NEW YORK, -- An outbreak of tuberculosis (TB) that began in Baltimore, Maryland, appears to have spread via a social network of transgender persons to New York City, public health officials reported Thursday.

Officials from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, said that they have identified 26 cases of active disease and 37 dormant infections in individuals who were either members of a transgender social network or in contact with these individuals.

In 1998, officials from the Baltimore City Health Department identified four cases of tuberculosis among young, homosexual black men, all of whom belonged to a social network of transgender persons. Three of the men also were infected with HIV and all four were commercial sex workers. Tests on isolates from the men revealed that all four were infected with the same strain of TB bacteria.

The health officials investigated the transgender social network of the men and identified an additional 22 tuberculosis patients. Among the 26 cases, 23 had the same TB strain. In all cases, the infection was caused by a TB strain that is treatable with first-line anti-TB drugs, such as isoniazid and rifampicin.

Investigations into social contacts of the Baltimore patients led to the discovery of 24 more cases of tuberculosis.

The investigators also traced the social network to New York City, where two more cases of tuberculosis were identified.

In an editorial comment in the April 21st issue of Morbidity and Mortality Weekly Report, CDC officials note that transgender network members often participate in dance and fashion competitions called ``balls'' held in various eastern cities.

``Frequent travel and social network links identified among the Baltimore and NYC cases have raised concern that this strain of (tuberculosis) may be circulating in other cities among young, mobile, transgender persons with HIV infection,'' according to the CDC.

``Transgender persons are heterosexual, homosexual, or bisexual and may be cross-dressers (transvestites) or pre-operative and postoperative transsexuals,'' according to the report. Because transgender persons often fear discrimination and ridicule, they may conceal their identities, move frequently, and mistrust health authorities. This can make it difficult to trace contacts of those who are infected with TB.

CDC officials say they are still investigating whether other TB cases are linked to this outbreak and urge healthcare providers to ``report cases to local TB control programs.'' SOURCE: Morbidity and Mortality Weekly Report 2000;49:317-320.

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