Exogenous Reinfection with Multidrug-Resistant Mycobacterium tuberculosis

Turett, Glenn S.; Fazal, Barkat A.; Justman, Jessica; Alland, David; Duncalf, Richard; Telzak, Edward E.

doi:10.1093/clinids/24.3.513

Cited by 13 publications

(9 citation statements)

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“…In the present study, the only patient exhibiting exogenous re-infection (patient 5) was an immunocompetent person, and there were 6 yrs between the two episodes. Unlike in other studies [23,24], this patient only reported a history of alcohol abuse. These results suggest that re-infection and progression to active disease is possible once treatment has been discontinued in immunocompetent persons living in an area with a moderate incidence of TB.…”

Section: Discussionmentioning

confidence: 56%

Recurrent tuberculosis from 1992 to 2004 in a metropolitan area

Cacho

Meixeira²,

Cano³

et al. 2007

European Respiratory Journal

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The proportion of recurrent tuberculosis (TB) cases caused by re-infection has varied widely in previous studies. The aim of the present study was to determine the relative frequency of relapse and exogenous re-infection in patients with second episodes of TB, using DNA fingerprinting.A population-based retrospective longitudinal descriptive study was conducted in Madrid (Spain) during 1992-2004. The study consisted of 645 patients with culture-confirmed TB. Of these, 20 (3.1%) were retained because they presented with a second isolate of Mycobacterium tuberculosis. Finally, 12 of these cases were excluded because they did not complete the full treatment prescribed. All strains were typed by restriction fragment length polymorphism analysis and some by mycobacterial interspersed repetitive unit-variable number of tandem repeats analysis. The patients with recurrent TB were compared with those without recurrent TB.For seven out of the eight patients, the restriction fragment length polymorphism patterns of the Mycobacterium tuberculosis strains from the episodes of recurrent disease showed identical initial and final genotypes, indicating relapse; the remaining recurrent case showed different genotypes, suggesting exogenous re-infection.Re-infection is possible among people in developed countries, but the rates are lower than those occurring in high-risk areas. The risk factors for recurrent tuberculosis should be taken into account in the follow-up of treatment and tuberculosis control strategies.

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Section: Discussionmentioning

confidence: 56%

Recurrent tuberculosis from 1992 to 2004 in a metropolitan area

Cacho

Meixeira²,

Cano³

et al. 2007

European Respiratory Journal

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“…Subsequent studies, undertaking bacterial typing using bacteriophages and biovars (22)(23)(24)(25)(26), convincingly demonstrated instances of reinfection in immunocompromised patients (22,25). Further studies, using molecular fingerprint methods, confirmed reinfection, primarily in AIDS patients (4,8,11), but also in occasional patients without demonstrable immunosupressive conditions (6,(11)(12)(13)(14)(27)(28)(29)(30). The same techniques have demonstrated the occurrence of mixed initial infection (31), which, in some scenarios, would be indistinguishable from reinfection.…”

Section: Discussionmentioning

confidence: 85%

“…The majority of patients (13) were male and HIV seronegative. The median time between the first and second cultures was 19 mo (range 12 to 40).…”

Section: Resultsmentioning

confidence: 99%

“…With the use of mycobacterial genotyping techniques it has been possible to demonstrate conclusively that exogenous reinfection can occur. Most reported instances of exogenous reinfection have involved patients infected with the human immunodeficiency virus (4,(8)(9)(10), although a few cases have been documented in persons with no identifiable immunodeficiency (11)(12)(13).…”

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confidence: 99%

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Exogenous Reinfection with Tuberculosis on a European Island with a Moderate Incidence of Disease

Caminero

Peña

Campos-Herrero

et al. 2001

Am J Respir Crit Care Med

143

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The frequency and determinants of exogenous reinfection and of endogenous reactivation of tuberculosis in patients previously treated are poorly understood. In Gran Canaria Island, Spain, between 1991 and 1996, 962 tuberculosis cases were confirmed by culture. Drug susceptibility testing was performed on available bacterial isolates and IS6110-based RFLP genotyping was carried out. Twenty-three patients (2.4%) had two positive cultures separated by at least 12 mo, 18 of whom had bacterial DNA available for genotypic analysis. The initial and final isolates from eight (44%) were different genotypes, indicating exogenous reinfection. Six of them were retreated after cure and two retreated after default. Six were HIV seronegative and two were HIV seropositive. Endogenous reactivation was seen in the remaining 10 patients of whom eight were retreated after default and two after cure. Three of the eight (38%) being retreated after default developed multidrug resistance. One genotype was responsible for a second episode of tuberculosis in five cases, three exogenous reinfections and two endogenous reactivations. In the context of a moderate incidence of tuberculosis, exogenous reinfection is an important cause of TB recurrence, even in HIV-seronegative patients.

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“…§ The significance of superinfection has been a highly controversial issue for many years (18). Evidence in favor of superinfection includes anatomical evidence (19), restriction fragment length polymorphism analyses (20,21), and epidemiological studies (22)(23)(24).…”

Section: Methodsmentioning

confidence: 99%

Modeling the impact of global tuberculosis control strategies

Murray¹,

Salomon²

1998

Proc. Natl. Acad. Sci. U.S.A.

206

135

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An epidemiological model of tuberculosis has been developed and applied to five regions of the world. Globally, 6.7 million new cases of tuberculosis and 2.4 million deaths from tuberculosis are estimated for 1998. Based on current trends in uptake of the World Health Organization's strategy of directly observed treatment, short-course, we expect a total of 225 million new cases and 79 million deaths from tuberculosis between 1998 and 2030. Active case-finding by using mass miniature radiography could save 23 million lives over this period. A single contact treatment for tuberculosis could avert 24 million cases and 11 million deaths; combined with active screening, it could reduce mortality by nearly 40%. A new vaccine with 50% efficacy could lower incidence by 36 million cases and mortality by 9 million deaths. Support for major extensions to global tuberculosis control strategies will occur only if the size of the problem and the potential for action are recognized more widely.

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Exogenous Reinfection with Multidrug-Resistant Mycobacterium tuberculosis

Cited by 13 publications

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Recurrent tuberculosis from 1992 to 2004 in a metropolitan area

Recurrent tuberculosis from 1992 to 2004 in a metropolitan area

Exogenous Reinfection with Tuberculosis on a European Island with a Moderate Incidence of Disease

Modeling the impact of global tuberculosis control strategies

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