ArticleAmerican journal of respiratory and critical care medicine2005
Reinfection and mixed infection cause changing Mycobacterium tuberculosis drug-resistance patterns.
Article in American journal of respiratory and critical care medicine, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00760149 (Pharmacokinetics and Pharmacodynamics of High Versus Standard Dose Rifampicin in Patients With Pulmonary Tuberculosis in the Kilimanjaro Region, Tanzania.), which is not on this map. Cited by 108 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pharmacokinetics and Pharmacodynamics of High Versus Standard Dose Rifampicin in Patients With Pulmonary Tuberculosis in the Kilimanjaro Region, Tanzania.
Who cites it
108 citing papers in PubMed, 5 syntheses or guidelines pooled it, 176 citations in OpenAlex.
- Mycobacterium tuberculosis mixed infections and drug resistance in sub-Saharan Africa: a systematic review.African health sciences · 2022Pooled it
- Pooled it
- HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis.BMC infectious diseases · 2021Pooled it
- Methods for Detecting Mycobacterial Mixed Strain Infections-A Systematic Review.Frontiers in genetics · 2020Pooled it
- Multidrug resistance after inappropriate tuberculosis treatment: a meta-analysis.The European respiratory journal · 2012Pooled it
- Trial
- Multidrug-resistant tuberculosis in the Czech Republic: strategy and therapeutic outcomes.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2007Trial
- The host immune response to Mycobacterium tuberculosis determining protection or disease progression.Nature immunology · 2026Review
- Article
- Mixed infections and heteroresistance ofEmerging microbes & infections · 2025Article
- Characterization of Drug Resistance Mutations inMicroorganisms · 2025Article
- Ecology, global diversity and evolutionary mechanisms in the Mycobacterium tuberculosis complex.Nature reviews. Microbiology · 2025Review
- Host-intrinsic and host-extrinsic factors modulate immunity to Mtb infection, reinfection, and noncanonical vaccination routes.Cell reports. Medicine · 2025Review
- New mini-satellite tandem repeat markers for strain typing of Mycobacterium avium subsp. paratuberculosis.Molecular biology reports · 2025Article
- Trends in and Risk Factors for Drug Resistance inViruses · 2024Article
- Effect of mixed Mycobacterium tuberculosis infection on rapid molecular diagnostics among patients starting MDR-TB treatment in Uganda.BMC infectious diseases · 2024Article
- Lineage classification and antitubercular drug resistance surveillance ofMicrobiology spectrum · 2023Article
- InvestigatingMicrobiology spectrum · 2023Article
- The Detection of Mutations and Genotyping of Drug-ResistantInfectious disease reports · 2023Article
- Analysis of Discordance between Genotypic and Phenotypic Assays for Rifampicin-ResistantPathogens (Basel, Switzerland) · 2023Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors at 1 institution in 3 countries.
Funding
Abstract
rationaleMultiple infections with different strains of Mycobacterium tuberculosis may occur in settings where the infection pressure is high. The relevance of mixed infections for the patient, clinician, and control program remains unclear.
objectivesThis study aimed to describe reinfection and mixed infection as underlying mechanisms of changing drug-susceptibility patterns in serial sputum cultures.
methodsSerial M. tuberculosis sputum cultures from patients diagnosed with multi-drug-resistant (MDR) tuberculosis were evaluated by phenotypic drug-susceptibility testing and mutation detection methods. Genotypic analysis was done by IS6110 DNA fingerprinting and a novel strain-specific polymerase chain reaction amplification method. MEASUREMENTS AND MAIN
resultsDNA fingerprinting analysis of serial sputum cultures from 48 patients with MDR tuberculosis attributed 10 cases to reinfection and 1 case to mixed infection. In contrast, strain-specific polymerase chain reaction amplification analysis in 9 of the 11 cases demonstrated mixed infection in 5 cases, reinfection in 3 cases, and laboratory contamination in 1 case. Analysis of clinical data suggests that first-line therapy can select for a resistant subpopulation, whereas poor adherence or second-line therapy resulted in the reemergence of the drug-susceptible subpopulations.
conclusionsWe have shown that, in some patients with MDR tuberculosis, mixed infection may be responsible for observations attributed to reinfection by DNA fingerprinting. We conclude that treatment and adherence determines which strain is dominant. We hypothesize that treatment with second-line drugs may lead to reemergence of the drug-susceptible strain in patients with mixed infection.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.