Molecular investigation of recurrent tuberculosis in patients from 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.
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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