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Peter F. Barnes, MD; Hiyam El-Hajj, PhD; Susan Preston-Martin, PhD; M. Donald Cave, PhD; Brenda E. Jones, MD; Michiko Otaya, BSN; Janice Pogoda, PhD; Kathleen D. Eisenach, PhD

JAMA. 1996;275(4):305-307.

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 on Mycobacterium tuberculosis isolates. If results were inconclusive, pTBN12-based RFLP analysis was performed.

Main Outcome Measure.
—Clustering of M tuberculosis isolates. 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)

Author Affiliations
From the Division of Infectious Diseases, Department of Medicine (Drs Barnes and Jones and Ms Otaya), and the Department of Preventive Medicine (Dr Preston-Martin), University of Southern California School of Medicine, Los Angeles; the Departments of Pathology (Drs El-Hajj and Eisenach) and Anatomy (Dr Cave), University of Arkansas for Medical Sciences, and Medical Research Service, McLellan Memorial Veterans Hospital (Drs El-Hajj, Cave, and Eisenach), Little Rock, Ark; and Statology, Tahoe Paradise, Calif (Dr Pogoda).

Footnotes
This article is one of a series addressing emerging and reemerging global microbial threats.

Reprint requests to HMR 904, University of Southern California School of Medicine, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr Barnes).

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