Department of Epidemiology, University of Florida, College of Public Health and Health Professions, College of Medicine, 2004 Mowry Road, P.O. Box 100231, Gainesville, FL 32610, United States; Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, United States.
Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, United States; Division of Infectious Diseases and Global Medicine, University of Florida, College of Medicine, 2055 Mowry Road, P.O. Box 103600, Gainesville, FL 32610, United States.
Infect Genet Evol. 2021 Jan;87:104659. doi: 10.1016/j.meegid.2020.104659. Epub 2020 Dec 1.
Mixed infections with genetically distinct Mycobacterium tuberculosis (MTB) strains within a single host have been documented in different settings; however, this phenomenon is rarely considered in the management and care of new and relapse tuberculosis (T.B.) cases. This study aims to establish the epidemiological and clinical features of mixed infections among culture-confirmed T.B. patients enrolled in tuberculosis care at the Florida Department of Health (FDOH) and measure its association with T.B. mortality. We analyzed de-identified surveillance data of T.B. cases enrolled in T.B. care from April 2008 to January 2018. Mixed MTB infection was determined by the presence of more than one Copy Number Variant (CNV) in at least one locus, based on the genotype profile pattern of at least one isolate using 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR). The prevalence of mixed MTB infections among the 4944 culture-confirmed TB cases included in this analysis was 2.6% (129). Increased odds of mixed infections were observed among middle-aged patients, 45-64 years (AOR = 2.38; 95% CI: 0.99, 5.69; p = 0.0513), older adults 65 years and above (AOR = 3.95; 95% CI: 1.63, 9.58; p = 0.0023) and patients with diabetes (OR = 1.77; 95% CI: 1.12, 2.80; p = 0.0150). There was no significant association between mixed infections and death. Our study provides insight into the epidemiological and clinical characteristics of patients with mixed MTB infections, which is essential in the management of T.B. patients.
在同一宿主内发生的具有遗传上不同的结核分枝杆菌（MTB）菌株的混合感染在不同环境中已有记载；然而，这种现象在新发病例和复发病例的结核病（T.B.）管理和护理中很少被考虑。本研究旨在确定佛罗里达州卫生部（FDOH）登记的结核护理中经培养证实的结核患者中混合感染的流行病学和临床特征，并衡量其与结核死亡率的关系。我们分析了 2008 年 4 月至 2018 年 1 月登记的结核护理中结核病例的匿名监测数据。混合 MTB 感染是根据至少一个分离株的基因型谱模式，通过至少一个位点存在多个拷贝数变异（CNV）来确定的，该模式基于 24 个基因座分枝杆菌插入重复单元-可变数量串联重复（MIRU-VNTR）。本分析纳入的 4944 例经培养证实的结核病例中，混合 MTB 感染的患病率为 2.6%（129 例）。在中年患者（45-64 岁；优势比 [AOR] = 2.38；95%置信区间：0.99，5.69；p = 0.0513）、65 岁及以上的老年患者（AOR = 3.95；95%置信区间：1.63，9.58；p = 0.0023）和患有糖尿病的患者（OR = 1.77；95%置信区间：1.12，2.80；p = 0.0150）中，混合感染的可能性更高。混合感染与死亡之间无显著关联。本研究提供了对混合 MTB 感染患者的流行病学和临床特征的深入了解，这对于结核病患者的管理至关重要。
