N Engl J Med. 1992 Jan 23;326(4):231-5. Unique Identifier : AIDSLINE
BACKGROUND. Tuberculosis typically develops from a reactivation of
latent infection. Clinical tuberculosis may also arise from a primary
infection, and this is thought to be more likely in persons infected
with the human immunodeficiency virus (HIV). However, the relative
importance of these two pathogenetic mechanisms in this population is
unclear. METHODS. Between December 1990 and April 1991, tuberculosis was
diagnosed in 12 residents of a housing facility for HIV-infected
persons. In the preceding six months, two patients being treated for
tuberculosis had been admitted to the facility. We investigated this
outbreak using standard procedures plus analysis of the cultured
organisms with restriction-fragment-length polymorphisms (RFLPs).
RESULTS. Organisms isolated from all 11 of the culture-positive
residents had similar RFLP patterns, whereas the isolates from the 2
patients treated for tuberculosis in the previous six months were
different strains. This implicated the first of the 12 patients with
tuberculosis as the source of this outbreak. Among the 30 residents
exposed to possible infection, active tuberculosis developed in 11 (37
percent), and 4 others (13 percent) had newly positive tuberculin skin
tests. Of 28 staff members with possible exposure, at least 6 had
positive tuberculin-test reactions, but none had tuberculosis.
CONCLUSIONS. Newly acquired tuberculous infection in HIV-infected
patients can spread readily and progress rapidly to active disease.
There should be heightened surveillance for tuberculosis in facilities
where HIV-infected persons live, and investigation of contacts must be
undertaken promptly and be focused more broadly than is usual.
Adult Contact Tracing *Disease Outbreaks Female Human HIV
Infections/*COMPLICATIONS Male Middle Age Polymorphism, Restriction
Fragment Length Residential Facilities San Francisco Support,
Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Tuberculosis,
Pulmonary/EPIDEMIOLOGY/MICROBIOLOGY/*TRANSMISSION JOURNAL ARTICLE