Tuberculosis Research Centre Research Articles

Cytomorphological Patterns of AFB Positive Tubercular Lymphadenitis: A Cross-sectional Study

Introduction: Tuberculosis (TB) remains a global threat despite advancements in diagnostic technologies and treatment options. Tubercular lymphadenitis is the most common presentation of Extra Pulmonary Tuberculosis (EPTB) in developing countries, accounting for approximately 30-52% of cases. Fine Needle Aspiration Cytology (FNAC) plays a crucial role in the cost- effective and efficient outpatient diagnosis of tubercular lymphadenitis. Understanding the different cytomorphological patterns and Acid Fast Bacilli (AFB) density in tubercular lymphadenitis aids in early diagnosis, management, and reducing morbidity and mortality. Aim: To analyse the various cytomorphological patterns observed in tubercular lymphadenitis, along with AFB density. Materials and Methods: The present cross-sectional cytomorphological study study was conducted between September and October 2021. Data from September 2020 to August 2021 were collected from the records of Shanthabai Devarao Shivaram(SDS) Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, a tertiary care hospital in Bengaluru, Karnataka, India. Out of a total of 128 patients with lymphadenopathy who underwent FNAC, four cases were excluded due to failed aspiration. The remaining 124 cases were available for analysis. Smears that exhibited features suggestive of tuberculosis were selected and categorised based on cytomorphological patterns into the following groups: Pattern-1 (Exudative), Pattern-2 (Epithelioid granuloma without necrosis), Pattern-3 (Epithelioid granuloma with necrosis), and Pattern-4 (Predominantly Necrosis without epithelioid granuloma). Ziehl-Neelsen (ZN) stained AFB positive smears were further categorised into four groups based on mycobacterial load. The categories included scant (1-9 AFB in 100 fields), 1+ (10-99 AFB in 100 fields), 2+ (1-10 AFB per field), and 3+ (>10 AFB per field). Higher numbers indicated greater infectivity. Statistical analysis was performed using the Chi-square test. A probability level of less than 0.05 (p<0.05) was considered statistically significant. Results: Out of the 124 cases studied, 81 (65.32%) were females and 43 (34.68%) were males, with a female preponderance (1.9:1). The overall prevalence of tubercular lymphadenopathy was 89 cases (71.77%), with Pattern 4 (Acellular necrosis without granuloma) being the most common cytomorphological pattern 25 cases (28.09%) followed closely by Pattern-2 (Epithelioid cell granuloma without necrosis) 23 cases (25.84%). AFB positivity was observed in 57 cases (64.04%). Pattern-1 (Exudative pattern) showed 100% AFB positivity (21 out of 21 cases), while Pattern 4 (Predominantly necrosis without epithelioid granuloma) demonstrated 92% AFB positivity (23 out of 25 cases). Conclusion: Understanding the various cytomorphological patterns in tubercular lymphadenitis is crucial for its diagnosis. Additionally, identifying AFB positivity, acid-fast bacilli distribution, and Bacterial Index (BI) in various patterns aids in planning early treatment and ensuring a favourable prognosis. FNAC serves as an easy, inexpensive, and quick procedure that can help avoid unnecessary surgical intervention or biopsy in the diagnosis of tubercular lymphadenitis.

Comparison of Gene Xpert MTB/RIF Assays with Conventional Standard Proportion Method for Determination of Drug Susceptibility In Multidrug Resistant TB Suspects

Background: Tuberculosis (TB) is a contagious disease and multidrug resistant tuberculosis is an emerging global issue. Rapid detection of such type of tuberculosis is necessary for timely control of the disease. GeneXpert test has already been implemented by World Health Organization to diagnose the infection on urgent basis. Objectives: This study was designed to apply GeneXpert MTB/RIF assays for the detection of rifampicin resistant tuberculosis and validation of assays by comparing with conventional standard drug proportion method. Additionally, to explore whether the assay can be utilized in treatment of Multidrug Resistant TB Settings: This study was undertaken in Pakistan Health Research Council TB Research Centre in collaboration with Department of Pulmonology, King Edward Medical University, Mayo Hospital, Lahore. Methods: Sputum samples from 125 patients were collected from confirmed pulmonary TB patients who were not responding to standard regimen of first line anti-tubercular treatment. Smears were stained by Ziehl-Neelsen method. All specimens were processed for culture and drug sensitivity by drug proportion method using Lowenstein Jensen medium as well as GeneXpert MTB/RIF assay. Results: A total of 125 subjects were registered in present study including 64 (51.2%) males and 61 (48.8%) females of age 15 years and above with mean age of 36.9±14.99. Sensitivity and specificity of the assay was observed as 92.1% and 93.5%, respectively. Association of rifampicin resistant by MTB/RIF assay and isoniazid resistance was found to be 88.1% and an agreement rate of rifampicin resistance by GeneXpert MTB/ RIF assay with isoniazid resistance was 81.25%. A total of 56 (44.8%) cases were found to be multidrug resistant patients and an agreement rate of 92.9% (52/56) was demonstrated in multidrug resistant patients which was found to be rifampicin resistant by GeneXpert in present study. Conclusion: GeneXpert MTB/RIF assay shown high sensitivity (96.7%) and specificity (98.6%). This most modern and latest technique, particularly in smear negative patients, helps rapid detection of TB and rifampicin resistance, which facilitates prompt diagnosis of multidrug resistant TB. These results propose that effective treatment can be initiated at an early stage, which will greatly help in reducing multidrug resistant TB.

Trend Analysis of Knowledge and Practice of National Tuberculosis Guidelines Among Medical Students: A Two-Year Interventional Study in Shiraz, Iran

Background: Tuberculosis (TB) is the second leading cause of death from infectious diseases. Delayed diagnosis of TB and emergence of multidrug-resistant TB are among the most important issues related to physician performance. Objectives: This study aimed to assess the level of knowledge and practice of TB among medical students. Methods: In this longitudinal, interventional study, 60 final-year medical students, who were referred to the Tuberculosis Research Center, affiliated to Shiraz University of Medical Sciences, were assessed regarding the knowledge and practice of national TB guidelines before education, 1 month after education, and 2 years after education. Data were collected using a valid and reliable questionnaire (Cronbach’s alpha, 0.62). The questionnaire consisted of 10 and 8 questions about knowledge and practice, respectively. The collected data were analyzed using SPSS. Results: Overall, 33 women and 27 men were recruited in this study. The mean age of the participants was 24 ± 1.5 years. The mean time from the internship period was 7.1 ± 4.4 months, and 53.3% of the participants had attended the infection ward during their clinical course. The median score of both knowledge and practice increased by about 50% after 1 month of education, while only practice showed a 25% increase after 2 years of education. No significant difference was found regarding knowledge and practice between genders. In addition, there was no significant difference among individuals who attended the infection ward and those who did not. Similarly, there was no significant difference among individuals who participated in continued medical programs after graduation and those who did not participate in such programs; also, students who visited patients with suspected TB were not significantly different from those who did not. However, a higher frequency of acceptable knowledge (≥ 50%) was reported in students who visited patients with suspected TB; also, a higher sum score of knowledge and practice was found in male students. Conclusions: This study showed that the level of TB knowledge and practice was not optimal among medical students. Therefore, for achieving a higher level of knowledge and practice, a regular patient-centered educational approach is needed, especially for postgraduates.

Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis.

Pulmonary tuberculosis is one of the major health concerns in the developing countries. Isolation of acid-fast bacilli (AFB) or tuberculosis bacilli from the sputum is required for the diagnosis. A proportion of suspected pulmonary tuberculosis (PTB) cases either clinically or radiologically will not produce sputum or will have sputum negative for AFB. These subsets of cases pose a diagnostic challenge to the treating clinicians. In this study, we present our experience and outcomes with flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis. This was a prospective cross-sectional study, conducted at SDS Tuberculosis research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India, from 2010 to 2016. A total of 1095 flexible bronchoscopies were done during this period, out of which 180 were patients with sputum negative for AFB, but were strongly suspected to have pulmonary tuberculosis on clinical examination or radiologically. There were 106 males and 74 females. The age ranged between 11 and 68years. All patients underwent complete evaluation of the tracheobronchial tree followed by bronchoalveolar lavage (BAL). Microbiological studies used were Ziehl-Neelsen (ZN) staining and culture in Lowenstein-Jensen (LJ) medium. Mucosal lesions suspected of tuberculosis were subjected to biopsy and histopathological confirmation. The data was analyzed. Out of 180 patients, 106 (58.88%) cases had positive AFB smear on BAL. The culture confirmed the diagnosis of pulmonary tuberculosis in 120 cases (66.66%). Histopathology showed caseous granuloma in 38 (42.22%) cases, nonspecific inflammation in 40 (44.44%) cases, and malignancy in 12 (13.33%) cases out of 90 cases, who underwent biopsy. There were no post-procedural complications. Bronchoscopy is the useful tool in the diagnosis of pulmonary tuberculosis in patients with sputum-negative pulmonary tuberculosis. It is also helpful in differentiating conditions having the clinical picture that mimics pulmonary tuberculosis.

Traumatic diaphragmatic hernia—17 years experience

Objective of this study is to review our experience in the management of traumatic diaphragmatic hernias over 17 years. Following Ethical Committee clearance, records of all patients who underwent traumatic diaphragmatic hernia surgery at Shanthabai Devarao Shivaram (SDS) Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India from January 1998 to December 2015 were reviewed. Data collected and analyzed were clinical presentation, mode of diagnosis, intraoperative findings and the postoperative clinical outcomes. Sixty patients underwent traumatic diaphragmatic hernia repair during this period. Age ranged between 10 and 80 years. The most common presentation was dyspnea. Blunt trauma was the cause in 52 (86.67%) cases and penetrating trauma in 8 (13.33%) cases. The diagnosis was within 24 h in 45 (75%) cases and in 15 (25%) cases the diagnosis was made after 24 h. Thoracotomy was the preferred approach for the repair in the absence of associated abdominal injuries. The most common site of rupture was the central tendon. The perioperative mortality was 8.33%. The hospital stay ranged between 5 and 84 days (mean 22 days). Right-sided diaphragmatic hernias are notorious to be missed on initial evaluation. Despite advances in diagnostic modalities, chest X-ray still continues to be useful in the diagnosis of traumatic ruptures. A high index of suspicion, together with the knowledge of mechanism of trauma is the key factor for the correct diagnosis.

"They are my babies": Meeting Mycobacterium tuberculosis and the Scientists Who Care for It

Moving beyond what various scholars call the “human exceptionalism” in the social sciences, this multispecies research explored the relationships between Mycobacterium tuberculosis (Mtb) − the bacteria that is responsible for causing the disease Tuberculosis (TB) − and four molecular biologists who worked at a TB research centre in the Western Cape of South Africa. Using fingeryeyes, a conceptual and methodological tool derived by Eva Hayward (2010), the ethnographer participated through observation and touched through sight. In a space that was scientific there was care, in a space of risk there was nurture. In an environment of scientific lingo and hard-core jargon, parenthood emerged. Rather than Mtb microbes being solely subjects for experiments, they were babies that needed to be cared for. Making these babies was also making parents and scientists.

Frequency and Type of Disputed rpoB Mutations in Mycobacterium tuberculosis Isolates from South Korea.

BackgroundA disputed rpoB mutation is a specific type of rpoB mutation that can cause low-level resistances to rifampin (RIF). Here, we aimed to assess the frequency and types of disputed rpoB mutations in Mycobacterium tuberculosis isolates from South Korea.MethodsBetween August 2009 and December 2015, 130 patients exhibited RIF resistance on the MTBDRplus assay at Asan Medical Center. Among these cases, we identified the strains with disputed rpoB mutation by rpoB sequencing analysis, as well as among the M. tuberculosis strains from the International Tuberculosis Research Center (ITRC).ResultsAmong our cases, disputed rpoB mutations led to RIF resistance in at least 6.9% (9/130) of the strains that also exhibited RIF resistance on the MTBDRplus assay. Moreover, at the ITRC, sequencing of the rpoB gene of 170 strains with the rpoB mutation indicated that 23 strains (13.5%) had the disputed mutations. By combining the findings from the 32 strains from our center and the ITRC, we identified the type of disputed rpoB mutation as follows: CTG511CCG (L511P, n=8), GAC516TAC (D516Y, n=8), CTG533CCG (L533P, n=8), CAC526CTC (H526L, n=4), CAC526AAC (H526N, n=3), and ATG515GTG (M515V, n=1).ConclusionDisputed rpoB mutations do not seem to be rare among the strains exhibiting RIF resistance in South Korea.

Relationship Between Prohormone Brain Natriuretic Peptide (NT-proBNP) Level and Severity of Pulmonary Dysfunction in Patients With Chronic Congestive Heart Failure

Introduction: Congestive heart failure (CHF) is a common disease and its prevalence is increasing in industrialized countries. NT-proBNP measurement is an established diagnostic test for diagnosis of CHF in patients who present to emergency room with acute dyspnea. The primary object of this study was to determine the relationship between levels of brain natriuretic peptide precursor and severity of lung function impairment in patients with chronic CHF. Methods: This cross-sectional and analytical study that performed in Tuberculosis and Lung Disease Research Center of Tabriz University of Medical Sciences on 95 patients with chronic heart failure, and relation between NT-proBNP levels and pulmonary function parameters were examined. Results: Sixty-four patients were male and 31 were female. The average age of male and females was 62.90 ± 11.54 and 61.61 ± 11.98 years, respectively. A significant inverse linear correlation was found between NT-proBNP and FEV1 (P < 0.001, r = -0.367), FVC (P < 0.001, r = -0.444), TLC (P = 0.022, r = -0.238), maximal midexpiratory flow (MMEF) (P = 0.047, r = -0.207) and left ventricular ejection fraction (LVEF) (P < 0.001, r = -0.461). A significant positive linear correlation was found between NT-proBNP and FEV1/FVC (P = 0.013, r = 0.257), RV/TLC (P = 0.003, r=0.303) and 5 Hz Raw (r = 0.231, P = 0.024). Conclusion: This study showed that, both restrictive and obstructive ventilator impairments can occur in chronic CHF and as NT-proBNP increases appropriate to hemodynamic deterioration, pulmonary dysfunction increases.

The Effectiveness of Family-Based DOTS versus Professional-Family Mix DOTS in Treating Smears Positive Tuberculosis.

The present study compared the effectiveness of Family-Based DOTS (FB-DOTS) versus Professional-Family Mix DOTS (PFM-DOTS) in smear positive tuberculosis (TB) patients. This semi-experimental study was performed in Tuberculosis and Lung Diseases Research Center of Tabriz in 2011-2012, among 57 TB patients recruited into either FB-DOTS or PFM-DOTS groups. At the baseline of the study, knowledge of both patients and their supervisors were assessed while at the end point, smear and culture of sputum, quality of life, knowledge and satisfaction of the patients along with the knowledge and satisfaction of their supervisors were assessed. The difference for sputum smear negative (culture) was 16.2 (4.8%) and 7.7(6.9%) for the PFM-DOTS in comparison with FB DOTS by the end of the second and forth months of treatment, respectively. A significant difference was observed between the two groups in relation to knowledge, satisfaction (patients and supervisors) and all four domains of quality of life: physical health (P=0.036), psychological health (P<0.001), social relations (P=0.026) and environmental health (P<0.001). The PFM-DOTS treatment strategy in which health experts follow the patients in their homes seems to be among most appropriate strategies in treating TB.

Immune Activation Is Associated With Increased Gut Microbial Translocation in Treatment-Naive, HIV-Infected Children in a Resource-Limited Setting

Gut damage resulting in microbial translocation (MT) is considered a major cause of immune activation (IA) in HIV infection, but data in children are limited, particularly in the absence of antiretroviral therapy. Sixty perinatally HIV-infected, antiretroviral therapy-naive children, aged 2-12 years, were evaluated for plasma levels of lipopolysaccharide, DNA sequences encoding bacterial 16 second ribosomal DNA (16S rDNA) and soluble CD14 concurrently with markers of CD4 and CD8 T-cell IA and immune exhaustion (IE), CD4 counts, and plasma viral load. At study entry, participants were classified into immune categories (ICs): IC1 (CD4% > 25), IC2 (CD4% 15-25), and IC3 (CD4% < 15). Age-matched HIV-uninfected children served as controls. Data were evaluated at study entry and at 12 months. Levels of MT, IA, and IE were increased in patients as compared with controls, were highest in patients in IC3 group, and did not change over 12 months. MT products lipopolysaccharide and 16S rDNA correlated with each other and each correlated with plasma viral load, soluble CD14, and T-cell IA and IE. There was a correlation of IA with IE. CD4 counts and percentage were inversely correlated with MT products and underlying CD4 activation. In a natural history cohort of HIV-infected children not on therapy, MT was more pronounced in the most severely immunocompromised patients and was associated with IA. Strategies to reduce MT may help to reduce IA and prevent CD4 depletion.

Diagnosis of Mycobacterium bovis in Captive Sloth Bears (Melursus ursinus) by Polymerase Chain reaction

Diagnosis of mycobacterial infection is paramount important from the public health perspective since treatment and control measures are very significant, particularly in captive animals. In this diagnostic study of Mycobacterium bovis infection in sloth bears (Melursus ursinus), polymerase chain reaction (PCR) had been used with the primer sequence of pncA-8 (5′-GGTTGGGTGGCCGCCGGTCAG-3′) and pncA-11 (5′-GCTTTGCGGCGAGCGCTCCA-3′) that were specific for M. bovis pncA gene. Forty-two fresh faecal samples were collected randomly from the apparently healthy sloth bears maintained in captive conditions. The DNA extraction procedure was done as per the manufacturer’s protocol and further subjected to amplification. The amplification profile includes respectively: initial heating of the samples for 5 min at 94 °C, annealing at 55 °C for 1 min, primer extension at 72 °C for 1 min and final elongation step for 10 min at 72 °C. Out of 57 samples, 5 samples were yielded on expected amplified PCR product size of 744 bp when electrophoresed in 1.5 % agarose gel. A positive control of M. bovis DNA procured from Tuberculosis Research Centre and a negative control from a healthy bovine sample were used. These results demonstrated that PCR test will increase the effectiveness of laboratory diagnosis to detect and identifying the M. bovis in captive wild animals.

Isolation of &amp;lt;em&amp;gt;Mycobacterium celatum&amp;lt;/em&amp;gt; from a Case of Koch’s Spine

Mycobacterium celatum is a newly discovered micro-organism causing disseminated infections in immuno compromised patients. Here we report a case of Mycobacterium celatum in an apparently immuno competent young patient with Koch’s spine, the organism was confirmed at tuberculosis research centre, Chennai. The patient was started with clarithromycin and ciprofloxin along with category-I ATT.

Immune reconstitution inflammatory syndrome in HIV-infected patients with and without prior tuberculosis

We conducted a nested case-control study in a cohort of patients initiating antiretroviral therapy (ART) to identify risk factors and common manifestations of immune reconstitution inflammatory syndrome (IRIS) and to validate the Robertson criteria for IRIS prediction. HIV-infected patients at the Tuberculosis Research Centre clinics, Chennai and Madurai, India, initiating ART between July 2004 and June 2005 were prospectively studied. Of 97 patients (62% men, median age 32 years, median CD4 count 63 cells/μL) included, 34 developed IRIS. IRIS was more common in patients with a prior history of tuberculosis (74% versus 52%, P = 0.04), median time to development was 46 days and the sensitivity and specificity of the Robertson criteria to predict IRIS were 91% and 22%, respectively. In this population, IRIS was a common event, more so among patients with prior tuberculosis, and neither the rate of CD4 increase nor the Robertson criteria were useful in predicting its development.

Research Output of Scientist of Tuberculosis Research Centre (TRC), Chennai, Tamil Nadu: A Scientometric Study

The prime objective of this study is to analyse the quantitative growth of research output by the scientists of Tuberculosis Research Centre (TRC), Chennai, Tamil Nadu. This article covers the TRC list of publications belong to the period of 1985-2009 for the study. It indicates the patterns of communications of TRC scientists and studies the extent of concentration and scattering of their research output of core journals. Growth of literature by year-wise, authorship pattern, ranking of authors, and ranking of journals has been analysed.

Extensively drug-resistant tuberculosis: experience at the Tuberculosis Research Centre, Chennai, India

Ten extensively drug-resistant tuberculosis (XDR-TB) patients were identified among 104 human immunodeficiency virus negative multidrug-resistant tuberculosis (MDR-TB) patients treated at the Tuberculosis Research Centre, Chennai, India, in two different cohorts between 1999-2003 and 2006-2007. They were managed with individualised treatment regimens. At the time of diagnosis of MDR-TB, one patient had XDR-TB and three had initial ofloxacin resistance. One patient who had had a lobectomy in addition to chemotherapy became bacteriologically negative, three died, three defaulted and the remaining three, who are bacteriologically positive, are still continuing treatment. Although based on a small number of patients, our results have not been encouraging.

Alcohol use disorders (AUD) among tuberculosis patients: a study from Chennai, South India.

BackgroundAlcohol Use Disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. Studies from Tuberculosis Research Centre (TRC), Chennai have reported that alcoholism has been one of the major reasons for default and mortality in under the DOTS programme in South India. Hence, it is planned to conduct a study to estimate prevalence of alcohol use and AUDs among TB patients attending the corporation health centres in Chennai, India.MethodologyThis is a cross-sectional cohort study covering 10 corporation zones at Chennai and it included situational assessment followed by screening of TB patients by a WHO developed Alcohol Use Disorders Identification Test AUDIT scale. Four zones were randomly selected and all TB patients treated during July to September 2009 were screened with AUDIT scale for alcohol consumption.ResultsOut of 490 patients, 66% were males, 66% were 35 years and above, 57% were married, 58% were from the low monthly income group of <Rs 5000 per month. No females reported alcohol use. Overall, out of 490 TB pts, 29% (141) were found to consume alcohol. Among 141 current drinkers 52% (73) had an AUDIT score of >8. Age (>35 years), education (less educated), income (<Rs 5000 per month), marital status (separated/divorced) and treatment category (Category 2) were statistically significant for TB patients with alcohol use than those TB patients without alcohol use.ConclusionsAUD among TB patients needs to be addressed urgently and the findings suggest the importance of integrating alcohol treatment into TB care.

Nutritional Supplementation in HIV‐Infected Individuals in South India: A Prospective Interventional Study

Malnutrition in human immunodeficiency virus (HIV)-infected individuals is associated with faster disease progression, higher mortality rates, and suboptimal response to antiretroviral therapy (ART). We conducted a prospective interventional study to evaluate the effects of an oral macronutrient supplement among HIV-infected adults in South India. Patients attending Tuberculosis Research Centre clinics from June 2005 through December 2007 had baseline nutritional assessment and laboratory investigations performed. Patients at 1 center received nutritional counseling and standard care, whereas patients at 2 centers additionally received a macronutrient providing 400 cal and 15 g of protein daily. Study outcomes were changes in anthropometry, body composition, blood chemistry, and immune status at 6 months. In total, 636 ART-naive patients were enrolled in the study; 361 completed 6 months of follow-up (282 received supplements and 79 received standard care). Mean age +/- standard deviation (SD) was 31 +/- 7 years, mean weight +/- SD was 50 +/- 10 kg, and 42% were male. Significant increases in body weight, body mass index, midarm circumference, fat-free mass, and body cell mass were observed in the supplement group but not in the control group at 6 months; gains were greater in patients with CD4 cell counts <200 cells/microL. No changes were observed in lipid levels, whereas the CD4 cell count decreased in the control group. However, after adjusting for baseline differences, these changes were not statistically significantly different between the groups. Macronutrient supplementation did not result in significantly increased weight gain compared with standard care (including nutritional counseling) among patients with moderately advanced HIV disease. The effect of supplementation on specific subsets of patients and on preserving immune function needs further research.

Impact of HIV Infection on the Recurrence of Tuberculosis in South India

There is limited information on the relative proportion of reactivation and reinfection at the time of recurrence among human immunodeficiency virus (HIV)-infected and HIV-uninfected patients who are successfully treated for tuberculosis infection in India. HIV-infected and HIV-uninfected patients with sputum culture-positive pulmonary tuberculosis were treated with short-course regimens and followed up for 36 months at the Tuberculosis Research Centre, South India. Bacteriologic recurrences were documented, and typing of strains was performed using 3 different genotypic techniques: restriction fragment length polymorphism (RFLP) by IS6110, spoligotyping, and mycobacterial interspersed repeat unit (MIRU)-variable number tandem repeat (VNTR). DNA fingerprints of paired Mycobacterium tuberculosis isolates (baseline and recurrence) were compared. Among 44 HIV-infected and 30 HIV-uninfected patients with recurrent tuberculosis during the period July 1999 to October 2005, 25 and 23 paired isolates, respectively, were typed using all 3 methods. Recurrence was due to exogenous reinfection in 88% of HIV-infected and 9% of HIV-uninfected patients (P<.05). Among recurrent isolates, the HIV-infected patients showed more clustering, as well as a higher proportion of drug resistance, including multidrug resistance. In India, a tuberculosis-endemic country, most recurrences after successful treatment of tuberculosis are due to exogenous reinfection in HIV-infected persons and endogenous reactivation in HIV-uninfected persons. Strategies for prevention and treatment of tuberculosis infection must take these findings into consideration.

Paradigm shift for tuberculosis control in high prevalence countries

Paradigm shift for tuberculosis control in high prevalence countries

Extensively Drug-ResistantMycobacterium tuberculosis, India

Extensively Drug-Resistant<i>Mycobacterium tuberculosis</i>, India