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Am. J. Respir. Crit. Care Med., Volume 157, Number 6, June 1998, 1881-1884

Risk Factors for Rifampin Mono-resistant Tuberculosis

RENÉE RIDZON, CYNTHIA G. WHITNEY, MATTHEW T. MCKENNA, JEFFERY P. TAYLOR, SUSAN H. ASHKAR, ANNETTE T. NITTA, SYDNEY M. HARVEY, SARAH VALWAY, CHARLES WOODLEY, ROBERT COOKSEY, and IDA M. ONORATO

Division of Tuberculosis Elimination, Epidemiology Program Office, and Division of AIDS, STD, and TB Laboratory Research, Centers for Disease Control and Prevention, Atlanta, Georgia; Infectious Disease Epidemiology and Surveillance Division, Texas Department of Health, Austin, Texas; Tuberculosis Control Program, Los Angeles County Department of Health Services, Los Angeles County Public Health Laboratory, Los Angeles, Calfornia

Use of rifampin is required for short-course treatment regimens for tuberculosis. Tuberculosis caused by isolates of M. tuberculosis with resistance to rifampin and susceptibility to isoniazid is unusual, but it has been recognized through surveillance. Patients with tuberculosis (cases) with rifampin mono-resistance were compared with HIV-matched controls with tuberculosis caused by a drug-susceptible isolate. A total of 77 cases of rifampin mono-resistant tuberculosis were identified in this multicenter study. Three were determined to be laboratory contaminants, and 10 cases had an epidemiologic link to a case with rifampin mono-resistant tuberculosis, suggesting primary acquisition of rifampin-resistant isolates. Of the remaining 64 cases and 126 controls, there was no difference between cases and controls with regard to age, sex, race, foreign birth, homelessness, or history of incarceration. Cases were more likely to have a history of prior tuberculosis than were controls. Of the 38 cases and 74 controls with HIV infection, there was no difference between cases and controls with regard to age, sex, race, foreign birth, homelessness, history of incarceration, or prior tuberculosis. Cases were more likely to have histories of diarrhea, rifabutin use, or antifungal therapy. Laboratory analysis of available isolates showed that there was no evidence of spread of a single clone of M. tuberculosis. Further studies are needed to identify the causes of the development of rifampin resistance in HIV-infected persons with tuberculosis and to develop strategies to prevent its emergence.




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