, number of cases increased, in response, scientists officials reinvigorated research control programs. These efforts have now turned tide, United States is again decreasing, being down 31% from peak resurgence.1 During this time, researchers disease controllers came together relatively new field, molecular epidemiology. This endeavor combines methods identifying individual strains bacteria with conventional epidemiologic investigate determinants distribution disease. Together they can establish transmission links, identify risk factors transmission, provide insight into pathogenesis tuberculosis. Bacterial DNA fingerprinting performed using restriction fragment-length polymorphism analysis that yields unique pattern unrelated clinical organisms an identical isolated outbreak settings. It can, used only track between persons active because technique requires viable culture Mycobacterium tuberculosis.2 In review, we present summary what has been learned about dynamics M since first description implication these lessons control. Summary points A variety social biologic foster accelerated progression tuberculosis Many populations recently had high rates transmission Transmission may disproportionately occur among identifiable subgroups specific locations Patients smears are negative acid-fast bacilli transmit infection others, although less infectious than patients positive bacilli Continued vigilance needed prevent false-positive cultures due laboratory cross-contamination People become exogenously reinfected tuberculosis, clinically indistinguishable relapsed disease Aggressive implementation currently available measures decrease