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Free Content A cluster of tuberculosis associated with use of a marijuana water pipe

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SETTING: New cases of pulmonary tuberculosis (TB) were noted in a cluster of young Caucasian males, an unusual ethnic group for this disease in Queensland, Australia. It was noted that marijuana water pipe (‘bong’) smoking was common amongst cases and contacts.

OBJECTIVE: To report this cluster of TB and to investigate whether shared use of a marijuana water pipe was associated with transmission of TB.

DESIGN: All contacts were identified and screened according to standard protocols. Cases were asked to list contacts with whom they had shared a marijuana water pipe.

RESULTS: Five cases of open pulmonary TB were identified clinically and on sputum culture, and all isolates of Mycobacterium tuberculosis were identical on typing. Of 149 contacts identified, 114 (77%) completed screening, and 57 (50%) had significant tuberculin skin test (TST) reactions on follow-up. Of 45 contacts who had shared a marijuana water pipe with a case, 29 (64%) had a significant TST reaction.

CONCLUSION: Sharing a marijuana water pipe with a case of pulmonary TB was associated with transmission of TB (OR 2.22, 95% CI 0.96–5.17), although the most important risk factor for acquiring TB infection in this cluster was close household contact with a case (OR 4.91, 95% CI 1.13–20.70).

Keywords: epidemiology; marijuana; tuberculosis; water pipe

Document Type: Regular Paper

Affiliations: 1: Infection Management Services, Princess Alexandra Hospital, Queensland, Australia 2: Specialised Health Services (Queensland Tuberculosis Control Centre), Queensland Health, Brisbane, Queensland, Australia 3: Queensland Government Office of Economic and Statistical Research, Brisbane, Queensland, Australia 4: Queensland Mycobacterium Reference Laboratory, Prince Charles Hospital, Brisbane, Queensland, Australia

Publication date: September 1, 2003

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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