Salmanzadeh Shokrollah, Karamian Masoumeh, Alavi Seyed Mohammad, Nashibi Roohangiz
Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Infectious Diseases and Tropical Medicine, Ahvaz Jundishapur University of Medical Sciences, Medical School, Razi Teaching Hospital, Ahvaz, Iran.
J Family Med Prim Care. 2020 Apr 30;9(4):1958-1962. doi: 10.4103/jfmpc.jfmpc_983_19. eCollection 2020 Apr.
Despite the great efforts to control tuberculosis (TB), the disease is still one of the major health challenges throughout the world. The basic treatment for TB is drug therapy. Currently, the main anti-tuberculosis drugs with major use in the treatment and control of the disease are isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. One of the serious crises in controlling TB epidemic is diagnosis and treatment of patients with Multidrug Resistant Tuberculosis (MDR-TB MDR). The purpose of the study was to examine and evaluate the resistance of mycobacterium TB strains isolated from specimens of newly diagnosed smear positive pulmonary TB to isoniazid and rifampin using molecular methods and their risk factors.
Sputum samples of newly diagnosed smear positive pulmonary TB patients were prepared, collected, and sent to Reference Laboratory in Ahvaz. DNA of mycobacterium tuberculosis was prepared from the samples using Qiagen kit according to the instructions of the manufacturing company. Isoniazid resistance was evaluated using specific primers for inhA and KatG genes. Rifampin resistance was evaluated using MAS-PCR method with three specific alleles of rpobB codons and codons 516, 526 and 531.
Mycobacterium tuberculosis resistance to Isoniazid was 7.3%, to Rifampin 5.5% and to both drugs 1.8%. In our study, there were no association between drug resistance and gender, age, prison history, smoking, drug use, underlying disease, occupation, and HIV.
According our findings that include prevalence of 7.3% Isoniazide resistance, 5.5% Rifampin resistance and 1.8% to both drugs, evaluating all newly diagnosed patients for resistance to standard anti-tuberculosis treatment seems rational.
尽管在控制结核病方面付出了巨大努力，但该疾病仍是全球主要的健康挑战之一。结核病的基本治疗方法是药物治疗。目前，在该疾病的治疗和控制中主要使用的抗结核药物有异烟肼、利福平、吡嗪酰胺、乙胺丁醇和链霉素。控制结核病流行的严重危机之一是耐多药结核病（MDR-TB）患者的诊断和治疗。本研究的目的是使用分子方法检测和评估从新诊断的涂片阳性肺结核患者标本中分离出的结核分枝杆菌菌株对异烟肼和利福平的耐药性及其危险因素。
制备、收集新诊断的涂片阳性肺结核患者的痰液样本，并将其送至阿瓦士的参考实验室。根据生产公司的说明，使用Qiagen试剂盒从样本中制备结核分枝杆菌的DNA。使用针对inhA和KatG基因的特异性引物评估异烟肼耐药性。使用具有rpobB密码子以及密码子516、526和531的三个特异性等位基因的MAS-PCR方法评估利福平耐药性。
结核分枝杆菌对异烟肼的耐药率为7.3%，对利福平的耐药率为5.5%，对两种药物的耐药率为1.8%。在我们的研究中，耐药性与性别、年龄、监禁史、吸烟、吸毒、基础疾病、职业和艾滋病毒之间没有关联。
根据我们的研究结果，包括7.3%的异烟肼耐药率、5.5%的利福平耐药率和1.8%的两种药物耐药率，对所有新诊断的患者进行标准抗结核治疗耐药性评估似乎是合理的。
