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Exogenous reinfection of tuberculosis in a low-burden area

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Abstract

Purpose

Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection.

Methods

Prospective cohort study based on the TB database, maintained at the Division of Infectious Diseases, Luigi Sacco Hospital (Milan, Italy). Time period: 1995–2010. Inclusion criteria: (1) ≥2 episodes of culture-confirmed TB; (2) cure of the first episode of TB; (3) availability of one Mycobacterium tuberculosis isolate for each episode. Genotyping of the M. tuberculosis strains to differentiate relapse and exogenous reinfection. Logistic regression analysis was used to assess the influence of risk factors on exogenous reinfections.

Result

Of the 4682 patients with TB, 83 were included. Of these, exogenous reinfection was diagnosed in 19 (23 %). It was independently associated with absence of multidrug resistance at the first episode [0, 10 (0.01–0.95), p = 0.045] and with prolonged interval between the first TB episode and its recurrence [7.38 (1.92–28.32) p = 0.004]. However, TB relapses occurred until 4 years after the first episode. The risk associated with being foreign born, extrapulmonary site of TB, and HIV infection was not statistically significant. In the relapse and re-infection cohort, one-third of the patients showed a worsened drug resistance profile during the recurrent TB episode.

Conclusions

Exogenous TB reinfections have been documented in low endemic areas, such as Italy. A causal association with HIV infection could not be confirmed. Relapses and exogenous reinfections shared an augmented risk of multidrug resistance development, frequently requiring the use of second-line anti-TB regimens.

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Acknowledgments

We owe a debt to Anna Pavan, formerly responsible for the Unit for Prevention, Hygiene and Infectious Diseases of the Health’s General Office, Lombardy region for access to TB regional database. All authors have seen and approved the manuscript and contributed significantly to the work. The manuscript has not been previously published or considered for publication elsewhere.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, H. Sacco, Milan, Italy

    Consuelo Schiroli, Manuela Carugati, Fabio Zanini, Silvia Di Nardo Stuppino, Elisa Monge, Manuela Morosi & Fabio Franzetti

  2. A. O. San Gerardo, Monza, Italy

    Alessandra Bandera & Andrea Gori

  3. A. O. Spedali Civili, Brescia, Italy

    Alberto Matteelli

  4. Centre of Tuberculosis Control of Lombardy, Villa Marelli, Milan, Italy

    Luigi Codecasa

Authors
  1. Consuelo Schiroli
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  2. Manuela Carugati
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  3. Fabio Zanini
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  4. Alessandra Bandera
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  5. Silvia Di Nardo Stuppino
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  6. Elisa Monge
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  7. Manuela Morosi
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  8. Andrea Gori
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  9. Alberto Matteelli
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  10. Luigi Codecasa
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  11. Fabio Franzetti
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Corresponding author

Correspondence to Consuelo Schiroli.

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Schiroli, C., Carugati, M., Zanini, F. et al. Exogenous reinfection of tuberculosis in a low-burden area. Infection 43, 647–653 (2015). https://doi.org/10.1007/s15010-015-0759-9

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  • DOI: https://doi.org/10.1007/s15010-015-0759-9

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