       Document 1127
 DOCN  M9591127
 TI    Outbreak of tuberculosis among regular patrons of a neighborhood bar.
 DT    9509
 AU    Kline SE; Hedemark LL; Davies SF; Department of Medicine, Hennepin
       County Medical Center,; Minneapolis, MN, USA.
 SO    N Engl J Med. 1995 Jul 27;333(4):222-7. Unique Identifier : AIDSLINE
       MED/95312035
 AB    BACKGROUND. Outbreaks of tuberculosis have been reported in prisons,
       nursing homes, urban homeless shelters, and other crowded settings. We
       report a nonresidential outbreak of tuberculosis that originated in a
       neighborhood bar. METHODS. A homeless patient with highly infectious
       pulmonary tuberculosis was a regular patron of a neighborhood bar during
       a long symptomatic interval before diagnosis. We investigated 97 other
       regular customers and employees of the bar through interviews,
       tuberculin skin testing, and chest roentgenography. We performed DNA
       fingerprinting on isolates from the index patient and 11 other patients.
       RESULTS. The index patient apparently infected 41 of 97 contacts (42
       percent), resulting in 14 cases of active tuberculosis and 27 cases of
       infection but no disease (indicated by positive tuberculin skin tests).
       Four other cases of active tuberculosis occurred among regular customers
       of the bar who were missed by the contact investigation. There were also
       two secondary cases. Radiographic findings in active cases included
       upper-lobe disease in seven cases (three cavitary) and negative chest
       films at the time of diagnosis in four cases. All 12 culture isolates we
       tested had the same chromosomal-DNA restriction pattern. CONCLUSIONS.
       The spread of tuberculosis in a neighborhood bar can be a major public
       health problem. The high rate of infection and disease among the
       contacts was unexpected and was not due to coinfection with the human
       immunodeficiency virus. Possible explanations include heavy alcohol use
       among the contacts, high infectivity of the index case, or both. Sputum
       cultures must be performed in tuberculin-positive contacts who have
       symptoms, even if the chest films are normal.
 DE    Alcoholism/COMPLICATIONS  Contact Tracing  *Disease Outbreaks  Homeless
       Persons  Human  Male  Mental Disorders/COMPLICATIONS  Middle Age
       Minnesota/EPIDEMIOLOGY  Mycobacterium tuberculosis/GENETICS/ISOLATION &
       PURIF  Tuberculosis, Pulmonary/COMPLICATIONS/*EPIDEMIOLOGY/MICROBIOLOGY/
       TRANSMISSION  Urban Health  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

