Pillay Manormoney, Sturm A Willem
Department of Medical Microbiology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
Clin Infect Dis. 2007 Dec 1;45(11):1409-14. doi: 10.1086/522987. Epub 2007 Oct 22.
Although several hot spots of multidrug-resistant tuberculosis have been identified on the African continent, extensive drug resistance (XDR) has not been reported until recently, when a large number of XDR cases were identified in KwaZulu-Natal. The majority of the patients involved were infected with the same strain of Mycobacterium tuberculosis (F15/LAM4/KZN). We report this strain's development from multidrug resistance to XDR.
We searched databases for studies performed during the period 1994-2005 that involved the resistance patterns of isolates of M. tuberculosis with the F15/LAM4/KZN strain fingerprint.
As early as 1994, the F15/LAM4/KZN strain was responsible for a number of cases of multidrug-resistant tuberculosis, indicating the ability of the strain to cause cases of primary resistant tuberculosis. Some of the isolates were also resistant to streptomycin. From 1994 onwards, multidrug-resistant isolates with resistance to additional drugs were found, and the first XDR isolate was discovered in 2001.
Drug resistance to as many as 7 drugs developed in a local strain of M. tuberculosis in slightly more than a decade. This coincided with the introduction of the directly observed therapy-based and directly observed therapy-plus-based tuberculosis-control programs. It is postulated that the introduction of these programs in the absence of susceptibility testing or drug resistance surveillance has been instrumental in the development of XDR in this highly transmissible F15/LAM4/KZN strain. The expanding pool of human immunodeficiency virus-infected, tuberculosis-susceptible individuals has likely contributed to this development.
尽管在非洲大陆已发现多个耐多药结核病热点地区，但直到最近在夸祖鲁 - 纳塔尔省发现大量广泛耐药（XDR）病例之前，广泛耐药情况尚未见报道。大多数相关患者感染的是同一株结核分枝杆菌（F15/LAM4/KZN）。我们报告了该菌株从耐多药发展为广泛耐药的过程。
我们检索了数据库中1994 - 2005年期间涉及具有F15/LAM4/KZN菌株指纹的结核分枝杆菌分离株耐药模式的研究。
早在1994年，F15/LAM4/KZN菌株就导致了多例耐多药结核病病例，表明该菌株有能力引起原发性耐药结核病病例。一些分离株还对链霉素耐药。从1994年起，发现了对更多药物耐药的耐多药分离株，2001年发现了首例广泛耐药分离株。
在略多于十年的时间里，当地一株结核分枝杆菌对多达7种药物产生了耐药性。这与基于直接观察治疗和基于直接观察治疗加其他措施的结核病控制项目的引入同时发生。据推测，在缺乏药敏试验或耐药监测的情况下引入这些项目，对这种高传播性的F15/LAM4/KZN菌株广泛耐药的发展起到了推动作用。感染人类免疫缺陷病毒且易患结核病的人群不断增加，可能也促成了这种情况的发展。
