2012
DOI: 10.1093/infdis/jis601
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Abstract: M. tuberculosis population within patients exhibited considerable genetic diversity, which underwent selections for most fit resistant mutant. These findings have important implications and emphasize the need for early diagnosis of tuberculosis to decrease the chance of evolving highly fit drug-resistant strains.

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Cited by 164 publications
(173 citation statements)
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“…While the current study was retrospective, and therefore limited by samples that were collected, it will be interesting in the future to attempt to gain insight into the impact of spatial population heterogeneity on the evolution of resistance. For instance, by sequencing entire bacterial populations from multiple patient sites during the course of treatment, the presence of distinct evolutionary trajectories within a single patient could be monitored (Sun et al 2012). …”
Section: Discussionmentioning
confidence: 99%
“…While the current study was retrospective, and therefore limited by samples that were collected, it will be interesting in the future to attempt to gain insight into the impact of spatial population heterogeneity on the evolution of resistance. For instance, by sequencing entire bacterial populations from multiple patient sites during the course of treatment, the presence of distinct evolutionary trajectories within a single patient could be monitored (Sun et al 2012). …”
Section: Discussionmentioning
confidence: 99%
“…Several studies in individual patients who have developed progressive drug resistance over time have documented the initial acquisition of isoniazid resistance as a result of one or more mutations, followed by acquisition of resistance to rifampicin or ethambutol (or both), pyrazinamide, and finally, the second-line and third-line drugs. [15][16][17] The order in which resistance is acquired might reflect the number of different mutations that lead to resistance to a specific drug, 14 the relative fitness costs associated with specific mutations (ie, mutations might lead to less successful survival and reproduction of the organism), 18 or phenotypic changes following an initial drug-resistance mutation that might facilitate the acquisition of further mutations. 19 When resistance to one or more drugs is acquired in this way, it is referred to as secondary resistance.…”
Section: Determinants Of Drug Resistancementioning
confidence: 99%
“…Mtb remains a major threat to global health, especially in the developing countries. Emergence of multidrug resistant (MDR) and extensively drug-resistant (XDR) Mtb, and also the emergence of co-infection between TB and HIV have further worsened the situation (25)(26)(27). Among bacterial pathogens, Mtb has a distinctive life cycle spanning different environments and developmental stages (28).…”
mentioning
confidence: 99%