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Volume 18, Number 3—March 2012

Letter

Discordance in Mycobacterium tuberculosis Rifampin Susceptibility

Ameeta S. Kalokhe, Majid Shafiq, James C. Lee, Beverly Metchock, James E. Posey, Susan M. Ray, Albert Anderson, Yun F. Wang, and Minh Ly T. Nguyen
Author affiliations: Emory University School of Medicine, Atlanta, Georgia, USA (A.S. Kalokhe, M. Shafiq, J.C. Lee, S.M. Ray, A. Anderson, Y.F. Wang, M.T. Nguyen); Centers for Disease Control and Prevention, Atlanta (B. Metchock, J.E. Posey, M.T. Nguyen)

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Table A1

AFB culture sequence of patient with discordant in Mycobacterium tuberculosis RF susceptibility*

Date 2008
2009
May 13 Jun 2 Dec 28 Jan 31 Feb 3 Feb 24 Aug 3 Aug 4 Aug 5 Aug 19 Sep 10 Sep 11 Oct 5 Oct 7 Oct 12
Specimen type Sp × 3 BAL Sp × 3 Sp Sp × 2 Sp × 3 Blood Sp Sp Sp Blood Sp Sp Sp Sp
AFB smear (MTD) 4+
(MTD+) NA 4+
(MTD+) 4+ (MTD+) 1+ NA 1+ (MTD+)
AFB culture M. tuberculosis M. avium-intraceullulare M. tuberculosis M. tuberculosis M. tuberculosis M. tuberculosis, M. avium-intraceullulare
Drug susceptibility (MGIT 960) INH resistant (0.2 μg/mL);
RIF susceptible; EMB susceptible; STR susceptible INH resistant
(0.1 μg/mL)
RIF resistant
EMB susceptible
STR susceptible INH resistant
(0.2 μg/mL); RIF resistant; EMB susceptible; STR susceptible
Molecular resistance testing Sequencing:
inhA mutation associated with INH resistance HAIN test: inhA point mutation; no rpoB mutation detected CDC genotyping:
inhA mutation associated with INH resistance + novel rpoB mutation
(2009 Sep 9)
Drug treatment INH/RIF/PZA/EMB initiated (2008 Jun 5) 6 mos. RIF/PZA/ EMB completed (2008 Dec 12) INH/RIF/PZA/ EMB, AMK, MXF initiated (2009 Aug 4) AMK stopped (2009 Sep 1) AMK resumed (2009 Sep 9)

*RIF, rifampin; AFB, acid-fast bacilli; sp, sputum; BAL, bronchoalveolar lavage; MTD, Mycobacterium tuberculosis Direct Test (Gen-Probe, San Diego, CA, USA); –, negative; +, positive; NA, not applicable; MGIT, BACTEC Mycobacterium Growth Indicator Testing (MGIT 960; Becton Dickinson, Franklin Lakes, NJ, USA); INH, isoniazid; RIF, rifampin; EMB, ethambutol; INH, isoniazid; STR, streptomycin; HAIN, GenoType MTBDR plus line probe assay (HAIN Lifescience, Nehren, Germany); CDC, Centers for Disease Control and Prevention (Atlanta, GA, USA); PZA, pyrazinamide; AMK, amikacin; MXF, moxifloxacin.

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