Prevalence and risk factors of drug-resistant tuberculosis in border provinces of Iran

Abstract

Objective. Rapid detection of mycobacterium tuberculosis (MTB) resistance is a key step in the control of disease. This study aimed to identify the prevalence and accuracy of isoniazid (INH) and rifampin (RMP) resistance and their risk factors using multiplex allele-specific polymerase chain reaction (MAS-PCR) to detect such mutations. Materials and methods. In this cross-sectional study (2012–2013), 257 MTB patients from five frontier border provinces of Iran were selected and after divulging a full clinical history and undergoing a physical evaluation, the accuracy of drug resistance detection was carried out using the standard proportion test, sequencing, and GeneXpert/rifampicin (RIF) technique. Full demographic and environmental histories were evaluated. Results. The overall frequency of mutations was 34. Frequency of patients with mutations in KatG315 and at least one rpoB codon (of 516, 526, and 531 codons) were seven cases (2.7%). In comparison to the standard proportion test, the sensitivity and specificity of MAS-PCR in detecting common INH-resistant mutations were 68.75 and 100%, and in the detection of common RMP-resistant mutation were 81.8 and 100%, respectively. Also, 88.89% of KatG 315 mutations and 100% of rpoB mutations were diagnosed and compared with DNA sequencings. Compared to GeneXpert/RIF, 100% of RMP common point mutation was determined by MAS-PCR. Mutation odds were higher in males and greater in those with a history of anti-tuberculosis treatment. Conclusion. The results of this study indicated that MAS-PCR is an efficient method for rapid detection of mutations leading to RMP resistance but merely to KatG it is not satisfactory for the detection of INH resistance. Accurate and rapid detection of drug resistance is crucial in males and patients with a history of tuberculosis.

Keywords:

• Mycobacterium tuberculosis
• drug-resistant
• multiplex allele-specific PCR
• microbial sensitivity test

Acknowledgements

The authors thank the staff of the East Azerbaijan reference laboratory, the TB & lung disease research center and province health center, Tabriz University of Medical Sciences. We would like to thank, individually, Dr. Seyyed Reza Moaddab, Maryam Seyyedi, Jalil Rashedi, Ahad Zarei, Hasan Yekrang, Dr. Simin Khayyat Zadeh, Dr. Tavana, Dr Nemati, Mr Seyyedi, and Mr. Sarhangi; the staff of the Ardabil laboratory and province health center: Dr. Arezu Moini and Mrs. Saraii, BSc of Laboratory Sciences; the staff of Kermanshah reference laboratory: Sara Atashi, BSc of Laboratory Sciences; Staff of Kurdistan laboratory and province health center: Seyran Nili, MSc of Epidemiology and Mr. Galilini, BSc of Laboratory Sciences and Lesley Carson for Editorial Solutions; This research was part of a PhD thesis and supported by Tabriz Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.