ArticleJournal of clinical microbiology2010
Molecular detection of mixed infections of Mycobacterium tuberculosis strains in sputum samples from patients in Karonga District, Malawi.
Article in Journal of clinical microbiology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
40 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Mycobacterium tuberculosis mixed infections and drug resistance in sub-Saharan Africa: a systematic review.African health sciences · 2022Pooled it
- Methods for Detecting Mycobacterial Mixed Strain Infections-A Systematic Review.Frontiers in genetics · 2020Pooled it
- Trial
- Detection of a Mixed-Strain Infection with Drug- and Multidrug-ResistantAntibiotics (Basel, Switzerland) · 2025Article
- TBtypeR: Sensitive detection and sublineage classification of Mycobacterium tuberculosis complex mixed-strain infections.Communications biology · 2025Article
- A new method for detecting mixed Mycobacterium tuberculosis infection and reconstructing constituent strains provides insights into transmission.Genome medicine · 2025Article
- Genetic Characterization and Population Structure of Drug-ResistantAntibiotics (Basel, Switzerland) · 2024Article
- Whole-Genome Sequencing Exhibits Better Diagnostic Performance than Variable-Number Tandem Repeats for Identifying Mixed Infections of Mycobacterium tuberculosis.Microbiology spectrum · 2023Article
- Genotyping of Mycobacterium tuberculosis complex isolated from humans and animals in northeastern Iran.Scientific reports · 2023Article
- Insights into the Complexity of a DormantMicrobiology spectrum · 2022Article
- Detection of Mycobacterium tuberculosis multiple strains in sputum samples from patients with pulmonary tuberculosis in south western Uganda using MIRU-VNTR.Scientific reports · 2022Article
- The detection of mixed tuberculosis infections using culture filtrate and resuscitation promoting factor deficient filtrate.Frontiers in cellular and infection microbiology · 2022Article
- Effect of mixed strain infections on clinical and epidemiological features of tuberculosis in Florida.Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases · 2021Article
- The recent trend in mycobacterial strain diversity among extra pulmonary lymph node tuberculosis and their association with drug resistance and the host immunological response in South India.BMC infectious diseases · 2020Article
- Possible Transmission Mechanisms of Mixed Mycobacterium tuberculosis Infection in High HIV Prevalence Country, Botswana.Emerging infectious diseases · 2020Article
- Article
- Role of MIRU-VNTR and spoligotyping in assessing the genetic diversity of Mycobacterium tuberculosis in Henan Province, China.BMC infectious diseases · 2018Article
- Identifying mixed Mycobacterium tuberculosis infections from whole genome sequence data.BMC genomics · 2018Article
- Use of whole-genome sequencing to distinguish relapse from reinfection in a completed tuberculosis clinical trial.BMC medicine · 2017Article
- Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
The occurrence of mixed infections of Mycobacterium tuberculosis is no longer disputed. However, their frequency, and the impact they may have on our understanding of tuberculosis (TB) pathogenesis and epidemiology, remains undetermined. Most previous studies of frequency applied genotyping techniques to cultured M. tuberculosis isolates and found mixed infections to be rare. PCR-based techniques may be more sensitive for detecting multiple M. tuberculosis strains and can be applied to sputum. To date, one study in South Africa has used a PCR approach and suggested that mixed infection could be common. We investigated mixed infections in northern Malawi using two lineage-specific PCR assays targeting the Latin American-Mediterranean (LAM) and Beijing lineages. Compared with spoligotyping, the specificity and sensitivity of both assays was 100%. From 160 culture-positive sputa, mixed LAM and non-LAM strains were detected in 4 sputa belonging to 2 (2.8%) patients. Both patients were HIV positive, with no history of TB. Cultured isolates from both patients showed only LAM by PCR and spoligotyping. In a set of 377 cultured isolates, 4 were mixed LAM and non-LAM. Only one showed evidence of more than one M. tuberculosis strain using IS6110-based restriction fragment length polymorphism (IS6110-RFLP) and spoligotyping analyses. Corresponding sputa for the 4 isolates were unavailable. Mixed Beijing and non-Beijing strains were not detected in this study. Mixed infections appear to be rare in our setting and are unlikely to affect findings based on DNA fingerprinting data. Molecular methods, which avoid the selective nature of culture and target distinct strains, are well suited to detection of mixed infections.
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