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Classification of drug-resistant tuberculosis in an epidemic area

dc.contributor.authorVan Rie A.
dc.contributor.authorWarren R.
dc.contributor.authorRichardson M.
dc.contributor.authorGie R.P.
dc.contributor.authorEnarson D.A.
dc.contributor.authorBeyers N.
dc.contributor.authorVan Helden P.D.
dc.date.accessioned2011-05-15T15:57:04Z
dc.date.available2011-05-15T15:57:04Z
dc.date.issued2000
dc.identifier.citationLancet
dc.identifier.citation356
dc.identifier.citation9223
dc.identifier.issn1406736
dc.identifier.urihttp://hdl.handle.net/10019.1/10193
dc.description.abstractBackground: Traditionally, patients with drug-resistant tuberculosis are classified as having acquired drug-resistant or primary drug-resistant disease on the basis of a history of previous tuberculosis treatment. Only cases of primary drug resistance are assumed to be due to transmission of drug-resistant strains. Methods: This descriptive study of 63 patients with drug-resistant tuberculosis assessed the relative contribution of transmission of drug-resistant strains in a high-incidence community of Cape Town, South Africa, by restriction-fragment length polymorphism (RFLP). The RFLP results were compared with the results obtained by traditional classification methods. Findings: According to RFLP definitions, 52% (33 cases) of drug-resistant tuberculosis was caused by transmission of a drug-resistant strain. The proportion of cases due to transmission was higher for multidrug-resistant (64%; 29 cases) than for single-drug-resistant (no cases) tuberculosis. By the clinical classification, only 18 (29%) patients were classified as having primary drug-resistant tuberculosis (implying transmission). The clinical classification was thus misleading in 25 patients. Interpretation: The term acquired drug resistance includes patients infected with strains that truly acquired drug resistance during treatment and patients who were initially infected with or reinfected with a drug-resistant strain. This definition could lead to misinterpretation of surveillance studies, incorrect evaluation of tuberculosis programmes, and delayed diagnosis and treatment of patients with multidrug-resistant disease. The clinical term acquired drug resistance should be replaced with the term "drug resistance in previously treated cases", which includes cases with drug resistance due to true acquisition as well as that due to transmitted drug-resistant strains.
dc.subjectadolescent
dc.subjectadult
dc.subjectarticle
dc.subjectchild
dc.subjectclassification
dc.subjectcluster analysis
dc.subjectcomparative study
dc.subjectdisease transmission
dc.subjectepidemic
dc.subjectfemale
dc.subjectgenetics
dc.subjecthuman
dc.subjectincidence
dc.subjectmale
dc.subjectmicrobiological examination
dc.subjectmiddle aged
dc.subjectmultidrug resistance
dc.subjectMycobacterium tuberculosis
dc.subjectprospective study
dc.subjectrestriction fragment length polymorphism
dc.subjectserodiagnosis
dc.subjectSouth Africa
dc.subjecttuberculosis
dc.subjectdrug resistance
dc.subjectmajor clinical study
dc.subjectpriority journal
dc.subjectschool child
dc.subjectAdolescent
dc.subjectAdult
dc.subjectChild
dc.subjectCluster Analysis
dc.subjectDisease Outbreaks
dc.subjectDrug Resistance, Multiple
dc.subjectFemale
dc.subjectHIV Seronegativity
dc.subjectHumans
dc.subjectIncidence
dc.subjectMale
dc.subjectMicrobial Sensitivity Tests
dc.subjectMiddle Aged
dc.subjectMycobacterium tuberculosis
dc.subjectPolymorphism, Restriction Fragment Length
dc.subjectProspective Studies
dc.subjectSouth Africa
dc.subjectTuberculosis, Multidrug-Resistant
dc.subjectisoniazid
dc.subjectrifampicin
dc.subjecttuberculostatic agent
dc.titleClassification of drug-resistant tuberculosis in an epidemic area
dc.typeArticle
dc.description.versionArticle


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