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SUSPECTED SMALL-SCALE INTERPERSONAL TRANSMISSION OF MYCOBACTERIUM TUBERCULOSIS IN WARDS OF AN URBAN HOSPITAL IN DELHI, INDIA

Genotypes of Mycobacterium tuberculosis causing disease were investigated in pulmonary tuberculosis patients admitted to two adjacent wards of a tuberculosis hospital in Delhi, India. Genetic markers, the insertion sequence IS6110, a direct repeat sequence, and a polymorphic GC-rich sequence supported the circumstantial epidemiologic link between eight strains of M. tuberculosis, suggesting their possible involvement in small-scale, interpersonal transmission of both drug-sensitive and drug-resistant tuberculosis. This is the first report of a suspected acquisition of M. tuberculosis among hospitalized patients in India. The use of multiple molecular typing markers and techniques unequivocally identified the exact clonality of strains isolated from the hospital. The result of this study emphasizes the need for more comprehensive investigation of high-risk situations for tuberculosis transmission and long-term follow-up analysis for identifying such instances of unsuspected transmission.

Received March 24, 2003. Accepted for publication September 3, 2003.

Acknowledgments: We thank Drs. Dick van Soolingen and J. D. A. van Embden (National Institute of Public Health and the Environment, Bilthoven, The Netherlands) for assistance with the RFLP studies.

Financial support: This study was supported by the International Atomic Energy Agency, Vienna (IND 9919), and the Indian Council of Medical Research (80/428/97-ECD-I). N. Vijaya Bhanu acknowledges a Research Fellowship from the Council for Scientific, and Industrial Research (Government of India) (Award # 9/6 [74]/EMR-I).

Authors’ addresses: Natarajan Vijaya Bhanu, Building 10, Room 9B17, Laboratory of Chemical Biology, National Institute of Diabetes, and Digestive, and Kidney Diseases National Institute of Health, Bethesda, MD 20892, Telephone: 301-435-4741, Fax: 301-435-5148, E-mail: natarajanb{at}intra.niddk.nih.gov. J. N. Banavalikar, Tuberculosis Clinic, Gulabi Bagh Building, Kalidas Marg, Delhi 110007, India, Telephone: 91-11-2365-4940, Fax: 91-11-27433431, E-mail: jnbanavaliker{at}yahoo.com. S. K. Kapoor, Comprehensive Rural Health Centre, Ballabhgarh, Haryana, India, Telephone: 91-95-129-2211227 and 91-95-129-2241362 Fax: 91-95-129-2211227, E-mail: crhspaiims{at}sancharnet.in. Pradeep Seth, Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110 029, India, Telephone: 91-11-659-3288, Fax: 91-11-686-2669, E-mail: pseth{at}aiims.aiims.ac.in and sethpradeep{at}hotmail.com.

Reprint requests: Pradeep Seth, Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110 029, India.

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