Abstract
OBJECTIVE: Evaluation of the extent and possible causes of the increased incidence of tuberculosis among Amazonian Indians in Surinam. DESIGN: Descriptive. METHOD: In two cross-sectional surveys in 1998 and 2000, the inhabitants of Kwamalasamutu, a village of Trio-Indians in Surinam, were examined for the presence of active and latent tuberculosis. Previous cases from the period 1995-2000 were evaluated retrospectively by consulting individual physicians and the archives of the 'Medische Zending' (Medical Mission), the 'Diakonessenhuis' hospital, the clinic for pulmonary diseases, and the Central Laboratory. Family ties and other factors that might be associated with tuberculosis were examined. Spoligotyping was done on all patient isolates. RESULTS: Between 1995 and 2000, active tuberculosis was diagnosed in 25 Indians from Kwamalasamutu, equal to 4.2 cases/1000 person-years (95% CI: 2.7-6.1). Tuberculin skin tests were positive in 105/733 Indians (14.3%). Cases of tuberculosis were found predominantly within certain families, who were genetically related. Spoligotyping of 5 Mycobacterium tuberculosis isolates from Trio-Indians showed unique patterns, which were also found in 34 isolates from elsewhere in Surinam. CONCLUSION: Tuberculosis was relatively common among Trio-Indians, clustering in certain families. This isolated tribe may have a genetic predisposition for tuberculosis, but their lifestyle and limited access to health care certainly play a role as well.
