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Erschienen in: Infection 6/2015

01.12.2015 | Original Paper

Exogenous reinfection of tuberculosis in a low-burden area

verfasst von: Consuelo Schiroli, Manuela Carugati, Fabio Zanini, Alessandra Bandera, Silvia Di Nardo Stuppino, Elisa Monge, Manuela Morosi, Andrea Gori, Alberto Matteelli, Luigi Codecasa, Fabio Franzetti

Erschienen in: Infection | Ausgabe 6/2015

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Abstract

Purpose

Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection.

Methods

Prospective cohort study based on the TB database, maintained at the Division of Infectious Diseases, Luigi Sacco Hospital (Milan, Italy). Time period: 1995–2010. Inclusion criteria: (1) ≥2 episodes of culture-confirmed TB; (2) cure of the first episode of TB; (3) availability of one Mycobacterium tuberculosis isolate for each episode. Genotyping of the M. tuberculosis strains to differentiate relapse and exogenous reinfection. Logistic regression analysis was used to assess the influence of risk factors on exogenous reinfections.

Result

Of the 4682 patients with TB, 83 were included. Of these, exogenous reinfection was diagnosed in 19 (23 %). It was independently associated with absence of multidrug resistance at the first episode [0, 10 (0.01–0.95), p = 0.045] and with prolonged interval between the first TB episode and its recurrence [7.38 (1.92–28.32) p = 0.004]. However, TB relapses occurred until 4 years after the first episode. The risk associated with being foreign born, extrapulmonary site of TB, and HIV infection was not statistically significant. In the relapse and re-infection cohort, one-third of the patients showed a worsened drug resistance profile during the recurrent TB episode.

Conclusions

Exogenous TB reinfections have been documented in low endemic areas, such as Italy. A causal association with HIV infection could not be confirmed. Relapses and exogenous reinfections shared an augmented risk of multidrug resistance development, frequently requiring the use of second-line anti-TB regimens.
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Metadaten
Titel
Exogenous reinfection of tuberculosis in a low-burden area
verfasst von
Consuelo Schiroli
Manuela Carugati
Fabio Zanini
Alessandra Bandera
Silvia Di Nardo Stuppino
Elisa Monge
Manuela Morosi
Andrea Gori
Alberto Matteelli
Luigi Codecasa
Fabio Franzetti
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Infection / Ausgabe 6/2015
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-015-0759-9

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