Endogenous reactivation and true treatment failure as causes of recurrent tuberculosis in a high incidence setting with a low HIV infection.
OBJECTIVE
To determine the relative frequencies of reinfection vs. reactivation or treatment failure in patients from a high tuberculosis incidence setting with a low prevalence of HIV infection.


METHODS
We performed DNA fingerprinting on serial isolates from one and multiple TB episodes from 97 retreatment patients; 35 patients had been previously cured, whereas 62 had not.


RESULTS
DNA fingerprinting patterns of recurrence Mycobacterium tuberculosis isolates of 5 of the 35 previously cured patients did not match with those of the corresponding initial isolates, indicating reinfection. We did not document reinfection during treatment. Isolates from each of the remaining 30 previously cured patients had identical DNA fingerprinting results, indicating reactivation. DNA fingerprinting patterns of isolates from the 62 patients with persistently positive sputum smears were identical, suggesting treatment failure.


CONCLUSIONS
These findings suggest that reinfection is not a common cause of relapse and treatment failure in this rural predominantly HIV-free population despite the high incidence of TB.
Shamputa
Isdore Chola
IC
Prince Leopold Institute of Tropical Medicine, Mycobacteriology Unit, Antwerp, Belgium. icshamputa@itg.be
Van Deun
Armand
A
Salim
Md Abdul Hamid
MA
Hossain
Md Anwar
MA
Fissette
Krista
K
de Rijk
Pim
P
Rigouts
Leen
L
Portaels
Françoise
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D016172:DNA Fingerprinting / Q000379:methods; D004269:DNA, Bacterial / Q000032:analysis; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D012150:Polymorphism, Restriction Fragment Length; D012008:Recurrence; D012423:Rural Health; D020080:Tandem Repeat Sequences; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents; D004269:DNA, Bacterial