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Volume 19, Number 7—July 2013

Dispatch

Undetected Multidrug-Resistant Tuberculosis Amplified by First-line Therapy in Mixed Infection

Suzanne M. Hingley-Wilson1Comments to Author , Rosalyn Casey1, David Connell, Samuel Bremang, Jason T. Evans, Peter M. Hawkey, Grace E. Smith, Annette Jepson, Stuart Philip, Onn Min Kon, and Ajit Lalvani
Author affiliations: Imperial College London, London, UK (S.M. Hingley-Wilson, R. Casey, D. Connell, S. Bremang, A. Lalvani); Heart of England National Health Service Foundation Trust, Birmingham, UK (J.T. Evans, P.M. Hawkey, G.E. Smith); School of Infection and Immunity, University of Birmingham, Birmingham (P.M. Hawkey); Imperial College National Health Service HealthcareTrust, London (A. Jepson, S. Philip, O.M. Kon); 1Current affiliation: University of Surrey, Guildford, UK.

Main Article

Table

Details for samples used in a study of the amplification of multidrug-resistant tuberculosis, resulting from competitive growth advantage, during treatment of a drug-sensitive Mycobacterium tuberculosis strain in a mixed infection*

Sample
Isolate
Smear
Resistance
MIRU-VNTR
Bronchoalveolar lavage, obtained February 2008 S + None 3243323125153242244235-1
Sputum, obtained April 2008 S ++ None 3243323125153242244235-1
Sputum, obtained June 2008 R +++ INH, ETB -2434233251533445-443330
Co-cultures 1) broth culture + INH, 2) colonies from broth culture − INH on plate with INH, 3) colonies from broth culture + INH on plates − INH and 4) colonies from broth culture + INH on plates − INH R NA INH -2434233251533445-443330
Co-cultures 5) broth culture − INH and 6) colonies from broth culture − INH on plates − INH S NA NA 3243323125153242244235-1

*MIRU-VNTR, mycobacterial interspersed repetitive unit–variable number tandem repeat; S, drug sensitive; +, ++, and +++, relative burden of acid-fast bacilli; R, drug resistant; INH, isoniazid; ETB, ethambutol; NA, not applicable.

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