EXOGENOUS REINFECTION WITH MULTIDRUG-RESISTANT MYCOBACTERIUM-TUBERCULOSIS IN PATIENTS WITH ADVANCED HIV-INFECTION
EXOGENOUS REINFECTION WITH MULTIDRUG-RESISTANT MYCOBACTERIUM-TUBERCULOSIS IN PATIENTS WITH ADVANCED HIV-INFECTION
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DOI：
10.1056/nejm199304223281601
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发表时间：
1993-04-22
影响因子：
158.5
通讯作者：
SCHOOLNIK, GK
中科院分区：
文献类型：
--
作者：
SMALL, PM;SHAFER, RW;SCHOOLNIK, GK
背景在美国，最近爆发了耐多药结核病。这些暴发主要涉及感染人类免疫缺陷病毒（HIV）的人。我们收集了纽约市一家医院的17名结核分枝杆菌培养反复阳性的患者的临床信息。采用限制性片段长度多态性（RFLPs）分析方法对M.结果：1. 6例患者的分离株仍对药物敏感，这些分离株的RFLP模式未随时间发生变化。11例患者的分离株对抗菌药物产生耐药性。尽管出现了耐药性，但其中6例患者分离株的RFLP模式基本保持不变（2株菌株显示出一条额外的条带）。然而，在另外5名患者中，在检测到耐药性时，分离株的RFLP模式发生了显著变化。来自一名患者的分离株的RFLP模式的变化似乎是实验室处理过程中污染的结果。在其余4名患者中，他们都患有晚期艾滋病毒疾病，临床和微生物学证据与一种新的M菌株引起的活动性结核病的存在一致。tuberculosis.Conclusions.抗结核药物的耐药性不仅可以在引起最初疾病的菌株中产生，而且也可以作为重新感染新菌株的结果。耐药结核病。多重耐药支原体的外源性再感染。结核病可以在治疗原发感染期间发生，也可以在治疗结束后发生。
Background. In the United States there have been recent outbreaks of multidrug-resistant tuberculosis. These outbreaks have primarily involved persons infected with the human immunodeficiency virus (HIV).Methods. We collected clinical information on 17 patients seen at a New York City hospital who had repeatedly positive cultures for Mycobacterium tuberculosis. Analysis of restriction-fragment-length polymorphisms (RFLPs) was performed on serial isolates of M. tuberculosis obtained from these patients.Results. Six patients had isolates that remained drug-susceptible, and the RFLP patterns of these isolates did not change over time. Eleven patients had isolates that became resistant to antimicrobial agents. The RFLP patterns of the isolates from six of these patients remained essentially unchanged (two strains showed one additional band) despite the development of drug resistance. In five other patients, however, the RFLP patterns of the isolates changed dramatically at the time that drug resistance was detected. The change in the RFLP pattern of the isolate from one patient appeared to be the result of contamination during processing in the laboratory. In the remaining four patients, all of whom had advanced HIV disease, the clinical and microbiologic evidence was consistent with the presence of active tuberculosis caused by a new strain of M. tuberculosis.Conclusions. Resistance to antituberculous drugs can develop not only in the strain that caused the initial disease, but also as a result of reinfection with a new strain of M. tuberculosis that is drug-resistant. Exogenous reinfection with multidrug-resistant M. tuberculosis can occur either during therapy for the original infection or after therapy has been completed.