Nolan C M, Williams D L, Cave M D, Eisenach K D, el-Hajj H, Hooton T M, Thompson R L, Goldberg S V
Seattle-King County Department of Public Health, University of Washington, Seattle 98104, USA.
Am J Respir Crit Care Med. 1995 Sep;152(3):1067-71. doi: 10.1164/ajrccm.152.3.7663785.
Acquired rifampin resistance without preexisting isoniazid resistance is highly unusual in patients with tuberculosis. The purpose of this report is to describe and characterize that unusual pattern of acquired drug resistance in three patients with human immunodeficiency virus (HIV) infection. The patients originally had Mycobacterium tuberculosis strains that were susceptible to isoniazid and rifampin. During treatment in two patients and after completion of therapy in the remaining one, each patient developed active, rifampin-resistant, isoniazid-susceptible tuberculosis. One patient subsequently developed isoniazid resistance also. Studies on patients' M. tuberculosis isolates using IS6110 restriction fragment length polymorphism typing and rpoB gene sequencing indicated that rifampin resistance in each patient arose during therapy by an rpoB gene mutation in the original M. tuberculosis isolate. Detection of this unusual drug-resistance phenotype in three patients with HIV infection suggests that acquired rifampin resistance is somehow associated with co-infection due to HIV and tuberculosis.
在结核病患者中，获得性利福平耐药而先前不存在异烟肼耐药的情况极为罕见。本报告的目的是描述和表征三例人类免疫缺陷病毒（HIV）感染患者中这种不寻常的获得性耐药模式。这些患者最初的结核分枝杆菌菌株对异烟肼和利福平敏感。在两名患者的治疗期间以及另一名患者完成治疗后，每名患者均发生了活动性、利福平耐药、异烟肼敏感的结核病。其中一名患者随后也出现了异烟肼耐药。使用IS6110限制性片段长度多态性分型和rpoB基因测序对患者的结核分枝杆菌分离株进行研究表明，每名患者的利福平耐药是在治疗期间由原始结核分枝杆菌分离株中的rpoB基因突变引起的。在三例HIV感染患者中检测到这种不寻常的耐药表型表明，获得性利福平耐药在某种程度上与HIV和结核病的合并感染有关。
