Transmission of Tuberculosis Among the Urban Homeless

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Abstract
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 onMycobacterium tuberculosisisolates. If results were inconclusive, pTBN12-based RFLP analysis was performed. Main Outcome Measure. —Clustering ofM tuberculosisisolates. 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)

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