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REPLY
Epidemiology of Mycobacterium kansasii
Karen C. Bloch, MD, MPH;
Duc J. Vugia, MD, MPH; and
Arthur L. Reingold, MD
17 August 1999 | Volume 131 Issue 4 | Page 311
IN RESPONSE:
Alcaide and colleagues suggest that defining the molecular characteristics of M. kansasii strains isolated from patients in our study would have been helpful in delineating pathogenicity and patterns of transmission. DNA fingerprinting has been used to establish the molecular epidemiology of other species of mycobacteria. Restriction fragment length polymorphism has been pivotal in establishing transmission patterns of M. tuberculosis in well-defined outbreaks (1) and population-based community studies (2). This technique has been used to show that M. avium isolates cultured from HIV-infected persons residing in different cities are genetically unique, whereas clusters of genetically identical organisms may be found among individuals living in a single city (3).
Significant genetic heterogeneity exists among clinical isolates of M. kansasii (4, 5), suggesting that molecular analysis may also play an important role in elucidating patterns of transmission and disease due to M. kansasii. Unfortunately, the retrospective nature of our study did not allow for detailed microbiological or molecular testing because the isolates were no longer available for analysis. Furthermore, the significance of detecting genetic clusters of M. kansasii is unclear. Unlike M. tuberculosis, which is an obligate human pathogen, M. kansasii has been isolated from environmental sources (5), and clonality may represent either person-to-person transmission or a common environmental source. As we emphasized in the Discussion section of our paper, prospective studies incorporating detailed epidemiologic histories, genetic typing of isolates, and environmental cultures are needed to clarify the natural reservoir and mode of transmission for M. kansasii.
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Author and Article Information
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Vanderbilt University School of Medicine; Nashville, TN 37232-2605 (Bloch)
California Department of Health Services; Berkeley, CA 94704-1011 (Vugia)
University of California, Berkeley, School of Public Health; Berkeley, CA 94720-7360 (Reingold)
1. Daley CL, Small PM, Schecter GF, Schoolnik GK, McAdam RA, Jacobs WR Jr, et al. An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus. An analysis using restriction-fragment-length polymorphisms N Engl J Med. 1992;326:231-5.[Abstract]
2. Bradford WZ, Koehler J, El-Hajj H, Hopewell PC, Reingold AL, Agasino CB, et al. Dissemination of Mycobacterium tuberculosis across the San Francisco Bay Area J Infect Dis. 1998;177:1104-7.[Medline]
3. Mazurek GH, Chin DP, Hartman S, Reddy V, Horsburgh CR Jr, Green TA, et al. Genetic similarity among Mycobacterium avium isolates from blood, stool, and sputum of persons with AIDS J Infect Dis. 1997;176:976-83.[Medline]
4. Iinuma Y, Ichiyama S, Hasegawa Y, Shimokata K, Kawahara S, Matsushima T. Large-restriction-fragment analysis of Mycobacterium kansasii genomic DNA and its application in molecular typing J Clin Microbiol. 1997;35:596-9.[Abstract]
5. Picardeau M, Prod'Hom G, Raskine L, LePennec MP, Vincent V. Genotypic characterization of five subspecies of Mycobacterium kansasii J Clin Microbiol. 1997;35:25-32.[Abstract]
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