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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Exogenous reinfection as a cause of multidrug-resistant and extensively drug-resistant tuberculosis in rural South Africa
Journal of Infectious Diseases, Volume 198, No. 11, Year 2008
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Description
Background. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are now major threats in areas of South Africa with a high prevalence of TB and human immunodeficiency virus (HIV) infection. The role of exogenous reinfection as a cause of MDR and XDR TB in these settings has not been determined. Methods. We reviewed data from patients with culture-positive TB who later developed MDR or XDR TB in Tugela Ferry, KwaZulu-Natal, South Africa during 2005-2006. We performed spoligotyping on initial isolates (obtained at the time of treatment initiation) and follow-up isolates obtained from these patients. Results. We identified 23 patients who developed MDR or XDR TB after being treated for less resistant TB between June 2005 and June 2006. Both initial and follow-up isolates were available for spoligotyping for 17 of these patients. In all cases, the follow-up isolates' spoligotypes differed from those of the initial isolate, indicating exogenous reinfection. Two genotypes (shared type [ST] 34 and ST 60, associated with MDR and XDR TB, respectively) were responsible for 85% of reinfections. All 17 patients had been hospitalized; all 15 whose HIV infection status was known were HIV-infected. Conclusions. Exogenous reinfection is an important mechanism for the development of MDR and XDR TB. In addition to strengthening TB treatment programs, effective infection control strategies are urgently needed to reduce the transmission of MDR and XDR TB. © 2008 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Andrews, Jason Randolph
United States, San Francisco
University of California, San Francisco
Gandhi, Neel R.
United States, New York
Albert Einstein College of Medicine of Yeshiva University
United States, New York
Montefiore Medical Center
Moodley, Prashini
South Africa, Durban
The Nelson R. Mandela Medical School
Shah, N. Sarita
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Bohlken, Louise
South Africa, Durban
The Nelson R. Mandela Medical School
Moll, Anthony P.
South Africa
Philanjalo and Church of Scotland Hospital
Pillay, Manormoney
South Africa, Durban
The Nelson R. Mandela Medical School
Friedland, Gerald H.
United States, New Haven
Yale School of Medicine
Sturm, Adriaan Willem
South Africa, Durban
The Nelson R. Mandela Medical School
Statistics
Citations: 161
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1086/592991
ISSN:
00221899
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa