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Transmission of Mycobacterium tuberculosis Through Casual Contact With an Infectious Case
Jonathan E. Golub, MPH;
Wendy A. Cronin, MT, PhD;
Olugbenga O. Obasanjo, MD, PhD;
William Coggin, BS;
Kristina Moore, RN;
Diana S. Pope, MSN;
Deidre Thompson, BSN;
Timothy R. Sterling, MD;
Susan Harrington, MPH;
William R. Bishai, MD, PhD;
Richard E. Chaisson, MD
Arch Intern Med. 2001;161:2254-2258.
Background An ongoing restriction fragment length polymorphism study of Mycobacterium tuberculosis isolates from tuberculosis cases showed
an identical 12-band IS6110 pattern unique to 3 unrelated patients (Patients
A-C) diagnosed as having tuberculosis within a 9-month period.
Methods In an attempt to identify epidemiologic links between the 3 patients,
we performed site visits to the retail business work site of patient A and
conducted detailed interviews with all 3 patients and their contacts.
Results Patient B had visited patient A's work site 3 times during patient A's
infectious period, spending no more than 15 minutes each time. Patient C visited
patient A's work site on 6 to 10 occasions during this period for no more
than 45 minutes at any one time. There were no other epidemiologic links between
these 3 cases other than the contact at the store. Contact investigation identified
4 tuberculin skin test conversions among 8 (50%) of patient A's coworkers,
6 positive tests among 15 household contacts (40%), and 8 positive tests among
16 identified customers who were casual contacts (50%). Patient B and patient
C were most likely infected by patient A during one of their brief visits
to patient A's work site.
Conclusions These data demonstrate that some tuberculosis is spread through casual
contact not normally pursued in traditional contact investigations and that,
in certain situations, M tuberculosis can be transmitted
despite minimal duration of exposure. In addition, this outbreak emphasizes
the importance of DNA fingerprinting data for identifying unusual transmission
in unexpected settings.
From the Departments of Epidemiology (Mr Golub, Drs Obasanjo and Chaisson,
and Ms Pope) and International Health (Drs Bishai and Chaisson), The Johns
Hopkins University School of Public Health, Baltimore, Md; Maryland Department
of Health and Mental Hygiene, Baltimore (Mr Golub and Dr Cronin); and Departments
of Medicine (Drs Sterling, Bishai, and Chaisson) and Pathology (Ms Harrington),
The Johns Hopkins University School of Medicine, Baltimore; and Baltimore
City Health Department (Mr Coggin; Mss Moore, Pope, and Thompson; and Drs
Sterling and Chaisson).
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