Correspondence

Molecular Epidemiology of Tuberculosis

N Engl J Med 2003; 349:2364December 11, 2003

Article

To the Editor:

In their excellent review of the molecular epidemiology of tuberculosis, Barnes and Cave (Sept. 18 issue)1 recommend that the Centers for Disease Control and Prevention (CDC) support newer, more rapid genotyping tests. In fact, the CDC is doing just that. This winter, two genotyping laboratories will use two polymerase-chain-reaction–based methods — mycobacterial-interspersed-repetitive-units (MIRU) analysis2 and spoligotyping3 — for primary genotyping of Mycobacterium tuberculosis isolates. The laboratories will have the capacity to analyze isolates from every patient with culture-positive tuberculosis in the United States and will report results in less than two weeks. In combination, these methods are highly discriminatory. For isolates with identical MIRU and spoligotype patterns, a third genotyping method, IS6110-based fingerprinting,4 will be available, if needed, to provide further discriminatory power. We anticipate that rapid access to genotyping results will be a powerful tool for controlling and preventing tuberculosis.5

Lisa S. Rosenblum, M.D., M.P.H.
Thomas R. Navin, M.D.
Jack T. Crawford, Ph.D.
Centers for Disease Control and Prevention, Atlanta, GA 30333
lsr2@cdc.gov

5 References

1. 1

   Barnes PF, Cave MD. Molecular epidemiology of tuberculosis. N Engl J Med 2003;349:1149-1156
   Full Text | Web of Science | Medline

2. 2

   Mazars E, Lesjean S, Banuls AL, et al. High-resolution minisatellite-based typing as a portable approach to global analysis of Mycobacterium tuberculosis molecular epidemiology. Proc Natl Acad Sci U S A 2001;98:1901-1906
   CrossRef | Web of Science | Medline

3. 3

   Kamerbeek J, Schouls L, Kolk A, et al. Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 1997;35:907-914
   Web of Science | Medline

4. 4

   Van Embden JDA, Cave MD, Crawford JT, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406-409
   Web of Science | Medline

5. 5

   McNabb SJN, Braden CR, Navin TR. DNA fingerprinting of Mycobacterium tuberculosis: lessons learned and implications for the future. Emerg Infect Dis 2002;8:1314-1319
   Web of Science | Medline

To the Editor:

The review article on the molecular epidemiology of tuberculosis by Barnes and Cave is excellent. We do, however, want to point out that more than 95 percent of the new cases of tuberculosis in the world occur in developing countries, especially in the 22 high-burden countries.1 The lack of studies on the dynamics of tuberculosis in these settings with the use of new molecular techniques is alarming.

We advocate a major effort to establish a collaboration in tuberculosis research between developed and developing nations in order to shed light where it is most needed. Molecular epidemiology can be an important tool for understanding the current tuberculosis pandemic and for influencing the design of future policies in global tuberculosis control.

Jose Luis Portero, M.D., Ph.D.
Maria Rubio, M.D., D.T.M.H.
Tuberculosis Research and Training Center, 1003 Manila, Philippines
jporteronavio@yahoo.com

1 References

1. 1

   Global tuberculosis control: surveillance, planning, financing. WHO report 2003. Geneva: World Health Organization, 2003. (WHO/CDS/TB2003.316.)
   

Citing Articles (3)

Citing Articles

1. 1

   C. Brooke Steele, Valerie Richmond-Reese, Sherry Lomax. (2006) Racial and Ethnic Disparities in HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis among Women. Journal of Women's Health 15:2, 116-122
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2. 2

   Eileen Schneider, Marisa Moore, Kenneth G. Castro. (2005) Epidemiology of Tuberculosis in the United States. Clinics in Chest Medicine 26:2, 183-195
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3. 3

   N. Malakmadze, I. M. Gonzalez, T. Oemig, I. Isiadinso, D. Rembert, M. M. McCauley, P. Wand, L. Diem, L. Cowan, G. J. Palumbo, M. Fraser, K. Ijaz. (2005) Unsuspected Recent Transmission of Tuberculosis among High-Risk Groups: Implications of Universal Tuberculosis Genotyping in Its Detection. Clinical Infectious Diseases 40:3, 366-373
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