Abstract
Abstract During 2012–2015, 10 of 24 patients infected with matching genotypes of Mycobacterium tuberculosis received care at the same hospital in Gaborone, Botswana. Nosocomial transmission was initially suspected, but we discovered plausible sites of community transmission for 20 (95%) of 21 interviewed patients. Active case-finding at these sites could halt ongoing transmission.
Highlights
M. tuberculosis isolates were genotyped by 24-locus mycobacterial interspersed repetitive units–variable number tandem repeats (9)
We interviewed each patient, using an investigation form, to learn their primary residence; contacts; places of work and worship; and other frequented locations, including bars and combi routes used in the 6 months before diagnosis
We looked for epidemiologic links that might suggest ongoing transmission
Summary
§CD4 counts were available for 11 of 16 patients with HIV infection. most visits occurred after October 2013 (Figure 1). Patient V was admitted to the hospital with a known diagnosis of TB and had started TB therapy the day before admission. Patient X was in the hospital for a week but did not start TB therapy until 13 days after patient V was admitted. No members of this cluster were healthcare workers. Two of 4 spatially linked patients (C, D, I, and W) (Figure 2, panel B) did not name each other during enrollment when asked about contacts; when interviewed again as part of this investigation, these patients confirmed spending time together around the time of their diagnosis. Eight (38%) patients attended the same church as another patient, and 6 (29%) patients named each other as a contact, suggesting transmission could have occurred among them
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