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Superinfection with Rifampin-Isoniazid-Streptomycin-Ethambutol (RISE)-resistant Tuberculosis in Three Patients with AIDS: Confirmation by Polymerase Chain Reaction Fingerprinting

David L. Horn, MD; Dial Hewlett, MD; Walter H. Haas, MD; W. Ray Butler, MS; Celia Alfalla, MD; Edgar Tan, MD; Andrew Levine, MD; Atasu Nayak, MD; and Steven M. Opal, MD
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From Lincoln Medical and Mental Health Center, Bronx, New York; the Centers for Disease Control and Prevention, Atlanta, Georgia; Memorial Hospital of Rhode Island, Providence, Rhode Island. Requests for Reprints: Dial Hewlett, Jr., Department of Medicine, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451. Acknowledgments: The authors thank Yvonne Lue, PhD, Trevor McLean, Stephen Peterson, MD, Jack Crawford, PhD, and Fred Moore for their assistance.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(2):115-116. doi:10.7326/0003-4819-121-2-199407150-00007
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Reinfection with new strains of Mycobacterium tuberculosis has been reported [14]. Exogenous reinfection with M. tuberculosis resistant to isoniazid and streptomycin played an important role in an outbreak occurring in a homeless shelter [5]. Recently, restriction fragment-length polymorphism analysis has been used to show exogenous M. tuberculosis reinfection of patients with the acquired immunodeficiency syndrome (AIDS) who have multidrug-resistant tuberculosis that occurred during therapy for the initial drug-sensitive infection [67]. We describe three additional patients in whom rifampin-isoniazid-streptomycin-ethambutol (RISE)-resistant tuberculosis occurred during therapy for drug-susceptible tuberculosis. This was documented by DNA fingerprinting using the mixed-linker polymerase chain reaction (PCR) technique.

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Figure 1.
Mixed-linker fingerprints of Mycobacterium tuberculosis isolates.

Polymerase chain reaction products were separated by gel electrophoresis on an 8% polyacrylamide gel and visualized under ultraviolet light by staining with 0.5 µg/mL ethidium bromide. Lanes 1 to 3 are original patient isolates and corresponding isolate after suprainfection with the RISE-resistant strain; lane C indicates negative controls for sample processing and PCR; lane M shows 100-base pair DNA ladder-size marker (BRL, Life Technologies, Inc., Gaithersburg, Maryland). RISE = rifampin-isoniazid-streptomycin-ethambutol.

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