title: Undetected multidrug-resistant tuberculosis amplified by first-line therapy in mixed infection.
abstract: Infections with >1 Mycobacterium tuberculosis strain(s) are underrecognized. We show, in vitro and in vivo, how first-line treatment conferred a competitive growth advantage to amplify a multidrug-resistant M. tuberculosis strain in a patient with mixed infection. Diagnostic techniques that identify mixed tubercle bacilli populations are needed to curb the spread of multidrug resistance.
authors.affiliation: Imperial College London, London, UK. s.hingley-wilson@surrey.ac.uk
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Hingley-Wilson
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Casey
authors.forename: David
authors.initials: D
authors.lastname: Connell
authors.forename: Samuel
authors.initials: S
authors.lastname: Bremang
authors.forename: Jason T
authors.initials: JT
authors.lastname: Evans
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hawkey
authors.forename: Grace E
authors.initials: GE
authors.lastname: Smith
authors.forename: Annette
authors.initials: A
authors.lastname: Jepson
authors.forename: Stuart
authors.initials: S
authors.lastname: Philip
authors.forename: Onn Min
authors.initials: OM
authors.lastname: Kon
authors.forename: Ajit
authors.initials: A
authors.lastname: Lalvani
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D060085:Coinfection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D046508:Culture Techniques; D057210:Delayed Diagnosis; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D018598:Minisatellite Repeats; D025202:Molecular Diagnostic Techniques; D058885:Multilocus Sequence Typing; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000254:growth & development / Q000302:isolation & purification; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid
keywords: Mycobacterium tuberculosis; TB; antimicrobial resistance; bacteria; co-infection; drug sensitive; multidrug resistant; treatment resistance; tuberculosis and other mycobacteria