RSS Feeds
Superinfection with Rifampin-Isoniazid-Streptomycin-Ethambutol (RISE)-resistant Tuberculosis in Three Patients with AIDS: Confirmation by Polymerase Chain Reaction Fingerprinting
- David L. Horn, MD;
- Dial Hewlett, MD;
- Walter H. Haas, MD;
- W. Ray Butler, MS;
- Celia Alfalla, MD;
- Edgar Tan, MD;
- Andrew Levine, MD;
- Atasu Nayak, MD; and
- Steven M. Opal, MD
- From Lincoln Medical and Mental Health Center, Bronx, New York; the Centers for Disease Control and Prevention, Atlanta, Georgia; Memorial Hospital of Rhode Island, Providence, Rhode Island. Requests for Reprints: Dial Hewlett, Jr., Department of Medicine, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451. Acknowledgments: The authors thank Yvonne Lue, PhD, Trevor McLean, Stephen Peterson, MD, Jack Crawford, PhD, and Fred Moore for their assistance.
Reinfection with new strains of Mycobacterium tuberculosis has been reported [1-4]. Exogenous reinfection with M. tuberculosis resistant to isoniazid and streptomycin played an important role in an outbreak occurring in a homeless shelter [5]. Recently, restriction fragment-length polymorphism analysis has been used to show exogenous M. tuberculosis reinfection of patients with the acquired immunodeficiency syndrome (AIDS) who have multidrug-resistant tuberculosis that occurred during therapy for the initial drug-sensitive infection [6, 7]. We describe three additional patients in whom rifampin-isoniazid-streptomycin-ethambutol (RISE)-resistant tuberculosis occurred during therapy for drug-susceptible tuberculosis. This was documented by DNA fingerprinting using the mixed-linker polymerase chain reaction (PCR) technique.
Methods
Mycobacterium tuberculosis was isolated on Lowenstein-Jensen slants and identified by the AccuProbe System (Gen-Probe, Inc., San Diego, California). Susceptibility testing was done by the New York City Department of Health Bureau of Laboratories.
For DNA fingerprinting, mycobacterial growth was washed from the Lowenstein-Jensen slants, and the cells were lysed by beating with siliconized zirconium beads and …
