Nosocomial transmission of the F15/LAM4/KZN genotype of Mycobacterium tuberculosis in patients on tuberculosis treatment.
METHODS
King George V (KGV) Hospital has the largest tuberculosis (TB) facility in KwaZulu-Natal (KZN), the province with the highest prevalence of TB-HIV (human immunodeficiency virus) co-infection in South Africa. During the study, KGV was the only provincial referral hospital for patients with drug-resistant TB.


OBJECTIVE
To determine the role of nosocomial transmission in patients infected with a new strain of Mycobacterium tuberculosis during treatment.


METHODS
Insertion sequence 6110-DNA fingerprinting was performed on stored isolates from patients with culture-positive pulmonary TB for more than 6 weeks after treatment started and those who relapsed.


CONCLUSIONS
DNA fingerprints of 14 of 26 patients with differing isolates matched those of other patients. Four of them acquired a F15/LAM4/KZN genotype, while two acquired fully susceptible Beijing strains. Three of the four F15/LAM4/KZN strains were multidrug-resistant with identical fingerprint patterns, while the fourth was fully susceptible. One of these was acquired during hospitalisation and three after discharge. Both HIV-infected and non-infected patients are at risk of infection with the F15/LAM4/KZN strain in health care facilities and within the community. Rapid diagnostic tests, separation of TB and non-TB patients on admission and isolation of multidrug-resistant and extensively drug-resistant TB patients are essential to curb nosocomial transmission.
Pillay
M
M
Department of Medical Microbiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Sturm
A W
AW
D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission; D016172:DNA Fingerprinting; D018432:Drug Resistance, Multiple; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission*; D055815:Young Adult
D000995:Antitubercular Agents