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Free Content Multiple infection with resistant and sensitive M. tuberculosis strains during treatment of pulmonary tuberculosis patients

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OBJECTIVE: To identify multiple infection events during anti-tuberculosis treatment in a cohort of pulmonary tuberculosis (PTB) patients in a local hospital in Callao, Peru.

DESIGN: We evaluated 10 patients with smear-positive PTB who had two or more different isolates available during DOTS treatment. We determined drug susceptibility to rifampicin, isoniazid, ethambutol and streptomycin, and performed molecular sub-typing by restriction fragment length polymorphism (RFLP) and PCR.

RESULTS: Drug susceptibility patterns changed from sensitive to resistant in the first and subsequent isolate of three of 10 patients. This change coincided with a dramatic alteration of their DNA fingerprint profile. We ruled out the possibility of cross-contamination or potential labelling errors.

CONCLUSION: We found multiple infections with sensitive and resistant strains of Mycobacterium tuberculosis throughout the same treatment scheme in three patients with PTB. Further studies are needed to determine the frequency of exogenous re-infection and simultaneous/mixed infection and their impact on TB control in Peru.
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Keywords: DNA fingerprinting; Peru; RFLP; multiple infections; tuberculosis

Document Type: Regular Paper

Affiliations: 1: The Working Group on Tuberculosis, National Institute of Health, Lima, Peru 2: Tuberculosis Control Programme, Daniel A Carrión National Hospital, Callao, Peru 3: Alberto Hurtado School of Medicine, Cayetano Heredia University, Lima, Peru

Publication date: 2005-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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