Outbreak of pyrazinamide-monoresistant tuberculosis identified using genotype cluster and social media analysis

Abstract

SUMMARY SETTING Monoresistance to pyrazinamide (PZA) has infrequently been associated with Mycobacterium tuberculosis. OBJECTIVE To report an outbreak of PZA-monoresistant M. tuberculosis in Virginia involving two genotype clusters from December 2004 to August 2010. RESULTS Thirty cases were identified involving a predominantly young, US-born population with histories of substance use and incarceration and a large proportion of children aged <15 years (n = 6, 20%); of these, 23 cases (77%) were culture-confirmed as M. tuberculosis complex. DNA fingerprinting and molecular analysis of the PZA resistance gene, pncA, demonstrated a clonal strain that was not M. bovis. Genotypic data provided the initial link between seemingly unrelated cases, and helped reveal a historic genotype cluster of cases from 2004. Further genotype cluster and contact investigation procedures, including the novel use of the social networking website Facebook.com, revealed additional links between the 2004 and 2009 genotype clusters and described an ongoing, extensive outbreak necessitating an enhanced screening and treatment protocol for contacts. CONCLUSIONS This outbreak demonstrates how tuberculosis can spread through a young, vulnerable population. The use of genotypic data and the novel incorporation of social media investigations were critical to understanding the settings and context of infectivity.

Evolutionary History and Ongoing Transmission of Phylogenetic Sublineages of Mycobacterium tuberculosis Beijing Genotype in China

“…Children present a special risk group for TB and are more susceptible to infection and disease by more transmissible strains 45 46 . However, comparative studies of adult and pediatric groups are rare due to the difficulty to isolate M. tuberculosis strains from children 26 47 48 . In this study, the availability of a large pediatric TB collection helped to assess transmissibility (and epidemic danger) of the particular subgroups within the Beijing genotype.…”

Mycobacterium bovis hip bursitis in a lung transplant recipient

“…However, PZA monoresistant M. tuberculosis outbreaks have occurred within the United States. We had chosen to use rifabutin instead of rifampin in this patient, as it is a less potent P450 inducer, given her concurrent tacrolimus use and renal insufficiency . She completed a total of 9 months of anti‐TB therapy with resolution of symptoms.…”

Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People

“…Universal screening successfully identified many AYA with untreated TB infection or disease who enrolled in the United States military, for example, but still missed some AYA and was discontinued when declining TB incidence made false-positive results more likely [102,121]. Using social media to better understand AYA social networks may also aid case-finding [122].…”