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

• Published in: The international journal of tuberculosis and lung disease Vol. 18; no. 5; pp. 552 - 558
• Main Authors: Thomas, T. A., Heysell, S. K., Houpt, E. R., Moore, J. L., Keller, S. J.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01-05-2014; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Antitubercular Agents - therapeutic use; Bacterial diseases; Bacteriological Techniques; Biological and medical sciences; Child; Cluster Analysis; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial - analysis; Drug Resistance; Drug Resistance, Bacterial; Female; Genotype; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Mycobacterium tuberculosis; Mycobacterium tuberculosis - genetics; Pediatrics; Pnca Protein; Pneumology; Predictive Value of Tests; Pyrazinamide - therapeutic use; Retrospective Studies; Risk Factors; Social Media; Time Factors; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - transmission; Tuberculosis and atypical mycobacterial infections; Virginia; Virginia - epidemiology; United States; North America; Virginia; America; Cluster analysis; Pediatrics; Automatic classification; Identification; Mycobacterial infection; Antituberculous agent; Child; social media; Social aspect; Public health; Human; Epidemic; pncA protein; Treatment resistance; Typing; Respiratory disease; Media; Genotype; Pyrazinamide; Protein; Infection; Tuberculosis; Bacteriosis; Social analysis; Mass media; drug resistance; Antibacterial agent; Virginia
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.13.0663

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.