Volume 90, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We determined the prevalence of rifampin-monoresistant tuberculosis (RMR-TB) in Iran. Because development of RMR-TB is not common, we also identified the major risk factors associated with RMR-TB reported from different provinces of Iran. Data for 3,020 TB patients who remained or became smear positive after two, four, six, and nine months of standard first-line chemotherapy were retrospectively analyzed. Of 3,020 patients, 1,242 patients (41.1%) were culture and DNA positive for . Of these patients, 73 (7.4%) patients had monoresistant isolates to rifampin, which was significantly higher than that for multidrug-resistant TB (5.8%). The average rate of RMR-TB in the studied population ranged from 5% to 10%. Classical investigation showed that 33.6% of patients had either a previous or family history of TB. Molecular epidemiology methods (i.e., spoligotyping and intespersed repetitive unit–variable number tandem repeat), defined transmission link in three clusters (13%). These results outline the urgent need for a comprehensive plan for detection and treatment of RMR-TB cases.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Mirsaeidi SM, Tabarsi P, Khoshnood K, Pooramiri MV, Rowhani-Rahbar A, Mansoori SD, Masjedi H, Zahirifard S, Mohammadi F, Farnia P, Masjedi MR, Velayati AA, , 2005. Treatment of multiple drug-resistant tuberculosis (MDR-TB) in Iran. Int J Infect Dis 9: 317322.[Crossref] [Google Scholar]
  2. Mitchison DS, Nunn AJ, , 1986. Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis. Am Rev Respir Dis 133: 423430. [Google Scholar]
  3. Blanchard JS, , 1996. Molecular mechanisms of drug resistance in Mycobacterium tuberculosis . Annu Rev Biochem 65: 215239.[Crossref] [Google Scholar]
  4. Iseman MD, Madsen LA, , 1989. Drug- resistant tuberculosis. Clin Chest Med 10: 341353. [Google Scholar]
  5. Vos M, Quince C, Pijl AS, de Hollander M, Kowalchuk GA, , 2012. A comparison of rpoB and 16S rRNA as markers in pyrosequencing studies of bacterial diversity. PLOS One 7: e30600.[Crossref] [Google Scholar]
  6. Williams DL, Waguespack C, Eisenach K, Crawford JT, Portaels F, Salfinger M, Nolan CM, Abe C, Sticht-Groh V, Gillis TP, , 1994. Characterization of rifampin resistance in pathogenic mycobacteria. Antimicrob Agents Chemother 38: 23802386.[Crossref] [Google Scholar]
  7. De Beenhouwer H, Lhiang Z, Jannes G, Mijs W, Machtelinckx L, Rossau R, Traore H, Portaels F, , 1995. Rapid detection of rifampin resistance in sputum and biopsy specimens from tuberculosis patients by PCR and line probe assay. Tuber Lung Dis 76: 425430.[Crossref] [Google Scholar]
  8. Telenti A, Imboden P, Marchesi F, Lowrie D, Cole S, Colston MJ, Matter L, Schopfer K, Bodmer T, , 1993. Detection of rifampin-resistance mutations in Mycobacterium tuberculosis . Lancet 341: 647650.[Crossref] [Google Scholar]
  9. Hanrahan CF, Dorman SE, Erasmus L, Koornhof H, Coetzee G, Golub JE, , 2012. The impact of expanded testing for multidrug resistant tuberculosis using genotype MTBDR plus in South 15 Africa: an observational cohort study. PLoS ONE 7: e49898.[Crossref] [Google Scholar]
  10. World Health Organization, 1997. Anti-Tuberculosis Drug Resistance in the World. Report no. 1. WHO/TB/97.229. Geneva: World Health Organization. [Google Scholar]
  11. Masjedi MR, Farnia P, Sorooch S, Pooramiri MV, Mansoori SD, Zarifi AZ, Akbarvelayati A, Hoffner S, , 2006. Extensively drug resistant tuberculosis: 2 years of surveillance in Iran. Clin Infect Dis 43: 641847.[Crossref] [Google Scholar]
  12. Velayati AA, Masjedi MR, Farnia P, Tabarsi P, Ghanavi J, Ziazarifi AH, Hoffner SE, , 2009. Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran. Chest 136: 420425.[Crossref] [Google Scholar]
  13. Khazaei HA, Rezaei N, Bagheri GR, Dankoub MA, Shahryari K, Tahai A, Mahmoudi M, , 2005. Epidemiology of tuberculosis in the southeastern Iran. Eur J Epidemiol 20: 879883.[Crossref] [Google Scholar]
  14. Rafiee S, Besharat S, Jabbari A, Golalipour F, Nasermoaadeli A, , 2009. Epidemiology of tuberculosis in northeast of Iran: a population-based study. IJMS 34: 193197. [Google Scholar]
  15. Velayati AA, Farnia P, Masjedi MR, Hoffner S, , 2013. Detection of and treatment protocol for rifampicin-monoresistant tuberculosis: what is the role of isoniazid. Int J Tuberc Lung Dis 17: 849845.[Crossref] [Google Scholar]
  16. Kamerbeek J, Schouls L, Kolk A, van Agterveld M, van Soolingen D, Kuijper S, Bunschoten A, Molhuizen H, Shaw R, Goyal M, van Embden J, , 1997. Simultaneous detection and strain differentiation of Mycobacterium. tuberculosis for diagnosis and epidemiology. J Clin Microbiol 35: 907914. [Google Scholar]
  17. Brudey K, Driscoll JR, Rigouts L, Prodinger WM, Gori A, Al-Hajoj SA, Allix C, Aristimuño L, Arora J, Baumanis V, Binder L, Cafrune P, Cataldi A, Cheong S, Diel R, Ellermeier C, Evans JT, Fauville-Dufaux M, Ferdinand S, Garcia de Viedma D, Garzelli C, Gazzola L, Gomes HM, Guttierez MC, Hawkey PM, van Helden PD, Kadival GV, Kreiswirth BN, Kremer K, Kubin M, Kulkarni SP, Liens B, Lillebaek T, Ho ML, Martin C, Martin C, Mokrousov I, Narvskaïa O, Ngeow YF, Naumann L, Niemann S, Parwati I, Rahim Z, Rasolofo-Razanamparany V, Rasolonavalona T, Rossetti ML, Rüsch-Gerdes S, Sajduda A, Samper S, Shemyakin IG, Singh UB, Somoskovi A, Skuce RA, van Soolingen D, Streicher EM, Suffys PN, Tortoli E, Tracevska T, Vincent V, Victor TC, Warren RM, Yap SF, Zaman K, Portaels F, Rastogi N, Sola C, , 2006. Mycobacterium tuberculosis complex genetic diversity: mining the fourth international spoligotyping database (SpolDB4) for classification, population genetics and epidemiology. BMC Microbiol 6: 23.[Crossref] [Google Scholar]
  18. Weniger T, Krawczyk J, Supply P, Niemann S, Harmsen D, , 2010. MIRU-VNTR plus: a web tool for polyphasic genotyping of Mycobacterium tuberculosis complex bacteria. Nucleic Acids Res 38: 326331.[Crossref] [Google Scholar]
  19. Allix-Béguec C, Harmsen D, Weniger T, Supply P, Niemann S, , 2008. Evaluation and user-strategy of MIRU-VNTR plus, a multifunctional database for online analysis of genotyping data and phylogenetic identification of Mycobacterium tuberculosis complex isolates. J Clin Microbiol 46: 26922699.[Crossref] [Google Scholar]
  20. Yang Z, Durmaz R, Yang D, Gunal S, Zhang L, Foxman B, Sanic A, Marrs CF, , 2005. Simultaneous detection of isoniazid, rifampin, and ethambutol resistance of Mycobacterium tuberculosis by a single multiplex allele-specific polymerase chain reaction (PCR) assay. Diagn Microbiol Infect Dis 53: 201208.[Crossref] [Google Scholar]
  21. Kazumi Y, Mitara S, , 2012. The evaluation of an identification algorithm for Mycobacterium species using the 16S rRNA coding gene and rpoB . Int J Myco 1: 2128. [Google Scholar]
  22. Buyankhishig B, Oyuntuya T, Tserelmaa B, Sarantuya J, Lucero MG, Mitara S, , 2012. Rapid molecular testing for multi-resistant tuberculosis in Mongolia: a diagnostic accuracy study. Int J Myco 1: 4044. [Google Scholar]
  23. Li J, Xin J, Zhang L, Jiang L, Cao H, Li L, , 2012. Rapid detection of rpoB mutations in rifampin resistant M. tuberculosis from sputum samples by denaturing gradient gel electrophoresis. Int J Med Sci 9: 148156.[Crossref] [Google Scholar]
  24. Ma X, Wang H, Deng Y, Liu Z, Xu Y, Pan X, Musser JM, Graviss EA, , 2006. rpoB gene mutations and molecular characterization of rifampin-resistant Mycobacterium tuberculosis isolates from Shandong Province, China. J Clin Microbiol 44: 34093412.[Crossref] [Google Scholar]
  25. Mani C, Selvakumar N, Narayanan S, Narayanan PR, , 2001. Mutation in the rpoB gene of multidrug resistant Mycobacterium tuberculosis clinical isolates from India. J Clin Microbiol 39: 29872988.[Crossref] [Google Scholar]
  26. Mitchison DA, , 1998. How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis. Int J Tuberc Lung Dis 2: 1015. [Google Scholar]
  27. Munsiff SS, Friedan TR, , 1996. Mono-rifampin resistant tuberculosis, New York City, 1993–1994 (abstract no.C118). Abstracts of the 36th International Conference on Antimicrobial Agents and Chemotherapy. New Orleans, LA. Washington, DC: American Society for Microbiology Press. [Google Scholar]
  28. Ridzon R, Whitney CG, McKenna MT, Taylor JP, Ashkar SH, Nitta AT, Harvey SM, Valway S, Woodley C, Cooksey R, Onorato IM, , 1998. Risk factors for rifampin mono-resistant tuberculosis. Am J Respir Crit Care Med 157: 18811884.[Crossref] [Google Scholar]
  29. Sandman L, Schluger NW, Davidow AL, Bonk S, , 1999. Risk factors for rifampin-monoresistant tuberculosis: a case–control study. Am J Respir Crit Care Med 159: 468472.[Crossref] [Google Scholar]
  30. Pereira Pinto W, Hadad DJ, Silva Telles MA, Mizuka Ueki SY, Palaci M, Basile MA, , 2001. Tuberculosis and drug resistance among patients seen at an AIDS reference center in Sao Paolo, Brazil. Int J Infect Dis 5: 94100.[Crossref] [Google Scholar]
  31. Mukinda FK, Theron D, van der Spuy GD, Jacobson KR, Roscher M, Streicher EM, Musekiwa A, Coetzee GJ, Victor TC, Marais BJ, Nachega JB, Warren RM, Schaaf HS, , 2012. Rise in rifampicin-monoresistant tuberculosis in Western Cape, South Africa. Int J Tuberc Lung Dis 16: 196202.[Crossref] [Google Scholar]
  32. Sanders M, Van Deun A, Ntakirutimana D, Masabo JP, Rukundo J, Rigouts L, Fissette K, Portaelst F, , 2006. Rifampicin mono resistant Mycobacterium tuberculosis in Bujumbura, Burundi: results of a drug resistance survey. Int J Tuberc Lung Dis 10: 178183. [Google Scholar]
  33. Drobniewski F, Balabanova Y, Ruddy M, Weldon L, Jeltkova K, Brown T, Malomanova N, Elizarova E, Melentyey A, Mutovkin E, Zhakharova S, Fedorin I, , 2002. Rifampin and multidrug-resistant tuberculosis in Russian civilians and prison inmates: dominance of the Beijing strain family. Emerg Infect Dis 8: 13201326.[Crossref] [Google Scholar]
  34. Velayati AA, Farnia P, Mirsaeidi M, Reza Masjedi M, , 2006. The most prevalent Mycobacterium tuberculosis superfamilies among Iranian and Afghan TB cases. Scand J Infect Dis 38: 463468.[Crossref] [Google Scholar]
  35. Farnia P, Masjedi MR, Mirsaeidi M, Mohammadi F, Jallaledin-Ghanavi Vincent V, Bahadori M, Velayati AA, , 2006. Prevalence of Haarlem I and Beijing types of Mycobacterium tuberculosis strains in Iranian and Afghan MDR-TB patients. J Infect 53: 331336.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 28 Jan 2013
  • Accepted : 02 Sep 2013
  • Published online : 08 Jan 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error