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Volume 328:1137-1144 April 22, 1993 Number 16 Next

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ABSTRACT

Background In the United States there have been recent outbreaks of multidrug-resistant tuberculosis. These outbreaks have primarily involved persons infected with the human immunodeficiency virus (HIV).

Methods We collected clinical information on 17 patients seen at a New York City hospital who had repeatedly positive cultures for Mycobacterium tuberculosis. Analysis of restriction-fragment-length polymorphisms (RFLPs) was performed on serial isolates of M. tuberculosis obtained from these patients.

Results Six patients had isolates that remained drug-susceptible, and the RFLP patterns of these isolates did not change over time. Eleven patients had isolates that became resistant to antimicrobial agents. The RFLP patterns of the isolates from six of these patients remained essentially unchanged (two strains showed one additional band) despite the development of drug resistance. In five other patients, however, the RFLP patterns of the isolates changed dramatically at the time that drug resistance was detected. The change in the RFLP pattern of the isolate from one patient appeared to be the result of contamination during processing in the laboratory. In the remaining four patients, all of whom had advanced HIV disease, the clinical and microbiologic evidence was consistent with the presence of active tuberculosis caused by a new strain of M. tuberculosis.

Conclusions Resistance to antituberculous drugs can develop not only in the strain that caused the initial disease, but also as a result of reinfection with a new strain of M. tuberculosis that is drug-resistant. Exogenous reinfection with multidrug-resistant M. tuberculosis can occur either during therapy for the original infection or after therapy has been completed.

Source Information

From the Department of Medicine, Division of Infectious Diseases and Geographic Medicine, and the Howard Hughes Medical Institute (P.M.S., S.P.S., G.K.S.) and the Department of Medicine, Centers for AIDS Research (R.W.S.), Stanford University, Stanford, Calif.; the Medical Service, San Francisco General Hospital and the University of California, San Francisco (P.C.H.); the Department of Medicine, Division of Infectious Diseases (M.J.M.), and the Department of Pathology (M.F.S.), State University of New York Health Sciences Center at Brooklyn, Brooklyn; and the California Department of Health Services Microbial Diseases Laboratory, Berkeley (E.D.).

Address reprint requests to Dr. Small at the Howard Hughes Medical Institute, Rm. 251, Beckman Ctr., Stanford, CA 94306.

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Reinfection with Multidrug-Resistant Tuberculosis
Nolan C. M., Lin B. T.-y., Small P. M., Shafer R. W., Schoolnik G. K.
Extract | Full Text  
N Engl J Med 1993; 329:811-812, Sep 9, 1993. Correspondence

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