title: Clonal Complexity in Mycobacterium tuberculosis Can Hamper Diagnostic Procedures.
abstract: Clonal complexity is increasingly accepted inMycobacterium tuberculosisinfection, including mixed infections by ≥2 strains, which usually occur in settings with a high burden of tuberculosis and/or a high risk of overexposure to infected patients. Mixed infections can hamper diagnostic procedures; obtaining an accurate antibiogram is difficult when the susceptibility patterns of the strains differ. Here, we show how mixed infections can also prove challenging for other diagnostic procedures, even outside settings where mixed infections are traditionally expected. We show how an unnoticed mixed infection in an HIV-positive patient diagnosed in Madrid, Spain, with differences in the representativeness of the coinfecting strains in different sputum samples, markedly complicated the resolution of a laboratory cross-contamination false positivity alert.
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Pérez-Lago
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Herranz
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
authors.forename: Yurena
authors.initials: Y
authors.lastname: Navarro
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Ruiz Serrano
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Miralles
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.|Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.affiliation: Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain dgviedma2@gmail.com.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.|CIBER Enfermedades Respiratorias, CIBERES, Spain.
authors.forename: Darío
authors.initials: D
authors.lastname: García-de-Viedma
mesh_terms: D060085:Coinfection / Q000382:microbiology / Q000821:virology; D005189:False Positive Reactions; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics; D013030:Spain; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology
keywords: clonal complexity; diagnostic procedures; mixed infection; tuberculosis