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Previous Volume 341:1174-1179 October 14, 1999 Number 16 Next

	Full Text PDF Editorial by Fine, P. E.M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background For decades it has been assumed that postprimary tuberculosis is usually caused by reactivation of endogenous infection rather than by a new, exogenous infection.

Methods We performed DNA fingerprinting with restriction-fragment–length polymorphism analysis on pairs of isolates of Mycobacterium tuberculosis from 16 compliant patients who had a relapse of pulmonary tuberculosis after curative treatment of postprimary tuberculosis. The patients lived in areas of South Africa where tuberculosis is endemic. Medical records were reviewed for clinical data.

Results For 12 of the 16 patients, the restriction-fragment–length polymorphism banding patterns for the isolates obtained after the relapse were different from those for the isolates from the initial tuberculous disease. This finding indicates that reinfection was the cause of the recurrence of tuberculosis after curative treatment. Two patients had reinfections with a multidrug-resistant strain. All 15 patients who were tested for the human immunodeficiency virus were seronegative.

Conclusions Exogenous reinfection appears to be a major cause of postprimary tuberculosis after a previous cure in an area with a high incidence of this disease. This finding emphasizes the importance of achieving cures and of preventing anyone with infectious tuberculosis from exposing others to the disease.

Source Information

From the Department of Pediatrics and Child Health (A.V.R., R.P.G., N.B.) and the Medical Research Council Center for Molecular and Cellular Biology and the Department of Medical Biochemistry (R.W., M.R., T.C.V., P.D.V.H.), University of Stellenbosch, Tygerberg, South Africa; the Department of Pediatrics, Catholic University Leuven, Leuven, Belgium (A.V.R.); and the International Union against Tuberculosis and Lung Disease, Paris (D.A.E.).

Address reprint requests to Dr. van Helden at the Department of Medical Biochemistry, University of Stellenbosch, P.O. Box 19063, Tygerberg 7505, South Africa, or at pvh{at}gerga.sun.ac.za.

Full Text of this Article

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Recurrent Tuberculosis Due to Exogenous Reinfection
Stead W. W., Bates J. H., de Boer A. S., van Soolingen D., Borgdorff M. W., van Rie A., Warren R., van Helden P. D.
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N Engl J Med 2000; 342:1050-1051, Apr 6, 2000. Correspondence

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