Multidrug-Resistant Tuberculosis

To the Editor: Edlin et al. (June 4 issue)* ascribe the transmission of multidrug-resistant tuberculosis to patient-to-patient spread, on the basis of their epidemiologic study. In their discussion, they note that tuberculin-skin-test conversions occurred in 18 percent of health care workers, and that one worker had resistant tuberculosis whose pattern of restriction-fragmentlength polymorphisms matched that of the case isolates. More details are needed about the epidemiologic association between the patients and the workers with skin-test conversions, especially the worker with tuberculosis. What are the temporal relations? Person-to-person spread involving the infected health care worker is not excluded by the data…