Undetected Multidrug-Resistant Tuberculosis Amplified by First-line Therapy in Mixed Infection
Suzanne M. Hingley-Wilson1
, 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.
Figure 1. . Mycobacterium tuberculosis co-culture competition experiment in a study of the amplification of multidrug resistance induced by first-line treatment of a mixed M. tuberculosis infection. The results suggest competitive advantages in vitro, which may account for patient strain phenotype in vivo. S, drug sensitive; R, drug resistant; OADC, oleic acid, albumin, dextrose, catalase growth supplement; OD600, optical density read at 600 nm; −INH, without isoniazid; +INH, with INH; MIRU-VNTR, mycobacterial interspersed repetitive unit–variable number tandem repeat; CFU, colony-forming units.
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