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背景:1996～1997年,里斯本各医院的主要人类免疫缺陷病毒(HIV)血清阳性的病人中发生的耐性多药结核病(MDR-TB)。目的:在里斯本市的几家医院,包括一家监狱医院,发现耐多药结核病(MDR-TB)的传播与爆发流行。设计:用限定性片段长度多态性(RFLP)检测耐异烟肼、利福平和其他一种药物的结核分枝杆菌菌株的指纹。结果:共43个MDR-TB菌株被分型。HIV阳性病人占67％,HIV阴性病人占12％,其他病人的HIV情况未知。大约88％的菌株属于3种基因特征相似的簇,揭示可能是最近的传播。一个主要簇(A簇)的菌株占72％的病例,其中45％的病例来自监狱医院。这些簇的菌株对异烟肼、利福平、链霉素以及有时对乙胺丁醇耐药。对A簇的所有病人进行了回顾性的流行病学调查,以便探讨病例之间的流行病学联系。结论:结果表明,最近在里斯本医院的MDR-TB传播,主要发生在HIV阳性病人。此外,主要的MDR-TB簇菌株并非局限于HIV感染的个体,这些菌株在一些有免疫力的病人中也被分离出来。
Background: From 1996 to 1997, multidrug-resistant tuberculosis (MDR-TB) developed in major human immunodeficiency virus (HIV) seropositive hospitals in Lisbon hospitals. PURPOSE: In several hospitals in Lisbon, including a prison hospital, the spread and outbreak of MDR-TB was found. Design: Fingerprinting of M. tuberculosis isolates against isoniazid, rifampicin, and one other drug using restriction fragment length polymorphism (RFLP). Results: A total of 43 MDR-TB strains were typed. HIV-positive patients accounted for 67%, HIV-negative patients accounted for 12%, other cases of HIV status unknown. About 88% of the isolates belonged to three clusters with similar genetic characteristics, revealing the possibility of the most recent spread. Strain of a major cluster (cluster A) accounted for 72% of cases, of which 45% of cases were from prison hospitals. Strains of these clusters are resistant to isoniazid, rifampicin, streptomycin, and sometimes to ethambutol. A retrospective epidemiological survey of all patients in Cluster A was conducted to explore the epidemiological link between the cases. Conclusion: The results show that the recent MDR-TB transmission in Lisbon hospitals mainly occurs in HIV-positive patients. In addition, the major MDR-TB cluster strains are not restricted to HIV-infected individuals and these strains are also isolated in some immunocompetent patients.