title: Simultaneous infection with multiple strains of Mycobacterium tuberculosis.
abstract: Drug-susceptible and drug-resistant isolates of Mycobacterium tuberculosis were recovered from 2 patients, 1 with isoniazid-resistant tuberculosis (patient 1) and another with multidrug-resistant tuberculosis (patient 2). An investigation included patient interviews, record reviews, and genotyping of isolates. Both patients worked in a medical-waste processing plant. Transmission from waste was responsible for at least the multidrug-resistant infection. We found no evidence that specimens were switched or that cross-contamination of cultures occurred. For patient 1, susceptible and isoniazid-resistant isolates, collected 15 days apart, had 21 and 19 restriction fragments containing IS6110, 18 of which were common to both. For patient 2, a single isolate contained both drug-susceptible and multidrug-resistant colonies, demonstrating 10 and 11 different restriction fragments, respectively. These observations indicate that simultaneous infections with multiple strains of M. tuberculosis occur in immunocompetent hosts and may be responsible for conflicting drug-susceptibility results, though the circumstances of infections in these cases may have been unusual.
authors.affiliation: Division of Tuberculosis Elimination, National Center for Human Immunodeficiency Virus, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. crb5@cdc.gov
authors.forename: C R
authors.initials: CR
authors.lastname: Braden
authors.forename: G P
authors.initials: GP
authors.lastname: Morlock
authors.forename: C L
authors.initials: CL
authors.lastname: Woodley
authors.forename: K R
authors.initials: KR
authors.lastname: Johnson
authors.forename: A C
authors.initials: AC
authors.lastname: Colombel
authors.forename: M D
authors.initials: MD
authors.lastname: Cave
authors.forename: Z
authors.initials: Z
authors.lastname: Yang
authors.forename: S E
authors.initials: SE
authors.lastname: Valway
authors.forename: I M
authors.initials: IM
authors.lastname: Onorato
authors.forename: J T
authors.initials: JT
authors.lastname: Crawford
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D016172:DNA Fingerprinting; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D013045:Species Specificity; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid