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背景:结核病在一个低患病国家中的暴发流行。目的:描述一个国际传染源追踪过程,在此过程中限定性片段长度多态性分析(RFLP)起到了一个必不可少的作用。设计:1993年报告一名患结核性脑膜炎的儿童因传染源不能确定,在荷兰北部的港口城镇Harlin-gen开始了一项大规模的传染源追踪行动。传统的接触者追踪以检出感染源。RFLP用于绘制结核病传播图和鉴定传染源病例。结果:此项调查由荷兰北部扩展至其西部的几个地方。在筛查的6519人中;有276例受到感染者,其中确定了49例活动性结核。来自所有28例培养阳性患者的结核菌分离株的RFLP分析显示Harlingen型DNA指纹。传染源追踪5个月后鉴定出传染源病例是在英国。直到1996年总共发现37例患者(荷兰28例、英国7例、苏里南1例、摩洛哥1例)具有Harlingen型DNA特征的分离株。除非更明确的评估,方可以确定37例患者中5例与传染源病例或Harlingen的暴发流行无关。结论:证实RFLP分型在指导国际传染源追踪和接触者调查中是一个很有用的工具。
Background: An outbreak of tuberculosis in a low-prevalence country. OBJECTIVE: To describe an international source tracking process in which restriction fragment length polymorphism (RFLP) has played an essential role. Design: In 1993, a child with tuberculous meningitis was reported unsure of the source of infection. Harlin-gen, a port town in the north of the Netherlands, started a large-scale source tracking campaign. Traditionally contact traced to detect the source of infection. RFLP is used to map tuberculosis and identify cases of infection. Results: The survey expanded from northern Holland to several locations in the west. Of the 6,519 people screened, 276 were infected, of whom 49 had active tuberculosis. RFLP analysis of M. tuberculosis isolates from all 28 culture-positive patients revealed Harlingen-type DNA fingerprinting. Five months after the source of the infection was identified, the source of the infection was in the United Kingdom. By 1996 a total of 37 isolates with Harlingen-type DNA were found in 37 patients (28 in the Netherlands, 7 in the UK, 1 in Suriname and 1 in Morocco). Unless a more definitive assessment is made, five of 37 patients can be identified as having no association with an outbreak of infection or Harlingen. Conclusion: Confirming that RFLP typing is a useful tool in guiding international source tracking and contact investigations.