Emergence of New Forms of Totally Drug-Resistant Tuberculosis Bacilli Super Extensively Drug-Resistant Tuberculosis or Totally Drug-Resistant Strains in Iran
Emergence of New Forms of Totally Drug-Resistant Tuberculosis Bacilli Super Extensively Drug-Resistant Tuberculosis or Totally Drug-Resistant Strains in Iran
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DOI：
10.1378/chest.08-2427
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发表时间：
2009-08-01
期刊：
影响因子：
9.6
通讯作者：
Hoffner, Sven Eric
中科院分区：
文献类型：
--
作者：
Velayati, Ali Akbar;Masjedi, Mohammad Reza;Hoffner, Sven Eric
背景：本研究记录了耐多药结核病(MDR-TB)患者中出现新的耐药菌株(完全耐药[TDR]或超广泛耐药[TB]株)。方法：对分离的结核分枝杆菌进行一线和二线药物敏感性试验。结果：146株耐多药结核分枝杆菌中，XDR分离株8株(5.4%)，TDR分离株15株(10.3%)。其余菌株要么敏感(67%)，要么有其他耐药模式(20%)。总体而言，NIDR-TB患者以前接受的治疗和药物的中位数是5种药物(异烟肼、利福平、链霉素、乙胺丁醇和吡津酰胺)为期15个月的两个疗程。所有研究病例的体外耐药中位数为异烟肼和类风湿因子。XDR或TDR菌株来自移民(阿富汗，30.4%；阿塞拜疆，8.6%；伊拉克，4.3%)和伊朗(56.5%)耐多药结核病病例。在这些病例中，涂片和培养在二线药物(乙硫酰胺、对氨基水杨酸、环丝氨酸、氧氟沙星、阿米卡星和环丙沙星)治疗18个月后仍然呈阳性。Spoligo分型显示Haarlem(39.1%)、北京(21.7%)、EAI(21.7%)和CAS(17.3%)超级家庭中有结核分枝杆菌。结论：从不同地区国家的耐多药结核病患者中分离出TDR毒株令人震惊，并强调了此类毒株可能在亚洲国家传播。现在下一个问题是应该如何控制和处理这种情况。(《胸部》2009；136：420-425)
Background: The study documented the emergence of new forms of resistant bacilli (totally drug-resistant [TDR] or super extensively drug-resistant [XDR] tuberculosis [TB] strains) among patients with multidrug-resistant TB (MDR-TB).Methods: Susceptibility testing against first- and second-line drugs was performed on isolated Mycobacterium tuberculosis strains. Subsequently, the strains identified as XDR or TDR M tuberculosis were subjected to spoligotyping and variable numbers of tandem repeats (VNTR).Results: Of 146 MDR-TB strains, 8 XDR isolates (5.4%) and 15 TDR isolates (10.3%) were identified. The remaining strains were either susceptible (67%) or had other resistant patterns (20%). Overall, the median of treatments and drugs previously received by NIDR-TB patients was two courses of therapy of 15 months' duration with five drugs (isoniazid [INH], rifampicin [RF], streptomycin, ethambutol, and pyrazinamide). The median of in vitro drug resistance for all studied cases was INH and RF. The XDR or TDR strains were collected from both immigrants (Afghan, 30.4%; Azerbaijani, 8.6%; Iraqi, 4.3%) and Iranian (56.5%) MDR-TB cases. In such cases, the smear and cultures remained positive after 18 months of medium treatment with second-line drugs (ethionamide, para-aminosalicylic acid, cycloserine, ofloxacin, amikacin, and ciprofloxacin). Spoligotyping revealed Haarlem (39.1%), Beijing (21.7%), EAI (21.7%), and CAS (17.3%) superfamilies of M tuberculosis. These superfamilies had different VNTR profiles, which eliminated the recent transmission among MDR-TB cases.Conclusions: The isolation of TDR strains from MDR-TB patients from different regional countries is alarming and underlines the possible dissemination of such strains in Asian countries. Now the next question is how one should control and treat such cases. (CHEST 2009; 136:420-425)