• P F Barnes, H el-Hajj, S Preston-Martin, M D Cave, B E Jones, M Otaya, J Pogoda, and K D Eisenach.
• Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033, USA.
• JAMA. 1996 Jan 24; 275 (4): 305307305-7.

ObjectiveTo determine the relative frequencies of primary and reactivation tuberculosis in the urban homeless.DesignProspective evaluation of homeless tuberculosis patients.SettingCentral Los Angeles, Calif.PatientsThirty-four homeless patients with culture-proven tuberculosis.InterventionsIS6110-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 MeasureClustering of M tuberculosis isolates. A cluster consisted of two or more isolates with indistinguishable RFLP patterns.ResultsTwenty-four of 34 homeless patients had clustered isolates in six clusters.ConclusionsThe 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.

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