title: Advanced immune suppression is associated with increased prevalence of mixed-strain Mycobacterium tuberculosis infections among persons at high risk for drug-resistant tuberculosis in Botswana.
abstract: We examined factors associated with mixed-strain Mycobacterium tuberculosis infections among patients at high risk for drug-resistant tuberculosis in Botswana. Thirty-seven (10.0%) of 370 patients with tuberculosis had mixed M. tuberculosis infections, based on 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats genotyping. In log-binomial regression analysis, age <37 years (adjusted prevalence ratio [PR], 1.92; 95% confidence interval [CI], 1.01-3.57) and prior tuberculosis treatment (adjusted PR, 2.31; 95% CI, 1.09-4.89) were associated with mixed M. tuberculosis infections. Among human immunodeficiency virus-infected patients, prior tuberculosis treatment (adjusted PR, 2.11; 95% CI, 1.04-4.31) and CD4(+) T-cell count of <100 cells/μl (adjusted PR, 10.18; 95% CI, 2.48-41.71) were associated with mixed M. tuberculosis infections. Clinical suspicion of mixed M. tuberculosis infections should be high for patients with advanced immunosuppression and a prior history of tuberculosis treatment.
authors: Division of Infectious Diseases, University of California-Los Angeles.
authors: Sanghyuk S
authors: SS
authors: Shin
authors: Botswana-Upenn Partnership.
authors: Chawangwa
authors: C
authors: Modongo
authors: Botswana National Tuberculosis Program, Botswana Ministry of Health.
authors: Ronald
authors: R
authors: Ncube
authors: University of Botswana, Gaborone, Botswana.
authors: Enoch
authors: E
authors: Sepako
authors: Division of Infectious Diseases, University of California-Los Angeles.
authors: Jeffrey D
authors: JD
authors: Klausner
authors: Botswana-Upenn Partnership Division of Infectious Diseases, University of Pennsylvania, Philadelphia.
authors: Nicola M
authors: NM
authors: Zetola
mesh_terms: D000328:Adult; D001902:Botswana / Q000453:epidemiology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D060085:Coinfection / Q000453:epidemiology* / Q000276:immunology*; D005260:Female; D005838:Genotype; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology*; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000276:immunology*; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000276:immunology*
keywords: HIV/AIDS; immune suppression; mixed tuberculosis infection; reinfection; tuberculosis