Document 0248
 DOCN  M9650248
 TI    Independent origin of mono-rifampin-resistant Mycobacterium tuberculosis
       in patients with AIDS.
 DT    9605
 AU    Lutfey M; Della-Latta P; Kapur V; Palumbo LA; Gurner D; Stotzky G;
       Brudney K; Dobkin J; Moss A; Musser JM; Kreiswirth BN; Tuberculosis
       Center, Public Health Research Institute, Columbia; Presbyterian Medical
       Center, New York, New York 10016, USA.
 SO    Am J Respir Crit Care Med. 1996 Feb;153(2):837-40. Unique Identifier :
       AIDSLINE MED/96160606
 AB    Historically, infections caused by Mycobacterium tuberculosis have been
       treated simultaneously with isoniazid and rifampin. As a consequence of
       this combined therapy, strains resistant only to rifampin were rarely
       recovered. However, recently there has been an increasing number of
       reports describing HIV-positive patients infected with
       mono-rifampin-resistant M. tuberculosis strains. Organisms cultured from
       seven patients (including six with AIDS) with infections caused by
       mono-rifampin-resistant M. tuberculosis, and seen at one New York City
       hospital, were analyzed by molecular techniques to test the hypothesis
       that dissemination of a single clone had occurred. IS6110 DNA
       fingerprinting and automated DNA sequencing of a region of the RNA
       polymerase beta subunit structural gene (rpoB) containing mutations that
       confer rifampin resistance showed that all organisms independently
       acquired the mono-rifampin-resistant phenotype. Molecular analysis of
       mono-rifampin-resistant organisms cultured from 13 additional patients
       in New York City confirmed independent strain origin. The data rule out
       the possibility of person-to-person strain transmission among these
       patients, and they suggest that host factors such as poor compliance
       with antituberculosis medications or decreased absorption of rifampin
       have been a driving force in the origin of these strains.
 DE    Antibiotics, Antitubercular/*THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/*DRUG THERAPY/MICROBIOLOGY/  TRANSMISSION  Drug Resistance,
       Microbial  Genes, Structural, Bacterial  Human  Microbial Sensitivity
       Tests  Mycobacterium tuberculosis/*DRUG EFFECTS/GENETICS  Point Mutation
       Polymorphism, Restriction Fragment Length  Rifampin/*THERAPEUTIC USE
       RNA Polymerases/GENETICS  Support, U.S. Gov't, P.H.S.  Treatment Refusal
       Tuberculosis, Pulmonary/*DRUG THERAPY/MICROBIOLOGY/TRANSMISSION  JOURNAL
       ARTICLE

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