在艾滋病毒感染率较低的高发病地区，内源性再激活和真正的治疗失败作为复发性结核病的病因
Endogenous reactivation and true treatment failure as causes of recurrent tuberculosis in a high incidence setting with a low HIV infection.
作者信息
Shamputa Isdore Chola, Van Deun Armand, Salim Md Abdul Hamid, Hossain Md Anwar, Fissette Krista, de Rijk Pim, Rigouts Leen, Portaels Françoise
机构信息
Prince Leopold Institute of Tropical Medicine, Mycobacteriology Unit, Antwerp, Belgium.
出版信息
Trop Med Int Health. 2007 Jun;12(6):700-8. doi: 10.1111/j.1365-3156.2007.01840.x.
OBJECTIVE
To determine the relative frequencies of reinfection vs. reactivation or treatment failure in patients from a high tuberculosis incidence setting with a low prevalence of HIV infection.
METHOD
We performed DNA fingerprinting on serial isolates from one and multiple TB episodes from 97 retreatment patients; 35 patients had been previously cured, whereas 62 had not.
RESULTS
DNA fingerprinting patterns of recurrence Mycobacterium tuberculosis isolates of 5 of the 35 previously cured patients did not match with those of the corresponding initial isolates, indicating reinfection. We did not document reinfection during treatment. Isolates from each of the remaining 30 previously cured patients had identical DNA fingerprinting results, indicating reactivation. DNA fingerprinting patterns of isolates from the 62 patients with persistently positive sputum smears were identical, suggesting treatment failure.
CONCLUSION
These findings suggest that reinfection is not a common cause of relapse and treatment failure in this rural predominantly HIV-free population despite the high incidence of TB.
目的
确定来自结核病高发且艾滋病毒感染率低的地区的患者中，再感染与再激活或治疗失败的相对频率。
方法
我们对97例复治患者单次及多次结核病发作的系列分离株进行了DNA指纹分析；35例患者先前已治愈，而62例未治愈。
结果
35例先前已治愈患者中有5例复发的结核分枝杆菌分离株的DNA指纹图谱与相应的初始分离株不匹配，表明为再感染。我们在治疗期间未记录到再感染情况。其余30例先前已治愈患者的分离株DNA指纹分析结果均相同，表明为再激活。62例痰涂片持续阳性患者的分离株DNA指纹图谱相同，提示治疗失败。
结论
这些发现表明，尽管结核病发病率高，但在这个以农村为主且基本无艾滋病毒感染的人群中，再感染并非复发和治疗失败的常见原因。
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