Relapse Versus Reinfection of Recurrent Tuberculosis Patients in a National Tuberculosis Specialized Hospital in Beijing, China.

Zhaojing Zong,Jin Shi,Hairong Huang,Guangming Dai,Wei Jing,Guanglu Jiang,Fengmin Huo,Qian Liang,Yifeng Ma,Yu Pang

doi:10.3389/fmicb.2018.01858

Abstract

Tuberculosis (TB) recurrence can result from either relapse of an original infection or exogenous reinfection with a new strain of Mycobacterium tuberculosis (MTB). The aim of this study was to assess the roles of relapse and reinfection among recurrent TB cases characterized by a high prevalence rate of drug-resistant TB within a hospital setting. After 58 paired recurrent TB cases were genotyped to distinguish relapse from reinfection, 37 (63.8%) were demonstrated to be relapse cases, while the remaining 21 were classified as reinfection cases. Statistical analysis revealed that male gender was a risk factor for TB reinfection, odds ratios and 95% confidence interval (OR [95% CI]: 4.188[1.012–17.392], P = 0.049). Of MTB isolates obtained from the 37 relapse cases, 11 exhibited conversion from susceptible to resistance to at least one antibiotic, with the most frequent emergence of drug resistance observed to be levofloxacin. For reinfection cases, reemergence of rifampicin-resistant isolates harboring double gene mutations, of codon 531 of rpoB and codon 306 of embB, were observed. In conclusion, our data demonstrate that relapse is a major mechanism leading to TB recurrence in Beijing Chest Hospital, a national hospital specialized in TB treatment. Moreover, male patients are at higher risk for reinfection. The extremely high rate of multidrug-resistant tuberculosis (MDR-TB) among reinfection cases reflects more successful transmission of MDR-TB strains versus non-resistant strains overall.

Highlights

Tuberculosis (TB) is caused by bacteria of the Mycobacterium tuberculosis complex (MTBC) and is a major threat to public health worldwide (World Health Organization [WHO], 2016)
Completion of anti-TB treatment following the guidelines of National Tuberculosis Control Program; (2) exhibited two or more episodes of TB diagnosed in the period August 2011July 2014; (3) provided cultured MTB isolates from the first episode was used in this analysis
This is in contrast to findings from regions of high TB burden, where reinfection is the major mechanism leading to TB recurrence (Lambert et al, 2003)

Summary

Introduction

Tuberculosis (TB) is caused by bacteria of the Mycobacterium tuberculosis complex (MTBC) and is a major threat to public health worldwide (World Health Organization [WHO], 2016). Some patients still exhibit tuberculosis recurrence after treatment completion, a phenomenon which adds considerably to the burden of tuberculosis worldwide (Guerra-Assunção et al, 2015). Recurrence of TB can be due either to relapse of an original infection or to reinfection via exogenous infection by a new MTBC strain (Guerra-Assunção et al, 2015; Schiroli et al, 2015). Relapse Versus Reinfection in Tuberculosis cause for observed recurrence rates (van Rie et al, 1999). By differentiating between mechanisms underlying the two distinct types TB recurrence, relapse versus reinfection, more effective TB control strategies could be implemented to achieve better TB control (Guerra-Assunção et al, 2015)

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Conclusion