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Free Content Molecular investigation of recurrent tuberculosis in patients from Rwanda

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SETTING: Pulmonary tuberculosis (TB) patients enrolled in four provinces of Rwanda.

OBJECTIVE: To determine the cause of recurrent TB.

DESIGN: Serial Mycobacterium tuberculosis isolates obtained from patients with recurrent TB from January 2002 to September 2005 were genotyped by spoligotyping and mycobacterial interspersed repetitive unit-variable number of tandem repeat (MIRU-VNTR) typing. Drug resistance was determined by phenotypic susceptibility testing and sequencing of rpoB, katG, inhA and embB genes.

RESULTS: Among 710 culture-positive TB patients enrolled in the study, initial drug susceptibility testing results were available for 638. Sixty-nine of these had multidrug-resistant (MDR) TB and 569 were non-MDR-TB. Among the MDR-TB patients, 22 had follow-up isolates after cure (n = 12) or chronic infection (n = 10). The DNA patterns of sequential isolates from 4 of the 12 previously cured MDR-TB patients were different, indicating re-infection. DNA patterns of isolates from the remaining 8 previously cured and 10 chronic MDR-TB patients were identical, suggesting reactivation and treatment failure, respectively. Among the non-MDR-TB patients, disease recurrence was observed in one case; this was determined to be due to reactivation after initial mixed infection.

CONCLUSION: These results document a high treatment failure/reactivation rate for MDR-TB and suggest that re-infection within 2 years may not be a common cause of recurrent TB in this setting.
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Keywords: DNA fingerprinting; M. tuberculosis; re-infection; reactivation; recurrence

Document Type: Regular Paper

Affiliations: 1: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium; and Department of Microbiology, Centre Hospitalier Universitaire St Pierre, Brussels, Belgium 2: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium; and Microbiology Unit, Tropical Diseases Research Centre, Ndola, Zambia 3: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium 4: Department of Microbiology, Centre Hospitalier Universitaire St Pierre, Brussels, Belgium 5: Project San Francisco, Emory University, Kigali, Rwanda 6: Department of Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

Publication date: 2007-08-01

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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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