Independent origin of mono-rifampin-resistant Mycobacterium tuberculosis in patients with AIDS.
Historically, infections caused by Mycobacterium tuberculosis have been treated simultaneously with isoniazid and rifampin. As a consequence of this combined therapy, strains resistant only to rifampin were rarely recovered. However, recently there has been an increasing number of reports describing HIV-positive patients infected with mono-rifampin-resistant M. tuberculosis strains. Organisms cultured from seven patients (including six with AIDS) with infections caused by mono-rifampin-resistant M. tuberculosis, and seen at one New York City hospital, were analyzed by molecular techniques to test the hypothesis that dissemination of a single clone had occurred. IS6110 DNA fingerprinting and automated DNA sequencing of a region of the RNA polymerase beta subunit structural gene (rpoB) containing mutations that confer rifampin resistance showed that all organisms independently acquired the mono-rifampin-resistant phenotype. Molecular analysis of mono-rifampin-resistant organisms cultured from 13 additional patients in New York City confirmed independent strain origin. The data rule out the possibility of person-to-person strain transmission among these patients, and they suggest that host factors such as poor compliance with antituberculosis medications or decreased absorption of rifampin have been a driving force in the origin of these strains.
Lutfey
M
M
Tuberculosis Center, Public Health Research Institute, Columbia Presbyterian Medical Center, New York, New York 10016, USA.
Della-Latta
P
P
Kapur
V
V
Palumbo
L A
LA
Gurner
D
D
Stotzky
G
G
Brudney
K
K
Dobkin
J
J
Moss
A
A
Musser
J M
JM
Kreiswirth
B N
BN
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D004352:Drug Resistance, Microbial; D005798:Genes, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D017354:Point Mutation; D012150:Polymorphism, Restriction Fragment Length; D012293:Rifampin / Q000627:therapeutic use*; D016312:Treatment Refusal; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission
D000904:Antibiotics, Antitubercular; D012321:DNA-Directed RNA Polymerases; D012293:Rifampin