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J Infect Dis. 2016 Jun 1;213(11):1796-9. doi: 10.1093/infdis/jiw014. Epub 2016 Jan 14.

Within-Host Heterogeneity of Mycobacterium tuberculosis Infection Is Associated With Poor Early Treatment Response: A Prospective Cohort Study.

Author information

1
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
2
Infection Prevention and Control, University of KwaZulu-Natal, Durban.
3
Brigham and Women's Hospital.
4
Partners in Health, Boston, Massachusetts.
5
Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa.

Abstract

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).

KEYWORDS:

HIV/TB; coinfection; mixed infection; tuberculosis; within-host heterogeneity

PMID:
26768249
PMCID:
PMC4857469
DOI:
10.1093/infdis/jiw014
[Indexed for MEDLINE]
Free PMC Article

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