Exogenous reinfection with tuberculosis on a European island with a moderate incidence of disease
Exogenous reinfection with tuberculosis on a European island with a moderate incidence of disease
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DOI：
10.1164/ajrccm.163.3.2003070
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发表时间：
2001-03-01
影响因子：
24.7
通讯作者：
Enarson, DA
中科院分区：
文献类型：
--
作者：
Caminero, JA;Pena, MJ;Enarson, DA
对于既往治疗的患者中外源性再感染和内源性结核病再激活的频率和决定因素知之甚少。 1991年至1996年间，西班牙大加那利岛经培养确诊了962例结核病病例。对现有细菌分离株进行了药物敏感性测试，并进行了基于 IS6110 的 RFLP 基因分型。 23 名患者 (2.4%) 的两次阳性培养物相隔至少 12 个月，其中 18 名患者的细菌 DNA 可用于基因型分析。八个 (44%) 的初始和最终分离株具有不同的基因型，表明存在外源性再感染。其中6人治愈后退，2人违约后退。六人艾滋病毒血清阴性，两人艾滋病毒血清阳性。其余 10 名患者中观察到内源性再激活，其中 8 名患者在违约后接受治疗，2 名患者在治愈后接受治疗。违约后撤退的八人中的三人（38%）出现了多重耐药性。一种基因型导致五例结核病第二次发作、三例外源性再感染和两例内源性再激活。在结核病发病率中等的情况下，外源性再感染是结核病复发的重要原因，即使在艾滋病毒血清阴性患者中也是如此。
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.