Published ahead of print on October 11, 2004, doi:10.1164/rccm.200408-1081OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 12, December 2004, 1360-1366
A more recent version of this article appeared on December 15, 2004
Submitted on August 19, 2004
Accepted on September 27, 2004
Recurrent Tuberculosis in the United States and Canada: Relapse or Reinfection?
Robert M Jasmer1*, Lorna Bozeman2, Kevin Schwartzman3, M. Donald Cave4, Jussi J Saukkonen5, Beverly Metchock2, Awal Khan2, William J Burman6, and Tuberculosis Trials Consortium2
1 Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA,
2 Centers for Disease Control and Prevention, Atlanta, GA, USA,
3 Montreal Chest Institute and McGill University, Montreal, Quebec, Canada,
4 University of Arkansas for Medical Sciences, Little Rock, AR, USA,
5 Boston University School of Medicine, Boston, MA, USA,
6 Denver Public Health Department, Denver, CO, USA
* To whom correspondence should be addressed. E-mail: rjasmer{at}itsa.ucsf.edu.
Recurrence of active tuberculosis following treatment can be due to relapse of infection with the same strain or reinfection with a new strain of Mycobacterium tuberculosis. The proportion of recurrent tuberculosis cases due to reinfection has varied widely in previous studies. We evaluated cases of recurrent tuberculosis in two prospective clinical trials: a randomized study of two regimens for the last 4 months of treatment (n = 1075), and a study of a twice-weekly rifabutin-containing regimen for HIV-infected tuberculosis (n = 169). Isolates at diagnosis and from positive cultures after treatment completion underwent genotyping using IS6110 (with secondary genotyping for isolates with <6 copies of IS6110). Of 85 patients having a positive culture after completing treatment, 6 (6.0%) were classified as false-positive cultures by a review committee blinded to treatment assignment. Of the remaining 75 cases with recurrent tuberculosis and genotyping data available, 72 (96%, 95% confidence interval 88.8%-99.2%) paired isolates had the same genotype; only 3 (4%, 95% confidence interval 0.8%-11.2%) had a different genotype and were categorized as reinfection. We conclude that recurrent tuberculosis in the United States and Canada, countries with low rates of tuberculosis, is rarely due to reinfection with a new strain of M. tuberculosis.
Key words: pulmonary tuberculosis, relapse, reinfection, DNA fingerprinting
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