Cohen Ted, Chindelevitch Leonid, Misra Reshma, Kempner Maria E, Galea Jerome, Moodley Prashini, Wilson Douglas
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Infection Prevention and Control, University of KwaZulu-Natal, Durban.
J Infect Dis. 2016 Jun 1;213(11):1796-9. doi: 10.1093/infdis/jiw014. Epub 2016 Jan 14.
The clinical management of tuberculosis is a major challenge in southern Africa. The prevalence of within-host genetically heterogeneous Mycobacterium tuberculosis infection and its effect on treatment response are not well understood. We enrolled 500 patients with tuberculosis in KwaZulu-Natal and followed them through 2 months of treatment. Using mycobacterial interspersed repetitive units-variable number of tandem repeats genotyping to identify mycobacterial heterogeneity, we report the prevalence and evaluate the association of heterogeneity with treatment response. Upon initiation of treatment, 21.1% of participants harbored a heterogeneous M. tuberculosis infection; such heterogeneity was independently associated with a nearly 2-fold higher odds of persistent culture positivity after 2 months of treatment (adjusted odds ratio, 1.90; 95% confidence interval, 1.03-3.50).
结核病的临床管理是南部非洲面临的一项重大挑战。宿主内基因异质性结核分枝杆菌感染的流行情况及其对治疗反应的影响尚未得到充分了解。我们在夸祖鲁 - 纳塔尔省招募了500名结核病患者，并对他们进行了为期2个月的治疗随访。使用分枝杆菌散布重复单位 - 可变数量串联重复序列基因分型来识别分枝杆菌的异质性，我们报告了异质性的患病率，并评估了异质性与治疗反应之间的关联。在治疗开始时，21.1%的参与者感染了异质性结核分枝杆菌；这种异质性与治疗2个月后持续培养阳性的几率高出近2倍独立相关（调整后的优势比为1.90；95%置信区间为1.03 - 3.50）。
