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the risk of tuberculous infection is high [8, 9]. Our patient, and others described in previous reports [2-4], were in environments where they were heavily exposed to M. tuberculosis. In addition to varying degrees of immunosuppression, high levels of exposure to M. tuberculosis likely contributed to their risk of reinfection. The case described herein illustrates that diabetes may be a risk factor for exogenous reinfection in patients with prior tuberculous infection. To what extent, if any, exogenous reinfection occurs in immunocompetent hosts is unknown. Stead [10] suggested that healthy tuberculin reactors are at very low risk of reinfection when they are again exposed to M tuberculosis. Shafer et al. [5] presented a case of exogenous reinfection in an immunocompetent woman who had previously used alcohol heavily. However, it is not clear how previous heavy alcohol use affects the immune system. The number of cases of tuberculosis resulting from exogenous reinfection is undoubtedly underestimated since the cases described to date have involved only reinfection with isolates resistant to multiple drugs. Perhaps, when molecular epidemiological tools are more broadly used to analyze M. tuberculosis isolates, we will have a truer sense of the role reinfection plays in tuberculosis.

clinical infectious diseases/clinical infectious diseases (online. university of chicago. press)

Recurrent Vancomycin-Resistant Enterococcus faecium Bacteremia in a Leukemia Patient Who Was Persistently Colonized with Vancomycin-Resistant Enterococci for Two Years