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耐药性结核病已成为一个严重的公共卫生问题。利福平耐药性可能是由于分支杆菌RNA聚合酶突变所致。病人获得利福平耐药性的机理可能有三种:(1)由耐药菌引起的感染;(2) 在毒力较强的野生型菌存在的同时,一小群仍处于遏制中的耐药菌的选择;(3)原来感染菌群内的突变。本研究连续收集治疗过程中发生利福平耐药性的2例病人的结核分支杆菌分离菌株。一例病人由于HIV感染而免疫抑制,另一例病人原来分离菌株对异烟肼也耐药。应用DNA指纹技术对分离菌株分型,显示耐药性发生前后的分离菌株之间DNA图谱无差别。这些资料表明,这2例病人获得利福平耐药性是由于上述第三机理。
Drug-resistant tuberculosis has become a serious public health problem. Rifampicin resistance may be due to mycobacterial RNA polymerase mutations. There are three possible mechanisms by which patients may acquire rifampicin resistance: (1) infections caused by drug-resistant bacteria; (2) a small group that is still in containment with the presence of virulent wild-type bacteria The choice of drug-resistant bacteria; (3) The original mutation within the infected bacteria. This study continuously collected Mycobacterium tuberculosis isolates from 2 patients who developed rifampicin resistance during the course of treatment. One patient was immunosuppressed due to HIV infection and the other patient was originally resistant to isoniazid. DNA fingerprinting was used to genotype the isolates, showing no difference in DNA profiles between isolates before and after drug resistance. These data show that these 2 patients acquired rifampicin resistance due to the third mechanism described above.