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To the Editor: The article by Dr Bifani and colleagues¹ portrays the role of molecular epidemiology in the control of tuberculosis. The authors identified a strain (W4 variant) using multiple genetic markers that provide a definitive phylogenetic relationship among 43 isolates from patients in New Jersey. They also identified a more distant relationship between these isolates and the W strain, the cause of numerous outbreaks of drug-resistant tuberculosis in New York.

However, the phylogenetic relationship among strains does not necessarily translate to an epidemiological relationship among patients. In population-based studies, patient clustering based on matching isolate genotypes may result from recent transmission of Mycobacterium tuberculosis, the inability of genotyping methods to discriminate strains, or the circulation of only a few strains in a given community. Thus, previous infections may result in matching M tuberculosis genotypes from patients with no recent epidemiological connection.²

Bifani et al present highly strain-specific results . . . [Full Text of this Article]

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