High Prevelance of Rifampin-Monoresistant Tuberculosis: A Retrospective Analysis among Iranian Pulmonary Tuberculosis Patients

Ali Akbar Velayati Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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Parissa Farnia Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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Mohadese Mozafari Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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Maryam Fatemeh Sheikholeslami Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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Mona Afraei Karahrudi Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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Payam Tabarsi Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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Sven Hoffner Mycobacteriology Research Centre, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; World Health Organization Supranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden

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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 Mycobacterium tuberculosis. 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 Mycobacterium 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.

Author Notes

* Address correspondence to Parissa Farnia, Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran 19556, Iran. E-mail: pfarnia@sbmu.ac.ir

Financial support: This study was supported by National Manager of TB and Leprosy Control Programs (Ministry of Health and Medical Education) and the Mycobacteriology Research Centre (MRC-6011-M-00-5505-01).

Authors' addresses: Ali Akbar Velayati, Parissa Farnia, Mohadese Mozafari, Maryam Fatemeh Sheikholeslami, Mona Afraei Karahrudi, and Payam Tabarsi, Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease, World Health Organization Collaborating Centre, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, E-mails: velayati@theaasm.org, farina@theaasm.org, mycopf@hotmail.com, sheikholeeslam@theaasm.org, karahrudi@theaasm.org, and tabarsi@theaasm.org. Sven Hoffner, World Health Organization Suranational Reference Laboratory for Tuberculosis, Swedish Institute for Communicable Disease Control, Stockholm, Sweden, E-mail: sven.hoffner@smi.se.

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