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January 24, 1996

Transmission of Tuberculosis Among the Urban Homeless

Author Affiliations

From the Division of Infectious Diseases, Department of Medicine (Drs Barnes and Jones and Ms Otaya), and the Department of Preventive Medicine (Dr Preston-Martin), University of Southern California School of Medicine, Los Angeles; the Departments of Pathology (Drs El-Hajj and Eisenach) and Anatomy (Dr Cave), University of Arkansas for Medical Sciences, and Medical Research Service, McLellan Memorial Veterans Hospital (Drs El-Hajj, Cave, and Eisenach), Little Rock, Ark; and Statology, Tahoe Paradise, Calif (Dr Pogoda).

JAMA. 1996;275(4):305-307. doi:10.1001/jama.1996.03530280057037

Objective.  —To determine the relative frequencies of primary and reactivation tuberculosis in the urban homeless.

Design.  —Prospective evaluation of homeless tuberculosis patients.

Setting.  —Central Los Angeles, Calif.

Patients.  —Thirty-four homeless patients with culture-proven tuberculosis.

Interventions.  —IS61 10-based restriction fragment length polymorphism (RFLP) analysis was performed on Mycobacterium tuberculosis isolates. If results were inconclusive, pTBN12-based RFLP analysis was performed.

Main Outcome Measure.  —Clustering of M tuberculosis isolates. A cluster consisted of two or more isolates with indistinguishable RFLP patterns.

Results.  —Twenty-four of 34 homeless patients had clustered isolates in six clusters.

Conclusions.  —The minimum percentage of cases due to primary tuberculosis in the homeless was estimated to be 53%, compared with the traditional estimate of 10% in the general population. The results suggest that primary tuberculosis caused the majority of tuberculosis cases in this population of the urban homeless in central Los Angeles.(JAMA. 1996;275:305-307)