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Epidemiology of Mycobacterium kansasii
- Karen C. Bloch, MD, MPH;
- Duc J. Vugia, MD, MPH; and
- Arthur L. Reingold, MD
- 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)
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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.
Karen C. Bloch, MD, MPH
Vanderbilt University School of Medicine; Nashville, TN 37232-2605
Duc J. Vugia, MD, MPH
California Department of Health Services; Berkeley, CA 94704-1011
Arthur L. Reingold, MD
University of California, Berkeley, School of Public Health; Berkeley, CA 94720-7360
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
