Original Article
Exogenous Reinfection with Multidrug-Resistant Mycobacterium tuberculosis in Patients with Advanced HIV Infection
N Engl J Med 1993; 328:1137-1144April 22, 1993
- Abstract
Background
In the United States there have been recent outbreaks of multidrug-resistant tuberculosis. These outbreaks have primarily involved persons infected with the human immunodeficiency virus (HIV).
Methods
We collected clinical information on 17 patients seen at a New York City hospital who had repeatedly positive cultures for Mycobacterium tuberculosis. Analysis of restriction-fragment-length polymorphisms (RFLPs) was performed on serial isolates of M. tuberculosis obtained from these patients.
Results
Six patients had isolates that remained drug-susceptible, and the RFLP patterns of these isolates did not change over time. Eleven patients had isolates that became resistant to antimicrobial agents. The RFLP patterns of the isolates from six of these patients remained essentially unchanged (two strains showed one additional band) despite the development of drug resistance. In five other patients, however, the RFLP patterns of the isolates changed dramatically at the time that drug resistance was detected. The change in the RFLP pattern of the isolate from one patient appeared to be the result of contamination during processing in the laboratory. In the remaining four patients, all of whom had advanced HIV disease, the clinical and microbiologic evidence was consistent with the presence of active tuberculosis caused by a new strain of M. tuberculosis.
Conclusions
Resistance to antituberculous drugs can develop not only in the strain that caused the initial disease, but also as a result of reinfection with a new strain of M. tuberculosis that is drug-resistant. Exogenous reinfection with multidrug-resistant M. tuberculosis can occur either during therapy for the original infection or after therapy has been completed.
Media in This Article
Figure 1
RFLP Patterns of the Initial (A) and Final (B) Isolates from Six Patients with Persistently Drug-Susceptible Isolates of M. tuberculosis.Figure 2
RFLP Patterns of the Initial (A) and Final (B) Isolates from Six Patients Infected with Increasingly Drug-Resistant Strains of M. tuberculosis.Article Activity
- Article
Until recently, it was unusual to isolate drug-resistant Mycobacterium tuberculosis in the United States. Tuberculosis caused by such organisms occurred sporadically, and only rarely could epidemiologic connections be demonstrated between cases1,2. During the past three years, however, there have been numerous outbreaks of tuberculosis caused by organisms resistant to multiple antituberculous drugs3-11. Most such outbreaks have primarily involved persons infected with the human immunodeficiency virus (HIV), who are thought to have been exposed to the strains in medical or correction facilities. The purpose of our study was to examine the means by which patients acquire multidrug-resistant tuberculosis, since this information is needed for rational preventive strategies12.
Multidrug-resistant tuberculosis is thought to occur either through infection by organisms that are already resistant to antimicrobial agents (primary drug resistance), or through the development of drug resistance during therapy by a strain that was originally drug-sensitive (acquired drug resistance). The latter process is believed to be due to the selection of drug-resistant mutants of the original strain as a consequence of inadequate therapy13.
Analysis of restriction-fragment-length polymorphisms (RFLPs) is a well-established method of “DNA fingerprinting” that has been used to trace the transmission of particular strains of M. tuberculosis during investigations of outbreaks5,7-9,14-21. This report describes the use of RFLP analysis to determine how multidrug-resistant tuberculosis may have developed in a group of patients who continued to have positive cultures for M. tuberculosis after the institution of antimicrobial therapy.
Methods
Kings County Hospital is a 1200-bed municipal hospital in central Brooklyn that provides primary care to residents of the surrounding community and to New York City's correctional facility on Riker's Island. In this hospital at least 300 patients, approximately half of whom are infected with HIV,22,23 have been found to have microbiologically confirmed tuberculosis each year for the past five years.
Specimen registries of the hospital mycobacteriology laboratory were reviewed for the period from April 1987 to July 1991. During this time antimicrobial-susceptibility testing was performed routinely on all initial isolates of M. tuberculosis and was repeated every three months on all subsequent isolates from the same patient. The susceptibility of the isolates to isoniazid (0.1 or 0.2 μg per milliliter), rifampin (2.0 μg per milliliter), streptomycin (6.0 μg per milliliter), and ethambutol (7.5 μg per milliliter) was determined with a radiometric broth method (BACTEC system, Johnston Laboratories, Towson, Md.). Specimens processed after October 1990 were also tested for their susceptibility to pyrazinamide (100 μg per milliliter).
The results of all drug-susceptibility tests were reviewed to identify patients who had repeatedly positive cultures for M. tuberculosis at Kings County Hospital that either remained sensitive to all antituberculous drugs for more than one year or became resistant to isoniazid, rifampin, or both drugs.
Slant cultures of Lowenstein-Jensen medium inoculated from the primary cultures, which had been maintained at 4 °C, were subcultured. These isolates were retested for antimicrobial susceptibility in the California State Department of Health Services Microbial Diseases Laboratory with the proportion method24. The medium included the following concentrations of antimicrobial agents: isoniazid, 0.2 μg per milliliter; rifampin, 1 μg per milliliter; streptomycin, 2 μg per milliliter; and ethambutol, 5 μg per milliliter24. The isolates were considered to be resistant if there was more than 1 percent growth on medium containing antituberculous drugs as compared with the growth on drug-free medium.
The RFLP patterns of the isolates were determined according to internationally standardized procedures25. In brief, the organisms were grown in Dubos broth base supplemented with Dubos medium albumin (Difco Laboratories, Detroit) at 37 °C for two to four weeks. Bacterial cell walls were digested with lysozyme, proteinase K, and sodium dodecyl sulfate. Genomic DNA was extracted with cetyltrimethylammonium bromide, chloroform-isoamyl alcohol, and isopropanol and then digested with the restriction endonuclease PvuII. The resulting fragments were electrophoretically separated and transferred to nylon membranes, which were probed with a 245-base-pair fragment of the insertion sequence IS6110. Hybridizing fragments were detected by chemiluminescence (ECL kit, Amersham, Arlington Heights, Ill.).
Clinical data were collected by reviewing hospital and outpatient records. None of the patients received supervised therapy as outpatients; therefore, the degree of compliance with treatment was based on the patients' statements and clinic attendance.
Results
From April 1987 to July 1991, a total of 1318 patients had cultures that grew M. tuberculosis. Forty-eight of these patients met the selection criteria, in that they had persistently positive cultures for more than one year with drug-sensitive organisms (17 patients) or they had persistently positive cultures with increasingly drug-resistant organisms (31 patients). Sets of multiple isolates were available from 6 of the 17 patients with organisms that remained drug-sensitive for more than one year and from 11 of the 31 patients with organisms that manifested increasing drug resistance (Table 1Table 1
Epidemiologic and Clinical Characteristics of 6 Patients with Persistently Drug-Susceptible M. tuberculosis Isolates and 11 Patients with Drug-Resistant Isolates.). Sequential isolates from the remainder of the patients were not available, were not viable, or had become contaminated. This report focuses on the 17 patients with isolates that could be evaluated.RFLP analysis of serial isolates from six patients (Patients 1 through 6 in Table 1) from whom drug-sensitive M. tuberculosis was persistently isolated demonstrated stable patterns (Figure 1Figure 1
RFLP Patterns of the Initial (A) and Final (B) Isolates from Six Patients with Persistently Drug-Susceptible Isolates of M. tuberculosis.). Likewise, the RFLP patterns of serial isolates from four patients (Patients 7, 8, 9, and 10 in Table 1) with organisms that became resistant during therapy also remained stable. The patterns of sequential isolates from two additional patients (Patients 11 and 12) infected with strains that had become resistant to rifampin during therapy were identical except for the development of one additional band (Figure 2Figure 2RFLP Patterns of the Initial (A) and Final (B) Isolates from Six Patients Infected with Increasingly Drug-Resistant Strains of M. tuberculosis.). Thus, on the basis of the stability of these RFLP patterns over time, 12 of the 17 patients with serially positive cultures were judged to have been persistently infected with the strain originally isolated.Five patients whose initial isolates had been drug-sensitive (Patients 13 through 17) had an organism resistant to at least isoniazid and rifampin isolated during the study period. In each case, the RFLP patterns of the original drug-sensitive strains dramatically differed from the pattern of the multidrug-resistant strains obtained subsequently (Figure 3Figure 3
RFLP Patterns of the Initial (A) and Final (B) Isolates from Five Patients Whose Cultures Became Positive for Multidrug-Resistant Tuberculosis during or after Therapy for a Drug-Sensitive Isolate.), indicating that the patients may have been infected with a new strain during therapy for the initial infection. The RFLP patterns of the multidrug-resistant strains isolated from these five patients were identical (except for one additional band in an isolate from Patient 17), pointing to the possibility that the same strain may have infected all these patients. Indeed, three of these patients (Patients 15, 16, and 17) had been hospitalized in the same open tuberculosis unit and at the same time as other patients who were infected with this strain. The same RFLP pattern as that for the multidrug-resistant strains isolated from Patients 13 through 17 has now been identified in multidrug-resistant strains isolated from at least 13 other patients at this hospital (unpublished data) and has been sporadically isolated in other New York City hospitals. However, although this is a common RFLP pattern in this region, it is different from the patterns of multidrug-resistant isolates from other, recently analyzed outbreaks of multidrug-resistant tuberculosis (Crawford JT: personal communication).All five of the patients whose cultures grew this multidrug-resistant strain were treated initially with standard therapy for tuberculosis and showed appropriate clinical improvement (including negative mycobacterial cultures) before the cultures became positive with the multidrug-resistant strain. In four of these five patients (Patients 14, 15, 16, and 17), isolation of the multidrug-resistant strain was associated with clinical and microbiologic deterioration. The clinical course of these four patients is depicted in Figure 4Figure 4
Clinical Course of the Four Patients with the Acquired Immunodeficiency Syndrome Who Were Exogenously Reinfected with Multidrug-Resistant Tuberculosis.. Multiple cultures from each of these patients grew the multidrug-resistant strain of M. tuberculosis shown in Figure 3. Two weeks after being discharged from the hospital after treatment for Pneumocystis carinii pneumonia, Patient 14 had new pulmonary symptoms in association with the appearance of the multidrug-resistant strain in his sputum; at the time he was still receiving isoniazid and rifampin for the initial, drug-sensitive strain. Patient 15 was treated as an inpatient for three weeks and then as an outpatient for six additional weeks for his drug-sensitive strain before he discontinued therapy. His cultures became positive for the multidrug-resistant strain nine weeks after he was discharged from the hospital and only three weeks after he discontinued therapy. A sputum culture obtained from Patient 16 on the day antituberculous agents were discontinued for the initial infection grew the multidrug-resistant strain of M. tuberculosis. He had persistent symptoms and an additional 15 positive cultures over the ensuing nine-month period. Patient 17 was readmitted with multidrug-resistant tuberculosis 10 weeks after having been discharged from the hospital after treatment for P. carinii pneumonia.In one of the five patients in whom multidrug-resistant tuberculosis had apparently developed during therapy for drug-sensitive tuberculosis (Patient 13), the isolation of the multidrug-resistant strain may not have reflected the onset of a new clinical episode, but rather may have been due to the contamination of a sterile culture during the processing of the patient's specimen in the laboratory. This patient had improved clinically with initial antimicrobial therapy and had multiple negative sputum cultures. Then, unexpectedly and without new clinical findings, he was found to have the multidrug-resistant strain of M. tuberculosis in one of numerous, otherwise negative sputum cultures. He continued to be clinically well despite only having received antimicrobial agents to which the newly isolated organism was resistant. A review of the mycobacteriology-laboratory records showed that a sputum specimen from another patient with the multidrug-resistant strain of M. tuberculosis was processed the same day as the specimen from Patient 13 (data not shown). Thus, cross-contamination had probably occurred in the laboratory, a problem that has been previously documented with phage typing26 and has been proved to have occurred on several occasions during the RFLP-based investigations (unpublished data).
Discussion
The resurgence of tuberculosis in the United States has been accompanied by alarming outbreaks of the disease caused by organisms resistant to multiple antituberculous drugs. The organisms isolated from patients in these outbreaks have generally been resistant to both isoniazid and rifampin, the most effective antituberculous drugs available3-5,7-11. A large proportion of these patients have been infected with HIV, and the case fatality rate has been extremely high10. The multidrug-resistant organisms have also been transmitted to persons without HIV infection in health care facilities11. Together with the lack of effective drugs for second-line treatment and methods of chemoprophylaxis, the transmission of multidrug-resistant strains of M. tuberculosis may be creating a substantial reservoir of latently infected people that will result in clinical multidrug-resistant tuberculosis for many years to come. Thus, there is an urgent need to understand the means by which this disease develops so that appropriate preventive strategies can be devised and implemented.
It is currently assumed, on the basis of studies conducted in the pre-HIV era, that drug resistance in tuberculosis develops by one of two mechanisms. Acquired drug resistance develops during treatment for drug-sensitive tuberculosis with regimens that are poorly conceived or poorly complied with, allowing the emergence of naturally occurring, drug-resistant mutants. Resistant organisms from affected patients may subsequently infect other people who have not been previously infected with M. tuberculosis, resulting in primary drug resistance13. In the current study, the use of RFLP analysis confirmed the development of acquired drug resistance in Patients 7 through 12. More importantly, however, it demonstrated through the RFLP analysis of isolates from Patients 14 through 17 that drug-resistant tuberculosis can develop by a third mechanism -- namely, exogenous reinfection with a new multidrug-resistant strain of M. tuberculosis during or after therapy for drug-sensitive tuberculosis.
The six patients in this study (Patients 7 through 12) whose original strains became resistant to antimicrobial agents during treatment had persistently positive cultures consisting of the same strain of M. tuberculosis with which they were initially infected (Figure 2). This demonstrated that their original strains had acquired drug resistance as classically defined. The development of acquired drug resistance can be prevented by ensuring that all patients comply with appropriate multidrug regimens.
In contrast, the dramatic change in the RFLP patterns of isolates from four patients (Patients 14, 15, 16, and 17) indicates that the multidrug-resistant strain isolated late in the course of infection in these patients was different from the strains that initially caused their tuberculosis. The isolation of a new multidrug-resistant strain from these patients indicates exogenous reinfection after successful eradication of the initial strain. In each of these cases the multidrug-resistant strain was isolated on multiple occasions during clinical episodes of active tuberculosis, so these patients had authentic infections with this strain, not artifactual infections due to cross-contamination of negative cultures in the laboratory.
The possibility that persons previously infected with M. tuberculosis can be exogenously reinfected has been debated for decades27-29. However, it was thought to occur rarely because of the immunity conferred by the initial infection. On the few occasions in which exogenous reinfection has been documented, it has involved only selected populations -- for example, alcoholic residents of a homeless shelter1. The four HIV-infected patients in this report (Patients 14, 15, 16, and 17) who were documented by RFLP analysis to have had a new infection with a multidrug-resistant strain are likely to have been reinfected because they were reexposed to M. tuberculosis and had not acquired protective immunity to the bacteria during their original infection. This lack of acquired immunity to M. tuberculosis, which permitted reinfection with a multidrug-resistant strain, presumably would also predispose HIV-infected persons to reinfection with drug-sensitive organisms. If so, exogenous reinfection might lead to second episodes of tuberculosis among substantial numbers of HIV-infected persons. Whether normal hosts can also be exogenously reinfected, and if so, how frequently, has not been determined.
The observation that HIV-infected patients with treated or cured tuberculosis might have subsequent episodes of tuberculosis as a result of exogenous reinfection with M. tuberculosis complicates the evaluation of clinical trials of chemotherapeutic and chemoprophylactic regimens. Currently, relapses after therapy are assumed to result from inadequacies in the regimen's efficacy or in patient compliance. However, if exogenous reinfection is found to be common, relapse may reflect the reinfection of persons whose initial therapy was completely adequate. RFLP analysis on the initial isolates and those obtained during relapse can detect exogenous reinfection. Similarly, patients with advanced HIV infection who have completed effective chemoprophylactic regimens may remain susceptible to reinfection that would appear to result from failure of chemoprophylaxis.
The lack of protective immunity to M. tuberculosis after therapy in HIV-infected patients also complicates efforts to control the disease. Persons who have been infected previously with M. tuberculosis are assumed to be resistant to reinfection, and as such they are neither specifically instructed to avoid further exposure nor reevaluated if such exposure occurs. However, the apparent susceptibility of HIV-infected patients to exogenous reinfection suggests that those who have a history of tuberculosis or known tuberculin reactivity need to be evaluated for the possible development of a new episode of tuberculosis after contact with someone whose disease is infectious, as has been recommended by the Centers for Disease Control and Prevention30. Open tuberculosis units, which are maintained in only a few American hospitals but which are common in developing countries, may place immunocompromised patients at considerable risk for reinfection.
It is not possible to infer from this study the frequency with which patients are reinfected with M. tuberculosis. Future studies are needed to define the frequency, settings, and specific risk factors for exogenous reinfection with M. tuberculosis. If future studies demonstrate that reinfection is common in this patient population, a fundamental change in the emphasis of efforts to control the disease may be necessary. The occurrence of persistent, exquisite susceptibility of HIV-infected patients to M. tuberculosis would mandate a shift in focus from the current, two-pronged approach of identifying and treating persons with latent infection and active disease31 to include a third prong, the identification and elimination of circumstances that foster the transmission of M. tuberculosis.
Supported by the Howard Hughes Medical Institute, the California Statewide AIDS Task Force, and Public Health Service grants (AI07089-11 and AI27762-03).
We are indebted to Janice Lopez of the Microbial Diseases Laboratory, California Department of Health Services, for performing susceptibility tests according to the proportion method.
Source Information
From the Department of Medicine, Division of Infectious Diseases and Geographic Medicine, and the Howard Hughes Medical Institute (P.M.S., S.P.S., G.K.S.) and the Department of Medicine, Centers for AIDS Research (R.W.S.), Stanford University, Stanford, Calif.; the Medical Service, San Francisco General Hospital and the University of California, San Francisco (P.C.H.); the Department of Medicine, Division of Infectious Diseases (M.J.M.), and the Department of Pathology (M.F.S.), State University of New York Health Sciences Center at Brooklyn, Brooklyn; and the California Department of Health Services Microbial Diseases Laboratory, Berkeley (E.D.).
Address reprint requests to Dr. Small at the Howard Hughes Medical Institute, Rm. 251, Beckman Ctr., Stanford, CA 94306.
- References
References
1
Nardell E ,McInnis B ,Thomas B ,Weidhaas S . Exogenous reinfection with tuberculosis in a shelter for the homeless. N Engl J Med 1986;315:1570-1575
Full Text | Web of Science | Medline2
Reves R ,Blakey D ,Snider DE Jr ,Farer LS . Transmission of multiple drug-resistant tuberculosis: report of a school and community outbreak. Am J Epidemiol 1981;113:423-435
Web of Science | Medline3
Nosocomial transmission of multidrug-resistant tuberculosis to health-care workers and HIV-infected patients in an urban hospital -- FloridaMMWR Morb Mortal Wkly Rep 1990;39:718-722
Medline4
Transmission of multidrug-resistant tuberculosis from an HIV-positive client in a residential substance-abuse treatment facility -- MichiganMMWR Morb Mortal Wkly Rep 1991;40:129-131
Medline5
Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons -- Florida and New York, 1988-1991MMWR Morb Mortal Wkly Rep 1991;40:585-591
Medline6
Dooley SW ,Villarino ME ,Lawrence M , et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA 1992;267:2632-2634
CrossRef | Web of Science | Medline7
Edlin BR ,Tokars JI ,Grieco MH , et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514-1521
Full Text | Web of Science | Medline8
Fischl MA ,Uttamchandani RB ,Daikos GL , et al. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992;117:177-183
Web of Science | Medline9
Pearson ML ,Jereb JA ,Frieden TR , et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers. Ann Intern Med 1992;117:191-196
Web of Science | Medline10
Dooley SW ,Jarvis WR ,Martone WJ ,Snider DE Jr . Multidrug-resistant tuberculosis. Ann Intern Med 1992;117:257-259
Web of Science | Medline11
Beck-Sague C ,Dooley SW ,Hutton MD , et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections: factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280-1286
CrossRef | Web of Science | Medline12
National action plan to combat multidrug-resistant tuberculosis
Medline13
Drug resistence in mycobacteria. In: Gangadharam PRJ. Definitions of drug resistance. New York: Academic Press, 1984:7.
14
Hermans PW ,van Soolingen D ,Dale JW , et al. Insertion element IS986 from Mycobacterium tuberculosis: a useful tool for diagnosis and epidemiology of tuberculosis. J Clin Microbiol 1990;28:2051-2058
Web of Science | Medline15
Eisenach KD ,Crawford JT ,Bates JH . Repetitive DNA sequences as probes for Mycobacterium tuberculosis. J Clin Microbiol 1988;26:2240-2245
Web of Science | Medline16
Mazurek GH ,Cave MD ,Eisenach KD ,Wallace RJ Jr ,Bates JH ,Crawford JT . Chromosomal DNA fingerprint patterns produced with IS6110 as strain-specific markers for epidemiologic study of tuberculosis. J Clin Microbiol 1991;29:2030-2033
Web of Science | Medline17
van Soolingen D ,Hermans PW ,de Haas PEW ,Soll DR ,van Embden JDA . Occurrence and stability of insertion sequences in Mycobacterium tuberculosis complex strains: evaluation of an insertion sequence-dependent DNA polymorphism as a tool in the epidemiology of tuberculosis. J Clin Microbiol 1991;29:2578-2586
Web of Science | Medline18
Otal E ,Martin C ,Vincent-Levy-Frebault V ,Thierry D ,Gicquel B . Restriction fragment length polymorphism analysis using IS6110 as an epidemiologic marker in tuberculosis. J Clin Microbiol 1992;29:1252-1254
Web of Science19
van Embden JDA ,van Soolingen D ,Small PM ,Hermans PWM . Genetic markers for the epidemiology of tuberculosis. Res Microbiol 1992;143:385-391
CrossRef | Web of Science | Medline20
Daley CL ,Small PM ,Schecter GF , et al. An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus: an analysis using restriction-fragment-length polymorphisms. N Engl J Med 1992;326:231-235
Full Text | Web of Science | Medline21
Godfrey-Faussett P ,Mortimer PR ,Jenkins PA ,Stoker NG . Evidence of transmission of tuberculosis by DNA fingerprinting. BMJ 1992;305:221-223
CrossRef | Web of Science | Medline22
Shafer RW ,Chirgwin KD ,Glatt AE ,Dahdouh MA ,Landesman SH ,Suster B . HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS. AIDS 1991;5:399-405
CrossRef | Web of Science | Medline23
Shafer RW ,Kim DS ,Weiss JP ,Quale JM . Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine (Baltimore) 1991;70:384-397
Web of Science | Medline24
Antimycobacterial susceptibility testing: proposed standards. Villanova, Pa.: National Committee for Clinical Laboratory Standards, 1990. (NCCLS publication M24-P).
25
van Embden JDA ,Cave MD ,Crawford JT , et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406-409
Web of Science | Medline26
Jones WD Jr . Bacteriophage typing of Mycobacterium tuberculosis cultures from incidents of suspected laboratory cross-contamination. Tubercle 1988;69:43-46
CrossRef | Medline27
Exogenous or endogenous reinfection: is an arrested primary infection protective or deleterious? In: Rich AR. The pathogenesis of tuberculosis. Springfield, Ill.: Charles C Thomas, 1944:779-810.
28
Stead WW . Pathogenesis of a first episode of chronic pulmonary tuberculosis in man: recrudescence of residuals of the primary infection or exogenous reinfection? Am Rev Respir Dis 1967;95:729-745
Web of Science | Medline29
Romeyn JA . Exogenous reinfection in tuberculosis. Am Rev Respir Dis 1970;101:923-927
Web of Science | Medline30
Management of persons exposed to multidrug-resistant tuberculosisMMWR Morb Mortal Wkly Rep 1992;41:61-71
Medline31
Snider DE ,Roper WL . The new tuberculosis. N Engl J Med 1992;326:703-705
Full Text | Web of Science | Medline
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CrossRef25
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CrossRef30
Jeffrey R Driscoll, Linda M Parsons, Max Salfinger, Harry W Taber. (2005) Genomic analysis of the Mycobacterium tuberculosis complex: applications to laboratory diagnosis and genotyping. Reviews in Medical Microbiology 16:2, 49-58
CrossRef31
William F Paolo, Joshua D Nosanchuk. (2004) Tuberculosis in New York city: recent lessons and a look ahead. The Lancet Infectious Diseases 4:5, 287-293
CrossRef32
Zhenhua Yang, Ying Kong, Frank Wilson, Betsy Foxman, Annadell H. Fowler, Carl F. Marrs, M. Donald Cave, Joseph H. Bates. (2004) Identification of Risk Factors for Extrapulmonary Tuberculosis. Clinical Infectious Diseases 38:2, 199-205
CrossRef33
Liselotte van Asten, Miranda Langendam, Robert Zangerle, Ildefonso Hernández Aguado, Faroudy Boufassa, Veronique Schiffer, Raymond P Brettle, J Roy Robertson, Arnaud Fontanet, Roel A Coutinho, Maria Prins. (2003) Tuberculosis risk varies with the duration of HIV infection. AIDS 17:8, 1201-1208
CrossRef34
Muktar H. Aliyu, Hamisu M. Salihu, Raoul Ratard. (2003) HIV infection and sputum-culture conversion in patients diagnosed withMycobacterium tuberculosis: A population-based study. Wiener Klinische Wochenschrift 115:10, 340-346
CrossRef35
Matthew Gandy, Alimuddin Zumla. (2002) The resurgence of disease: social and historical perspectives on the ‘new’ tuberculosis. Social Science & Medicine 55:3, 385-396
CrossRef36
Annika Krüüner, Lea Pehme, Solomon Ghebremichael, Tuija Koivula, Sven E. Hoffner, Marika Mikelsaar. (2002) Use of Molecular Techniques to Distinguish between Treatment Failure and Exogenous Reinfection with Mycobacterium tuberculosis. Clinical Infectious Diseases 35:2, 146-155
CrossRef37
Timothy A. Collyns, Deborah M. Gascoyne-Binzi, Peter M. Hawkey. (2002) Molecular fingerprinting of Mycobacterium tuberculosis: does it help in understanding the epidemiology of tuberculosis?. Reviews in Medical Microbiology 13:3, 119-127
CrossRef38
Adnan T. Abal, Suhail Ahmad, Eiman Mokaddas. (2002) Variations in the Occurrence of the S315T Mutation Within the katG Gene in Isoniazid-Resistant Clinical Mycobacterium tuberculosis Isolates from Kuwait. Microbial Drug Resistance 8:2, 99-105
CrossRef39
Stephen D Lawn, Salvatore T Butera, Thomas M Shinnick. (2002) Tuberculosis unleashed: the impact of human immunodeficiency virus infection on the host granulomatous response to Mycobacterium tuberculosis. Microbes and Infection 4:6, 635-646
CrossRef40
Parvathi Tiruviluamala, Lee B. Reichman. (2002) T
UBERCULOSIS . Annual Review of Public Health 23:1, 403-426
CrossRef41
A. ROSS HILL, VIVEK M. MANIKAL, PAUL F. RISKA. (2002) Effectiveness of Directly Observed Therapy (DOT) for Tuberculosis. Medicine 81:3, 179-193
CrossRef42
Pablo J. Bifani, Barun Mathema, Natalia E. Kurepina, Barry N. Kreiswirth. (2002) Global dissemination of the Mycobacterium tuberculosis W-Beijing family strains. Trends in Microbiology 10:1, 45-52
CrossRef43
PETER ORMEROD. (2001) The Clinical Management of the Drug-Resistant Patient. Annals of the New York Academy of Sciences 953b:1 DRUG-RESISTAN, 185-191
CrossRef44
ANTON POZNIAK. (2001) Multidrug-Resistant Tuberculosis and HIV Infection. Annals of the New York Academy of Sciences 953b:1 DRUG-RESISTAN, 192-198
CrossRef45
Pamela Sonnenberg, Jill Murray, Judith R Glynn, Stuart Shearer, Bupe Kambashi, Peter Godfrey-Faussett. (2001) HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: a cohort study in South African mineworkers. The Lancet 358:9294, 1687-1693
CrossRef46
Christopher R. Braden, Glenn P. Morlock, Charles L. Woodley, Kammy R. Johnson, A. Craig Colombel, M. Donald Cave, Zhenhua Yang, Sarah E. Valway, Ida M. Onorato, Jack T. Crawford. (2001) Simultaneous Infection with Multiple Strains of Mycobacterium tuberculosis. Clinical Infectious Diseases 33:6, e42-e47
CrossRef47
Yvonne M. Hale, Gaby E. Pfyffer, Max Salfinger. (2001) Laboratory Diagnosis of Mycobacterial Infections: New Tools and Lessons Learned. Clinical Infectious Diseases 33:6, 834-846
CrossRef48
Griselda Tudó, Julián González, Josep M. Gatell, Joan A. Caylà, Esteban Martínez, Albert García, Marian Navarro, Eladio Soriano, M. Teresa Jiménez de Anta, . (2001) Detection of Unsuspected Cases of Nosocomial Transmission of Tuberculosis by Use of a Molecular Typing Method. Clinical Infectious Diseases 33:4, 453-459
CrossRef49
Small, Peter M., Fujiwara, Paula I., . (2001) Management of Tuberculosis in the United States. New England Journal of Medicine 345:3, 189-200
Full Text50
D.G. du Plessis, R. Warren, M. Richardson, J.J. Joubert, P.D. van Helden. (2001) Demonstration of reinfection and reactivation in HIV-negative autopsied cases of secondary tuberculosis: multilesional genotyping of Mycobacterium tuberculosis utilizing IS 6110 and other repetitive element-based DNA fingerprinting. Tuberculosis 81:3, 211-220
CrossRef51
Robert S. Wallis, John L. Johnson. (2001) Adult tuberculosis in the 21st century: pathogenesis, clinical features, and management. Current Opinion in Pulmonary Medicine 7:3, 124-132
CrossRef52
D. Van Soolingen. (2001) Molecular epidemiology of tuberculosis and other mycobacterial infections: main methodologies and achievements. Journal of Internal Medicine 249:1, 1-26
CrossRef53
Walkyria Pereira Pinto, David Jamil Hadad, Maria A. Silva Telles, SueliYoshino Mizuka Ueki, Moisés Palaci, Maria Aparecida Basile. (2001) Tuberculosis and drug resistance among patients seen at an AIDS reference center in São Paulo, Brazil. International Journal of Infectious Diseases 5:2, 94-100
CrossRef54
A. Rivero, M. Marquez, J. Santos, A. Pinedo, M. A. Sanchez, A. Esteve, S. Samper, C. Martin. (2001) High Rate of Tuberculosis Reinfection during a Nosocomial Outbreak of Multidrug-Resistant Tuberculosis Caused by Mycobacterium bovis Strain B. Clinical Infectious Diseases 32:1, 159-161
CrossRef55
Pamela Sonnenberg, Jill Murray, Stuart Shearer, Judith R. Glynn, Bupe Kambashi, Peter Godfrey-Faussett. (2000) Tuberculosis treatment failure and drug resistance—same strain or reinfection?. Transactions of the Royal Society of Tropical Medicine and Hygiene 94:6, 603-607
CrossRef56
M. C. S. Lourenco, B. Grinsztejn, F. C. O. Fandinho-Montes, M. G. Silva, M. H. F. Saad, L. S. Fonseca. (2000) Genotypic patterns of multiple isolates of M. tuberculosis from tuberculous HIV patients. Tropical Medicine and International Health 5:7, 488-494
CrossRef57
H.S. Schaff, R.P. Gie, A. van Rie, H.I. Seifart, P.D. van Helden, M.F. Cotton. (2000) Second Episode of Tuberculosis in an HIV-infected Child: Relapse or Reinfection?. Journal of Infection 41:1, 100-103
CrossRef58
Zhilan Feng, Carlos Castillo-Chavez, Angel F. Capurro. (2000) A Model for Tuberculosis with Exogenous Reinfection. Theoretical Population Biology 57:3, 235-247
CrossRef59
D. Kumar, N.A. Saunders, J.M. Watson, A.M. Ridley, S. Nicholas, K.F. Barker, R. Wall, Q.N. Karim, S. Barrett, R.C. George, A.C. McCartney. (2000) Clusters of new tuberculosis cases in North-west London: a survey from three hospitals based on IS6110 RFLP typing. Journal of Infection 40:2, 132-137
CrossRef60
M.C Rousseau, J Moreau, J Delmont. (1999) Vaccination and HIV: a review of the literature. Vaccine 18:9-10, 825-831
CrossRef61
van Rie, Annelies, Warren, Robin, Richardson, Madeleine, Victor, Thomas C., Gie, Robert P., Enarson, Donald A., Beyers, Nulda, van Helden, Paul D., . (1999) Exogenous Reinfection as a Cause of Recurrent Tuberculosis after Curative Treatment. New England Journal of Medicine 341:16, 1174-1179
Full Text62
Fine, Paul E.M., , Small, Peter M., . (1999) Exogenous Reinfection in Tuberculosis. New England Journal of Medicine 341:16, 1226-1227
Full Text63
Julia Del Amo, Adam S. Malin, Anton Pozniak, Kevin M. De Cock. (1999) Does tuberculosis accelerate the progression of HIV disease? Evidence from basic science and epidemiology. AIDS 13:10, 1151-1158
CrossRef64
Arnaud Trebucq. (1999) Tuberculosis in prisons. The Lancet 353:9171, 2244
CrossRef65
Katsuhiko Tsukaguchi, Barbara de Lange, W.Henry Boom. (1999) Differential Regulation of IFN-γ, TNF-α, and IL-10 Production by CD4+ αβTCR+ T Cells and Vδ2+ γδ T Cells in Response to Monocytes Infected with Mycobacterium tuberculosis-H37Ra. Cellular Immunology 194:1, 12-20
CrossRef66
Fernando Chaves, Fernando Dronda, Mercedes Alonso-Sanz, Antonio R. Noriega. (1999) Evidence of exogenous reinfection and mixed infection with more than one strain of Mycobacterium tuberculosis among Spanish HIV-infected inmates. AIDS 13:5, 615-620
CrossRef67
R Coninx, C Mathieu, M Debacker, F Mirzoev, A Ismaelov, R de Haller, DR Meddings. (1999) First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons. The Lancet 353:9157, 969-973
CrossRef68
Cabot, Richard C.Scully, Robert E., Mark, Eugene J., McNeely, William F., Ebeling, Sally H., Skolnik, Paul R.Mark, Eugene J.. (1999) Case 5-1999. New England Journal of Medicine 340:7, 545-554
Full Text69
Havlir, Diane V., Barnes, Peter F., . (1999) Tuberculosis in Patients with Human Immunodeficiency Virus Infection. New England Journal of Medicine 340:5, 367-373
Full Text70
WALTER H. HAAS, BEATE AMTHOR, GUIDO ENGELMANN, DAGMAR RIMEK, HANS J. BREMER. (1998) Preoperative diagnosis of Mycobacterium avium lymphadenitis in two immunocompetent children by polymerase chain reaction of gastric aspirates. The Pediatric Infectious Disease Journal 17:11, 1016-1020
CrossRef71
T Porco. (1998) Quantifying the Intrinsic Transmission Dynamics of Tuberculosis. Theoretical Population Biology 54:2, 117-132
CrossRef72
Pablos-Méndez, Ariel, Raviglione, Mario C., Laszlo, Adalbert, Binkin, Nancy, Rieder, Hans L., Bustreo, Flavia, Cohn, David L., Lambregts-van Weezenbeek, Catherina S.B., Kim, Sang Jae, Chaulet, Pierre, Nunn, Paul, . (1998) Global Surveillance for Antituberculosis-Drug Resistance, 1994–1997. New England Journal of Medicine 338:23, 1641-1649
Full Text73
Neal A Halsey, Jacqueline S Coberly, Julio Desormeaux, Phyllis Losikoff, Joan Atkinson, Lawrence H Moulton, Mireil Contave, Michael Johnson, Homer Davis, Lawrence Geiter, Erica Johnson, Robin Huebner, Reginald Boulos, Richard E Chaisson. (1998) Randomised trial of isoniazid versus rifampicin and pyrazinamide for prevention of tuberculosis in HIV-1 infection. The Lancet 351:9105, 786-792
CrossRef74
Javier Aznar, Hassan Safi, Maria C. Conejo, José C. Palomares. (1997) Molecular epidemiology of tuberculosis in a prison facility in Seville: a 3-year study (1993-95). Clinical Microbiology and Infection 3:5, 586-588
CrossRef75
John F Murray. (1997) Tuberculosis and HIV Infection: Global Perspectives. Respirology 2:3, 209-213
CrossRef76
D. Schürmann, S. D. Nightingale, F. Bergmann, B. Ruf. (1997) Tuberculosis and HIV infection: A review. Infection 25:5, 274-280
CrossRef77
George R. Saade. (1997) Human immunodeficiency virus (HIV)-related pulmonary complications in pregnancy. Seminars in Perinatology 21:4, 336-350
CrossRef78
Sofía Samper, Carlos Martín, Alfonso Pinedo, Antonio Rivero, Jesús Blázquez, Fernando Baquero, Dick van Soolingen, Jan van Embden. (1997) Transmission between HIV-infected patients of multidrug-resistant tuberculosis caused by Mycobacterium bovis. AIDS 11:10, 1237-1242
CrossRef79
L Sechi. (1997) Detection ofMycobacterium tuberculosisby PCR analysis of urine and other clinical samples from AIDS and non-HIV-infected patients. Molecular and Cellular Probes 11:4, 281-285
CrossRef80
Charles F. Gilks, Peter Godfrey-Faussett, Barry I.F. Batchelor, Josephine C. Ojoo, Sylvia J. Ojoo, Richard J. Brindle, John Paul, Joseph Kimari, Marian C. Bruce, Joab Bwayo, Francis A. Plummer, David A. Warrell. (1997) Recent transmission of tuberculosis in a cohort of HIV-1-infected female sex workers in Nairobi, Kenya. AIDS 11:7, 911-918
CrossRef81
Susan T. Cookson, William R. Jarvis. (1997) PREVENTION OF NOSOCOMIAL TRANSMISSION OF MYCOBACTERIUM TUBERCULOSIS. Infectious Disease Clinics of North America 11:2, 385-409
CrossRef82
Edward E. Telzak. (1997) TUBERCULOSIS AND HUMAN IMMUNODEFICIENCY VIRUS INFECTION. Medical Clinics of North America 81:2, 345-360
CrossRef83
Paul Farmer. (1997) Social scientists and the new tuberculosis. Social Science & Medicine 44:3, 347-358
CrossRef84
Felissa L. Cohen, Donna Tartasky. (1997) Microbial resistance to drug therapy: A review. American Journal of Infection Control 25:1, 51-64
CrossRef85
Francis Drobniewski. (1997) Is death inevitable with multiresistant TB plus HIV infection?. The Lancet 349:9045, 71-72
CrossRef86
Sorana Segal-Maurer, Carl Urban, James J. Rahal. (1996) CURRENT PERSPECTIVES ON MULTIDRUG-RESISTANT BACTERIA. Infectious Disease Clinics of North America 10:4, 939-957
CrossRef87
Daniel P. Chin, Philip C. Hopewell. (1996) MYCOBACTERIAL COMPLICATIONS OF HIV INFECTION. Clinics in Chest Medicine 17:4, 697-711
CrossRef88
Larry I. Lutwick. (1996) POSTEXPOSURE PROPHYLAXIS. Infectious Disease Clinics of North America 10:4, 899-915
CrossRef89
T.R. Frieden, C.L. Woodley, J.T. Crawford, D. Lew, S.M. Dooley. (1996) The molecular epidemiology of tuberculosis in New York City: The importance of nosocomial transmission and laboratory error. Tubercle and Lung Disease 77:5, 407-413
CrossRef90
Robert Miller. (1996) HIV-associated respiratory diseases. The Lancet 348:9023, 307-312
CrossRef91
Rong-Luh Lin, Edward M. Bernard, Donald Armstrong, Chien-Hsin Chen, Lee W. Riley. (1996) Transmission patterns of tuberculosis in Taiwan: Analysis by restriction fragment length polymorphism. International Journal of Infectious Diseases 1:1, 18-21
CrossRef92
Bishai, William R., Graham, Neil M.H., Harrington, Susan, Page, Christopher, Moore-Rice, Kristina, Hooper, Nancy, Chaisson, Richard E., . (1996) Rifampin-Resistant Tuberculosis in a Patient Receiving Rifabutin Prophylaxis. New England Journal of Medicine 334:24, 1573-1576
Full Text93
Charlah A. Robinson, Nancy C. Rose. (1996) Tuberculosis. Obstetrical & Gynecological Survey 51:2, 115-124
CrossRef94
B VEBER. (1996) Tuberculose pulmonaire en 1996. Données récentes et conséquences pratiques pour le médecin anesthésiste. Annales Françaises d’Anesthésie et de Réanimation 15:7, 1080-1087
CrossRef95
R.W. Shafer, S.P. Singh, C. Larkin, P.M. Small. (1995) Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in an immunocompetent patient. Tubercle and Lung Disease 76:6, 575-577
CrossRef96
C.L. Daley. (1995) The typically ‘atypical’ radiographic presentation of tuberculosis in advanced HIV disease. Tubercle and Lung Disease 76:6, 475-476
CrossRef97
S. Das, C.N. Paramasivan, D.B. Lowrie, R. Prabhakar, P.R. Narayanan. (1995) IS6110 restriction fragment length polymorphism typing of clinical isolates of Mycobacterium tuberculosis from patients with pulmonary tuberculosis in Madras, South India. Tubercle and Lung Disease 76:6, 550-554
CrossRef98
H. Schütt-Gerowitt. (1995) On the Development of Mycobacterial Infections. Zentralblatt für Bakteriologie 283:2, 225-238
CrossRef99
A.G. Leitch, M. Rubilar, B. Watt, R. Laing, L. Willcocks, R.P. Brettle, C.L.S. Leen. (1995) Why disease due to Mycobacterium tuberculosis is less common than expected in HIV-positive patients in Edinburgh. Respiratory Medicine 89:7, 495-497
CrossRef100
Sally M. Blower, Angela R. Mclean, Travis C. Porco, Peter M. Small, Philip C. Hopewell, Melissa A. Sanchez, Andrew R. Moss. (1995) The intrinsic transmission dynamics of tuberculosis epidemics. Nature Medicine 1:8, 815-821
CrossRef101
Frieden, Thomas R., Fujiwara, Paula I., Washko, Rita M., Hamburg, Margaret A., . (1995) Tuberculosis in New York City — Turning the Tide. New England Journal of Medicine 333:4, 229-233
Full Text102
S.H. Gillespie, N. Kennedy, F.I. Ngowi, N.G. Fomukong, S. Al-Maamary, J.W. Dale. (1995) Restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis in northern Tanzania. Transactions of the Royal Society of Tropical Medicine and Hygiene 89:3, 335-338
CrossRef103
John B. Bass. (1995) Tuberculosis in the 1990s. Alcoholism: Clinical and Experimental Research 19:1, 3-5
CrossRef104
V. Ausina, N. Riutort, B. Viñado, J. M. Manterola, J. Ruiz Manzano, C. Rodrigo, L. Matas, M. Giménez, J. Tor, J. Roca. (1995) Prospective study of drug-resistant tuberculosis in a spanish urban population including patients at risk for HIV infection. European Journal of Clinical Microbiology & Infectious Diseases 14:2, 105-110
CrossRef105
Th. May, M. Dailloux, C. Amiel, C. Laurain, Ph. Canton, A. Faou. (1995) Mycobacterial infections in AIDS patients; Lorraine, France
. Journal of the European Academy of Dermatology and Venereology 4:1, 100-103
CrossRef106
F.A. Drobniewski, R.J. Kent, N.G. Stoker, A.H.C. Uttley. (1994) Molecular biology in the diagnosis and epidemiology of tuberculosis. Journal of Hospital Infection 28:4, 249-263
CrossRef107
K. A. Sepkowitz, J. Raffalli. (1994) Tuberculosis at the end of the twentieth century. European Journal of Clinical Microbiology & Infectious Diseases 13:11, 902-907
CrossRef108
Joaquim Trias, Roland Benz. (1994) Permeability of the cell wall of Mycobacterium smegmatis. Molecular Microbiology 14:2, 283-290
CrossRef109
Alland, DavidKalkut, Gary E.Moss, Andrew R.McAdam, Ruth A.Hahn, Judith A.Bosworth, WilliamDrucker, ErnestBloom, Barry R.. (1994) Transmission of Tuberculosis in New York City -- An Analysis by DNA Fingerprinting and Conventional Epidemiologic Methods. New England Journal of Medicine 330:24, 1710-1716
Full Text110
Small, Peter M.Hopewell, Philip C.Singh, Samir P.Paz, AntonioParsonnet, JulieRuston, Delaney C.Schecter, Gisela F.Daley, Charles L.Schoolnik, Gary K.. (1994) The Epidemiology of Tuberculosis in San Francisco -- A Population-Based Study Using Conventional and Molecular Methods. New England Journal of Medicine 330:24, 1703-1709
Full Text111
J. Randall Curtis, Thomas M. Hooton, Charles M. Nolan. (1994) New developments in tuberculosis and HIV infection. Journal of General Internal Medicine 9:5, 286-294
CrossRef112
John M. Hunt, Glenn D. Roberts, Leslie Stockman, Teresa A. Felmlee, David H. Persing. (1994) Detection of a genetic locus encoding resistance to rifampin in mycobacterial cultures and in clinical specimens. Diagnostic Microbiology and Infectious Disease 18:4, 219-227
CrossRef113
Jaygopal Nair, David A. Rouse, Gill-Han Bai, Sheldon L. Morris. (1993) The rpsL gene and streptomycin resistance in single and multiple drug-resistant strains of Mycobacterium tuberculosis. Molecular Microbiology 10:3, 521-527
CrossRef114
(1993) Reinfection with Multidrug-Resistant Tuberculosis. New England Journal of Medicine 329:11, 811-812
Full Text115
CharlesL Daley. (1993) Tuberculosis recurrence in Africa: true relapse or re-infection?. The Lancet 342:8874, 756-757
CrossRef116
Soeiro, Ruy, . (1993) A Tale of Two Mutants. New England Journal of Medicine 328:16, 1192-1193
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