title: Transmission of a multidrug-resistant Mycobacterium tuberculosis strain resembling "strain W" among noninstitutionalized, human immunodeficiency virus-seronegative patients.
abstract: Since 1990, several outbreaks of multidrug-resistant tuberculosis (MDR-TB) have been described among institutionalized patients infected with human immunodeficiency virus (HIV). We describe a community MDR-TB outbreak among HIV-seronegative patients in Cape Town, South Africa. Isolates were characterized by restriction fragment length polymorphism (RFLP) analysis and dot-blot hybridization analysis of mutations conferring resistance for isoniazid, rifampin, streptomycin, and ethambutol. All isolates were identical on RFLP analysis. In 2 patients, RFLP analysis showed exogenous reinfection during or after treatment for drug-susceptible TB. Mutation analysis confirmed the genotypic identity of the isolates. The infecting strain was genotypically related to strain W, which is responsible for the majority of MDR-TB outbreaks in New York City. Transmission of MDR-TB is thus not limited to HIV-seropositive patients in an institutional setting but occurs within a community.
authors.affiliation: Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: van Rie
authors.forename: R M
authors.initials: RM
authors.lastname: Warren
authors.forename: N
authors.initials: N
authors.lastname: Beyers
authors.forename: R P
authors.initials: RP
authors.lastname: Gie
authors.forename: C N
authors.initials: CN
authors.lastname: Classen
authors.forename: M
authors.initials: M
authors.lastname: Richardson
authors.forename: S L
authors.initials: SL
authors.lastname: Sampson
authors.forename: T C
authors.initials: TC
authors.lastname: Victor
authors.forename: P D
authors.initials: PD
authors.lastname: van Helden
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D015139:Blotting, Southern; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007326:Institutionalization; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects* / Q000235:genetics; D012150:Polymorphism, Restriction Fragment Length; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents