DNA fingerprint changes in tuberculosis: Reinfection, evolution, or laboratory error?
DNA fingerprint changes in tuberculosis: Reinfection, evolution, or laboratory error?
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DOI：
10.1086/423144
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发表时间：
2004-09-15
影响因子：
6.4
通讯作者：
Fine, PEM
中科院分区：
文献类型：
--
作者：
Glynn, JR;Yates, MD;Fine, PEM
背景由于模式进化、新感染和实验室错误，结核分枝杆菌菌株的DNA指纹模式在个体内和流行病学相关个体之间存在差异。我们探讨了这些因素的重要性。从个人在北方马拉维谁被诊断为结核病（TB）在1996年至2001年的文化进行了指纹与限制性片段长度多态性（RFLP）。通过使用日期或分离的阳性培养物推断可能的实验室错误。模式的演变进行了探讨内和个人之间，复发和再感染的相对重要性，估计在个人与复发TB。从806个个体中获得了930个分离株的RFLP结果。最大实验室错误率为3.9%。模式演变在连锁个体（17%）中比复发（11%）或治疗期间（3%）更常见。20例患者在完成治疗后结核病复发：在人类免疫缺陷病毒（HIV）阳性患者中，12例复发中有7例是由于再感染，而在HIV阴性患者中，8例复发中有0例是由于再感染（P= 0.01）。DNA指纹模式进化的速度不是线性的，从个体内重复培养计算的变化率可能不适用于个体之间的传播。在艾滋病毒阳性者中，由于再感染而复发的比例很高，这表明需要对这些人进行二级预防和/或抗逆转录病毒治疗。
Background. DNA fingerprint patterns of Mycobacterium tuberculosis strains vary within individuals and between epidemiologically linked individuals because of pattern evolution, new infections, and laboratory error. We explored the importance of these factors.Methods. Cultures from individuals in northern Malawi who had been diagnosed with tuberculosis (TB) during 1996-2001 were fingerprinted with restriction fragment-length polymorphism (RFLP). Probable laboratory error was inferred by use of dates or isolated positive cultures. Pattern evolution was explored within and between individuals, and the relative importance of relapse and reinfection was estimated in individuals with recurrent TB.Results. RFLP results were available for 930 isolates from 806 individuals. The maximum laboratory-error rate was 3.9%. Pattern evolution was more common in linked individuals (17%) than on relapse (11%) or during treatment (3%). Twenty individuals had recurrent TB after completing treatment: in human immunodeficiency virus (HIV)-positive individuals, 7 of 12 recurrences were due to reinfection, compared with 0 of 8 in HIV-negative individuals (P=.01).Conclusions. The rate of DNA fingerprint-pattern evolution is not linear, and rates of change calculated from repeat cultures within individuals may not be applicable to transmission between individuals. The high proportion of recurrence due to reinfection found in HIV-positive individuals suggests that secondary prophylaxis and/or antiretroviral treatments are needed for such individuals.