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Am. J. Respir. Crit. Care Med., Volume 163, Number 3, March 2001, 717-720

Exogenous Reinfection with Tuberculosis on a European Island with a Moderate Incidence of Disease

JOSÉ A. CAMINERO, MARÍA J. PENA, MARÍA I. CAMPOS-HERRERO, JOSÉ C. RODRÍGUEZ, OCTAVIO AFONSO, CARLOS MARTIN, JOSÉ M. PAVÓN, MARÍA J. TORRES, MARCOS BURGOS, PEDRO CABRERA, PETER M. SMALL, and DONALD A. ENARSON

Service of Pneumology, Service of Microbiology, Service of Immunology, Emergency Department, Research Unit, University General Hospital "Dr. Negrín," Las Palmas de Gran Canaria, Spain; International Union against Tuberculosis and Lung Diseases (IUATLD), París, France; Department of Microbiology, University of Zaragoza, Spain; and Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California

The frequency and determinants of exogenous reinfection and of endogenous reactivation of tuberculosis in patients previously treated are poorly understood. In Gran Canaria Island, Spain, between 1991 and 1996, 962 tuberculosis cases were confirmed by culture. Drug susceptibility testing was performed on available bacterial isolates and IS6110-based RFLP genotyping was carried out. Twenty-three patients (2.4%) had two positive cultures separated by at least 12 mo, 18 of whom had bacterial DNA available for genotypic analysis. The initial and final isolates from eight (44%) were different genotypes, indicating exogenous reinfection. Six of them were retreated after cure and two retreated after default. Six were HIV seronegative and two were HIV seropositive. Endogenous reactivation was seen in the remaining 10 patients of whom eight were retreated after default and two after cure. Three of the eight (38%) being retreated after default developed multidrug resistance. One genotype was responsible for a second episode of tuberculosis in five cases, three exogenous reinfections and two endogenous reactivations. In the context of a moderate incidence of tuberculosis, exogenous reinfection is an important cause of TB recurrence, even in HIV-seronegative patients.




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