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Is there a relationship between Mycobacterium tuberculosis strain type and TB paradoxical reaction?
  1. F M R Perrin1,
  2. R A M Breen1,
  3. M C I Lipman1,
  4. R J Shorten2,
  5. S H Gillespie2,
  6. T D McHugh2
  1. 1Department of Thoracic Medicine, Royal Free Hospital, London NW3 2QG, UK
  2. 2Centre for Medical Microbiology, Royal Free & University College Medical School, London NW3 2PF, UK
  1. Correspondence to:
    Dr F M R Perrin
    Department of Thoracic Medicine, Royal Free Hospital, London NW3 2QG, UK;

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Paradoxical reaction (PR) in tuberculosis (TB) is defined as transient worsening of symptoms and signs or the appearance of new lesions after beginning appropriate anti-tuberculosis chemotherapy. Recent studies suggest that PR occurs in 10–35% of patients. It is more common and more severe in HIV co-infected individuals with disseminated disease.1 PR is thought to be an immune mediated phenomenon but the reasons for its occurrence are unknown.1

Infection by Mycobacterium tuberculosis (MTB) results in highly variable outcomes between individuals. The characterisation of MTB strains by molecular typing techniques suggests this may be a reflection of the infecting organism, as well as host response and environmental factors. MTB strains with distinct genotypes have been shown to evoke different immunopathological events in mouse models2 and variable clinical manifestations …

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