Mycobacterium tuberculosis Complex Drug Resistance in a High Tuberculosis Incidence Area from the WHO Eastern Mediterranean Region

Abstract

-Purpose. The incidence of tuberculosis (TB) in Golestan province of Iran has been ranked 10th among countries of World Health Organization (WHO) Eastern Mediterranean Region. The province is residence of ethnically heterogeneous groups. However, there are limited data on Mycobacterium tuberculosis drug resistance in this province. The main aim of this study was to determine the resistance profile of M. tuberculosis complex (MTBC) isolates to first-line anti-TB drugs. Methods: The clinical specimens were collected from 11807 cases diagnosed during this study. MTBC isolates were tested for susceptibility to firstline anti-TB drugs. Results: A total of 176 new cases were diagnosed as culture positive for MTBC. There was one case that had multidrug-resistant (MDR) isolate and 18 (10.2%) had isolates that were resistant to at least one drug (any drug resistant). Resistance to streptomycin and isoniazid was noted in 15 (8.5%) and 5 isolates (2.8%), respectively. Also, a statistically significant association was observed between age groups and any drug resistance pattern (p = 0.022): 1-24 years vs. 25-45 years (p = 0.033), 25-45 years vs. >65 years (p = 0.010), 46-65 years vs. >65 years (p = 0.050). One third of any drug resistant isolates were obtained from TB patients of Persian ethnic group. Conclusion: Despite the high incidence of TB, the rate of MDR-TB in Golestan province was similar to those reported by WHO for Iranian new cases from other regions. One-tenth of the studied isolates showed any drug resistance pattern. This rate of any drug resistance implies the possibility of initial resistance of MTBC isolates circulating in this region.

Evaluation of the Xpert MTB/RIF test accuracy for diagnosis of tuberculosis in areas with a moderate tuberculosis burden

“…In a study conducted on ten provinces located in the west and northwest of Iran, the sensitivity and specificity of the Xpert assay for the determination of the RIF resistance were 71% and 100%, respectively (22). As the RIF resistance was uncommon in Golestan Province, 0.5% for new TB cases (8), additional research is recommended with a larger sample size.…”

“…Iran is one of the middle‐income countries with an intermediate TB burden, approximately 14 new TB cases per 100 000 individuals (7). Golestan Province is located north of Iran in the vicinity of the Caspian Sea, receiving a large number of immigrants from Afghanistan and other provinces of Iran (8). TB remains a major health concern in Golestan Province, with an incidence rate of 28 per 100 000 individuals (9).…”

<p>Spoligotype and Drug Susceptibility Profiles of <em>Mycobacterium tuberculosis</em> Complex Isolates in Golestan Province, North Iran</p>

“…Mycobacterium tuberculosis (MTB) and Mycobacterium bovis are the most important members of M. tuberculosis complex (MTBC). 1 They are known as causative agents of tuberculosis (TB), which infects almost one third of the global population. 2 The TB incidence is moderate in Iran as a fairly large country (14 per 100,000 people), but is high in neighbor countries such as Turkmenistan, Afghanistan and Pakistan.…”