Visualization of tuberculosis patient and Mycobacterium tuberculosis complex genotype data via host-pathogen maps

DNA fingerprints of Mycobacterium tuberculosis complex bacteria (MTBC) are routinely gathered from tuberculosis (TB) patient isolates for all TB patients in the United States to support TB tracking and control efforts, but few tools are available for visualizing and discovering host-pathogen relationships. We present a new visualization approach, host-pathogen maps, for simultaneously examining MTBC strains genotyped by multiple DNA fingerprinting methods such as spoligotyping and restriction fragment length polymorphisms (RFLP) typing along with associated patient surveillance data. The host-pathogen maps are dynamically coupled with spoligoforests or other phylogenetic tree approaches to allow easy navigation within the pathogen genotyping space. Visualization of New York State and New York City (NYC) TB patient data from 2001-2007 is used to illustrate how host-pathogen maps can be used to rapidly identify potential instances of uncontrolled spread of tuberculosis versus disease resulting from latent reactivation of prior infection, a critical distinction in tuberculosis control. Host-pathogen maps also reveal trends and anomalies in the relationships between patient groups and MTBC genetic lineages which can provide critical clues in epidemiology and contact investigations of TB.