title: Mixed-strain mycobacterium tuberculosis infections and the implications for tuberculosis treatment and control.
abstract: Numerous studies have reported that individuals can simultaneously harbor multiple distinct strains of Mycobacterium tuberculosis. To date, there has been limited discussion of the consequences for the individual or the epidemiological importance of mixed infections. Here, we review studies that documented mixed infections, highlight challenges associated with the detection of mixed infections, and discuss possible implications of mixed infections for the diagnosis and treatment of patients and for the community impact of tuberculosis control strategies. We conclude by highlighting questions that should be resolved in order to improve our understanding of the importance of mixed-strain M. tuberculosis infections.
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA. tcohen@hsph.harvard.edu
authors.forename: Ted
authors.initials: T
authors.lastname: Cohen
authors.forename: Paul D
authors.initials: PD
authors.lastname: van Helden
authors.forename: Douglas
authors.initials: D
authors.lastname: Wilson
authors.forename: Caroline
authors.initials: C
authors.lastname: Colijn
authors.forename: Megan M
authors.initials: MM
authors.lastname: McLaughlin
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.forename: Robin M
authors.initials: RM
authors.lastname: Warren
mesh_terms: D060085:Coinfection / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D014376:Tuberculosis / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy*