Kontsevaya Irina, Nikolayevskyy Vladyslav, Kovalyov Alexander, Ignatyeva Olga, Sadykhova Anna, Simak Tatiana, Tikhonova Olesya, Dubrovskaya Yulia, Vasiliauskiene Edita, Davidaviciene Edita, Skenders Girts, Makurina Olga, Balabanova Yanina, Drobniewski Francis
Imperial College London, Du Cane Road, London W12 0NN, UK; N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, 154 Novo-Sadovaya Street, Samara 443068, Russian Federation.
Imperial College London, Du Cane Road, London W12 0NN, UK; Public Health England National Mycobacterium Reference Laboratory, 2 Newark Street, London E1 2AT, UK; Queen Mary, University of London, Mile End Road, London E1 4NS, UK.
Infect Genet Evol. 2017 Mar;48:76-82. doi: 10.1016/j.meegid.2016.12.016. Epub 2016 Dec 18.
Mycobacterium tuberculosis superinfection is known to occur in areas with high rates of tuberculosis (TB) and has a significant impact on overall clinical TB management.
We aimed to estimate the superinfection rate in cohorts of drug sensitive and multi-drug resistant tuberculosis (MDR TB) patients from Eastern Europe and the potential role of a second MDR TB strain infecting a patient with active non-MDR TB in treatment outcome.
The study population included 512 serial M. tuberculosis isolates obtained from 84 MDR- and 136 non-MDR TB patients recruited sequentially at sites in Lithuania, Latvia and Russia in 2011-2013. Strains were genotyped using standardized 24-loci Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) typing.
Changes in two or more MIRU-VNTR loci suggesting superinfection were detected in 13 patients (5.9%). We found 4 initially non-MDR TB patients superinfected with an MDR TB strain during treatment and 3 of them had an unsuccessful outcome.
An unsuccessful treatment outcome in patients initially diagnosed with drug sensitive TB might be explained by superinfection with an MDR TB strain. Bacteriological reversion could be indicative of superinfection with another strain. Archiving of all serial isolates and their genotyping in case of culture reversion could support therapeutic strategies in high MDR TB burden settings if resources are available.
已知结核分枝杆菌重复感染发生在结核病（TB）高发地区，对结核病的整体临床管理有重大影响。
我们旨在估算来自东欧的药物敏感型和耐多药结核病（MDR-TB）患者队列中的重复感染率，以及第二种耐多药结核菌株感染活动性非耐多药结核病患者对治疗结果的潜在作用。
研究人群包括2011年至2013年在立陶宛、拉脱维亚和俄罗斯的研究地点依次招募的84例耐多药结核病患者和136例非耐多药结核病患者的512株连续结核分枝杆菌分离株。使用标准化的24位点分枝杆菌插入重复单位-可变数目串联重复序列（MIRU-VNTR）分型对菌株进行基因分型。
在13例患者（5.9%）中检测到两个或更多MIRU-VNTR位点的变化，提示存在重复感染。我们发现4例最初为非耐多药结核病的患者在治疗期间被耐多药结核菌株重复感染，其中3例治疗结果不佳。
最初诊断为药物敏感型结核病的患者治疗结果不佳可能是由耐多药结核菌株的重复感染所致。细菌学逆转可能表明被另一种菌株重复感染。如果资源可用，在培养物逆转时对所有连续分离株进行存档及其基因分型可支持耐多药结核病高负担地区的治疗策略。
