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Tuberculosis Recurrences
Reinfection Plays a Role in a Population Whose Clinical/Epidemiological Characteristics Do Not Favor Reinfection
Darío García de Viedma, PhD;
Mercedes Marín, PharmD, PhD;
Susana Hernangómez, MD;
Marisol Díaz, PharmD, PhD;
María Jesús Ruiz Serrano, PharmD;
Luis Alcalá, PharmD;
Emilio Bouza, MD, PhD
Arch Intern Med. 2002;162:1873-1879.
Background Tuberculosis (TB) recurrences can be due to either reactivation by the
same strain (standard assumption) or reinfection by a new strain. Reinfection
has mainly been studied in selected populations with a high risk of reexposure
to TB. Our aim was to analyze the role of reinfection in TB recurrences in
unselected populations, without the clinical/epidemiological circumstances
that favor the involvement of a new different strain of Mycobacterium tuberculosis in the recurrence.
Methods A molecular typing analysis was performed with 92 sequential isolates
of M tuberculosis from 43 patients with recurrent
TB, during a 12-year period. The subjects were both positive and negative
for the human immunodeficiency virus, most did not adhere to anti-TB therapy,
and they lived in an area with a moderate incidence of TB. Recurrence was
considered as being caused by reinfection when the molecular fingerprints
for the strains involved in the sequential episodes of TB were different.
Results In 14 (33%) of the 43 patients, different M tuberculosis strains were involved in the first and in subsequent episodes of TB.
Reinfection was found for patients who were both positive and negative for
the human immunodeficiency virus, and most patients did not adhere to anti-TB
therapy. Differences between the reinfection and reactivation groups were
not significant (P = .77) according to the time interval
between episodes.
Conclusions Reinfection plays an important role in recurrent TB in a population
without the clinical/epidemiological circumstances that are usually assumed
to favor it. Reinfection should, thus, be considered as a cause of TB recurrences
in a wider context than before.
From the Servicio de Microbiología y Enfermedades Infecciosas,
Hospital Gregorio Marañón, Madrid, Spain.
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