Mono-Rifampicin-Resistant Pulmonary Tuberculosis.
10.4046/trd.1999.46.5.618
- Author:
Tae Sun SHIM
1
;
Ki Man LEE
;
Chae Man LIM
;
Sang Do LEE
;
Younsuck KOH
;
Woo Sung KIM
;
Dong Soon KIM
;
Won Dong KIM
Author Information
1. Department of Internal Medicine, Asan Medical Center, University of Ulasn College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Rifampicin mono-resistance;
Tuberculosis;
rpoB gene
- MeSH:
Chungcheongnam-do;
Codon;
Drug Therapy;
HIV;
HIV Infections;
Humans;
Isoniazid;
Korea;
Lost to Follow-Up;
Retrospective Studies;
Rifampin;
Sex Ratio;
Tuberculosis;
Tuberculosis, Multidrug-Resistant;
Tuberculosis, Pulmonary*
- From:Tuberculosis and Respiratory Diseases
1999;46(5):618-627
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Rifampicin (RFP) is a key component of the antituberculous short-course chemotherapy. Usually the RFP resistant M.tuberculosis is also resistant to isoniazid (INH), so the RFP resistance is the marker of multi-drug resistant(MDR) tuberculosis. But unusual cases of mono-RFP-resistant tuberculosis have been recently reported with increasing frequency, especially associated with HIV infection in western countries. Therefore, we conducted a retrospective study to investigate the frequency, causes, and the clinical characteristics of mono-RFP-resistant tuberculosis in Korea. METHODS: Of the bacteriologically confirmed and susceptibility-proven 699 pulmonary tuberculosis patients (921 isolates) who visited Asan Medical Center from January 1990 to August 1997, eighteen patients with INH-susceptible and RFP-resistant tuberculosis were evaluated. Previous history of tuberculosis, antituberculous drug compliances, associated systemic illness, drug susceptibility patterns, and clinical outcomes were analysed. And rpoB gene sequencing was done in 6 clinical isolates of M. tuberculosis. RESULTS: The mean age of 18 patients was 43 14 years, and the sex ratio is 12:6 (M:F). Sixteen (89%) patients had previous history of tuberculosis. None had diagnosed gastrointestinal disorders, and 2 HIV tests that were performed came out negative. Susceptibility tests were done repeatedly in eleven patients, and six (55%) were mono-RFP resistant repeatedly while five (45%) evolved to MDR tuberculosis. Eight (44%) patients were cured, six (33%) failed, three (17%) were lost to follow-up, and the other one is now on treatment. rpoB gene sequencing showed 5 mutations , codon 531 TCG to TTG mutaitons in 4 isolates and 526 CAC to TAC in 1 isolate. CONCLUSION: The clinical characteristics of mono-RFP resistant tuberculosis were similar to that of MDR tuberculosis in Korea where the HIV infection rate is lower than western countries. But some patients with mono-RFP-resistant tuberculous could be cured by primary drug regimens inculding RFP, suggesting that mono-RFP-resistant tuberculous is a different entity from MDR tuberculosis.
