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Guide to the Application of Genotyping to Tuberculosis Prevention and Control										Related Pages
										**Tuberculosis Genotyping Case Studies: How TB Programs Have Used Genotyping**
**Apparent Genotyping Cluster Among Recent Immigrants from the Philippines: IS*****6110*****-based RFLP Needed to Discriminate Between Isolates Belonging to the Manila Strain**
Previous results from the National Tuberculosis Genotyping and Surveillance Network and other studies showed that spoligotyping alone was not particularly helpful in distinguishing between isolates that belonged to a group generally referred to as the Beijing family of *M. tuberculosis* isolates. Data from CDC suggest that MIRU analysis, especially when combined with RFLP analysis, will be more discriminatory than spoligotyping alone. At the same time, we are beginning to see new genotyping families that contain isolates that are often not distinguished by spoligotyping plus MIRU analysis. The following case study describes patients with isolates from one such family, which has been named the Manila strain family because of its predominance in patients from Manila.
During 2000–2003, isolates from seven patients were identified as belonging to the same PCR cluster (i.e., each isolate had the same spoligotype and MIRU type). On the basis of the spoligotype and MIRU type, the CDC recognized that these isolates belonged to the Manila family. Analysis of data from the initial case-patient interviews revealed that they were all recent immigrants from the Philippines, but they lived in different regions of Wisconsin. The contact investigations of the cases did not reveal epidemiologic links between any of the patients.
Because no epidemiologic links were identified for these PCR-clustered cases, the TB program requested that the seven isolates be analyzed by RFLP, which revealed seven distinct patterns. Therefore, despite identical spoligotypes and MIRU types, these seven isolates were shown to be genetically distinct by RFLP analysis. The TB program did not undertake a cluster investigation, since the seven isolates were shown not to belong to the same genotyping cluster.
							
					
						Page last reviewed:  September 1, 2012					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeGuide to the Application of Genotyping to Tuberculosis Prevention and Control
Acknowledgments
Introduction to Tuberculosis Genotypingplus icon
Introduction to this Guide
Overview of Tuberculosis Genotyping
Overview of the CDC Tuberculosis Genotyping Program
TB Program Eligibility and Application Procedures
Tuberculosis Genotyping Case Studiesplus icon
Investigation of a Genotyping Cluster in a Low-Incidence State
Apparent Genotyping Cluster among Recent Immigrants from the Philippines
False-Positive Culture Investigation
Algorithm to Detect False-Positive Cultures
A Misdiagnosis that was Identified with Genotyping
Genotyping Used to Improve Contact and Cluster Investigations
Identification of Nontraditional Transmission Settings
Investigation of a Multistate Tuberculosis Outbreak
Homeless Shelter Outbreak Investigation
Using Genotyping to Evaluate the Impact of a Screening Program
CDC Tuberculosis Genotyping Laboratory Proceduresplus icon
Science behind Tuberculosis Genotyping
Description of Genotyping Methods
Submission of Isolates
Genotyping Results, Designation of Clusters, and Reporting
Suspected False-Positive Cultures
IS*6110*-based RFLP Analysis
Combining Genotyping and Epidemiologic Data to Improve Our Understanding of TB Transmissionplus icon
Definitions
Reading the Genotyping Laboratory Report
Comparing Genotyping and Epidemiologic Results from Two TB Patients
Comparing Genotyping and Epidemiologic Results from Three or More TB Patients
Clustering as a Surrogate Measure of Recent Transmission
Developing a Tuberculosis Genotyping Programplus icon
Developing a Written Plan
Initial Decisions
Establishing Procedures for:plus icon
Submitting Isolates
Receiving and Acting on Genotyping Results
Requesting RFLP Analysis
Submitting Additional Isolates from the Same Patient
Comparing Genotyping Results between Jurisdictions
False-Positive Cultures
Database Management and Quality Control
Special Issues
Applying Genotyping Results to Tuberculosis Control Practicesplus icon
Evaluating Matching Genotypes
Evaluating Nonmatching Genotypes
Suspected False-Positive Culture Investigations
Expanded Contact Investigations
Outbreak Investigations
Cluster Investigations
Monitoring Trends
Appendicesplus icon
Appendix A: Glossary and Abbreviations
Appendix B: References and Useful Resourcesplus icon
References Cited in the Guide
NTGSN Special Issue References
Information on Packaging and Shipping Infectious Substances
Core Steps of an Outbreak Investigation
Consultants Available to Offer Guidance To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


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