Tuberculosis In Iran Research Articles

Pulmonary Nocardiosis in Suspected Tuberculosis Patients: A Systematic Review and Meta-Analysis of Cross-Sectional Studies.

nocardiosis is an opportunistic infectious disease in immunocompromised patients. The most common form of nocardiosis infection in humans is pulmonary nocrdiosis caused by inhaling Nocardia species from the environment. Thus, this study aimed to evaluate the pulmonary nocardiosis in patients with suspected tuberculosis using systematic review and meta-analysis. We conducted a systematic search for cross-sectional studies focused on the pulmonary nocardiosis among patients with pulmonary tuberculosis based on the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) published from January 2001 to October 2019. The search was conducted in MEDLINE/PubMed, Web of Science, Scopus, Cochrane Library, Google Scholar, Science Direct databases, and Iranian databases. Medical subject headings (MeSH) and text words were searched: "pulmonary nocardiosis", "nocardiosis", OR "nocardial infection", "pulmonary nocardial infections/agents", AND "pulmonary tuberculosis", OR "pulmonary TB", AND "Iran". Two of the reviewers enrolled independently articles published in English and Persian languages according to the inclusion and the exclusion criteria. Comprehensive Meta-Analysis software (Version 3.3.070) was used for meta-analysis. Only 4 studies met the eligibility criteria. The pulmonary nocardiosis prevalence varied from 1.7% to 6.7%. The combined prevalence of nocardiosis among patients with suspected pulmonary tuberculosis in Iran was 4.8% (95% CI: 3-7.3, Q=5.8, Z=12.7). No heterogeneity was observed between studies because I2 was 48.3. N. cyriacigeorgica and N. asteroides were reported as the prevalent isolates, respectively. This review showed in patients suspected TB when they were negative in all diagnosis laboratory tests, nocardiosis cases which be considered.

Role of immigration in tuberculosis transmission to Iran: A systematic review

Background:Today, because of increasing immigration and the prevalence of drug-resistant tuberculosis in Iran, identifying intra-community cases is necessary in the country. It will be possible through the use of molecular epidemiologic methods. In this inquiry, in order to determine the role of immigrants in the transmission of specific strains to Iran, the studies have been examined which had been conducted based on molecular epidemiologic methods among Iranians and non-Iranians people.Methods:All studies from 1997 to the end of March 2017 were examined in three databases of PubMed, Scopus, and Google Scholar and finally, 16 studies were selected.Results:The common clustering rate between Iranians and non-Iranians was determined to be 19.8, and the intra-community recent transmission rate was from 0% to 49% with average of 18.1%. The rate of multidrug-resistant tuberculosis (MDR-TB) was 12.5%, which was higher among immigrants, especially Afghans, and a significant number of the strains were Beijing.Conclusions:The studies have shown that migrants, especially Afghans, are more effective in transmitting specific strains of tuberculosis to migratory areas. To control tuberculosis, it is necessary to register of immigrant's health information, while enter to the country, so that, by doing appropriate diagnostic tests, the curing the patients, the transmission of tuberculosis to the country would be prevented.

Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data.

OBJECTIVESTuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.METHODSThis cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.RESULTSThe risk of mortality from TB was found to increase with the unemployment rate (=0.02), illiteracy (=0.04), household density per residential unit (=1.29), distance between the center of the county and the provincial capital (=0.03), and urbanization (=0.81). The following other risk factors for TB mortality were identified: diabetes (=0.02), human immunodeficiency virus infection (=0.04), infection with TB in the most recent 2 years (=0.07), injection drug use (=0.07), long-term corticosteroid use (=0.09), malignant diseases (=0.09), chronic kidney disease (=0.32), gastrectomy (=0.50), chronic malnutrition (=0.38), and a body mass index more than 10% under the ideal weight (=0.01). However, silicosis had no effect.CONCLUSIONSThe results of this study provide useful information on risk factors for mortality from TB.

Underascertainment, underreporting, representativeness and timeliness of the Iranian communicable disease surveillance system for tuberculosis

ObjectivesA well-functioning disease surveillance system is essential for effective control of diseases. Therefore, conducting evaluation studies on the performance of disease surveillance systems is necessary. This study was conducted to evaluate the performance of the Iranian syndrome-based surveillance system for tuberculosis (TB) in rural areas of Fars, the third largest province located in southern Iran. Study designThis was an evaluation study. MethodsTwo independent sources of information (data from a population-based survey and data from the surveillance system) were used in this evaluation. A group of trained female nurses used a specially designed interview-administered questionnaire to obtain data on the health status of family members from mothers or other adult women in rural houses. Subsequently, the nurses obtained data from individuals who reported a history of TB during a specified period and defined whether the patients presented themselves to a rural or urban health centre or clinic. ResultsA total of 48,771 individuals participated in this study. Of 156 cases who reported a history of TB, 137 (87.82%) presented themselves to at least one medical care provider seeking diagnosis and treatment services. Of patients who visited a health or medical centre, only 18 (13.14%) were reported to the highest level of the surveillance system. Accordingly, the rates of underascertainment and underreporting of the Iranian surveillance system for TB were 12.18% and 86.86%, respectively. Moreover, underascertainment was significantly higher for men (19.40%) than for women (6.74%). The mean time between the date at which TB was noticed and the date of diagnosis was 56.24 days, which was longer for men (79.29 days) than for women (40.10 days). The highest and lowest levels of underreporting were observed for private general practitioners (100%) and the health centres run by the government (87%), respectively. ConclusionThe quality of the communicable disease surveillance system for TB in Iran is facing important challenges, including underascertainment, underreporting and timeliness, in addition to different types of bias. Informing the general population and health workforce about TB and the importance of timely diagnosis is a good approach to improve the performance of Iran's national communicable disease surveillance system.

Determinant factors of drug resistant tuberculosis in Iran, a case control study

IntroductionDrug resistance is one of the critical aspects had to be considered in the tuberculosis control program. Factors related to drug resistance are different in geographic regions and vary during the time. The present study aims to determine the risk factors of drug resistance among TB patients in northern of Iran. MethodsIn this case control study, 22 cases (drug resistant TB patients) and 88 controls (TB patients selected out of those with successive treatment) were randomly selected from a cohort of TB patients in Northern of Iran. The required information was collected from TB registration software in Mazandaran University of Medical Sciences. ResultsOf 22 drug resistant TB patients, resistance to isoniazid, rifampin and also multidrug resistance were observed in 10(9.1%), 3(2.7%) and 9(8.2%) respectively. Moreover, 22.2% of MDR cases, 66.7% of rifampin resistant cases and 40% of isoniazid resistant patients had experienced previous TB treatment (p = 0.363). Logistic regression models showed that the history of previous treatment was significantly associated with drug resistance (OR = 16.55, 95% CI = 2.83–96.89). ConclusionHistory of previous anti-TB treatment can be a determinant factor for TB drug resistance.

Misdiagnosis of Mycobacterium abscessus Pulmonary Infection as Pulmonary Tuberculosis

Introduction: Mycobacterium absessus is one of the important pathogens of rapidly growing mycobacteria, which can cause various infections in humans. Non-tuberculosis pulmonary infection is similar to pulmonary tuberculosis and can be misdiagnosed as Mycobacterium tuberculosis. In this study, a case of pulmonary infection of M. abscessus is reported in healthy patients with previous pulmonary tuberculosis from Iran. Case Presentation: The patient was a 85 year-old woman admitted to a hospital due to productive cough, dyspnea, fever, night sweats, weigh lost, hemoptysis, chest pain, anorexia, vomiting, and hematuria who had the history of pulmonary tuberculosis. According to clinical manifestation, laboratory examination, chest X-ray, and presence of acid-fast bacilli in direct smear, reactivation of tuberculosis was assumed and anti-TB chemotherapy was started; however, the patients’ symptoms were not improved. The causative agent was isolated from the sputum samples of the patient and identified as Mycobacterium abscessus by using phenotypic tests and molecular method. According to the antibiotic susceptibility results, the patient was treated with linezolid, amikacin, and cefoxitin after two weeks. Conclusions: This is the first report of pulmonary infection caused by M. abscessus in patients with a history of pulmonary tuberculosis in Iran. Therefore, for the purpose of patient management, final diagnosis and appropriate treatment, non-tuberculosis mycobacteria (NTM) should be identified to the species level.

Geographic characterization of the tuberculosis epidemiology in iran using a geographical information system

Background: Medical geographic information systems (Medical GIS) has a pronounced capacity to help us understand infectious disease epidemiology, and the transmission of pathogens in a defined geographical area over time. This could not only help us increase the understanding of public health, but also be a most useful base for medical intervention as improved infection control where it is most needed. In this study, we applied GIS to characterize Tuberculosis (TB) epidemiology in Iran. TB, caused by Mycobacterium tuberculosis, is a severe bacterial infection that can be transmitted among humans and more than 10 million people develop active TB every year and with a mortality of 1.4 million. Methods: In this cross-sectional study carried out on 3710 tuberculosis patients who had been diagnosed in 2013 to 2017 at the National Tuberculosis Reference Laboratory, we aimed to explore the geographic and gender patterns of tuberculosis in Iran using GIS. Results: Results showed that the number of patients with tuberculosis was highest in Tehran city, despite the fact that it is the richest and most developed city of Iran and that the tuberculosis dispersion reflected by GIS revealed a significant geographical heterogeneity. Conclusion: These results could be useful to establish and implement new guidelines for effective control strategies in geographic areas with the highest prevalence of tuberculosis.

MIRU-VNTR analysis of Mycobacterium tuberculosis from Tehran, Sistan-Baluchestan, Kermanshah and Hormozgan during 2014 and 2015

Standard 15-locus Mycobacterial Interspersed Repetitive Unit Variable Number Tandem Repeat (MIRU-VNTR) typing of Mycobacterium tuberculosis (MTB) is a valuable instrumentation for TB control. Our knowledge about the genetic diversity of MTB and population structure of MTB circulating in Iran is limited. During 2014–2015, 98 MTB isolates were collected from the TB centers of four provinces of Iran. Isolates were genetically characterized using 15-locus based MIRU-VNTR typing. Ninety-five distinct mycobacterial interspersed repetitive unit MIRU-VNTR patterns were found among 98 isolates. 5 (5.1%) isolates grouped into 2 clusters and 93 (94.89%) isolates had a unique pattern. The HGDI was as high as 0.99 and 10 of loci were designated as highly discriminative. Clusters belonged to Tehran only. This indicates these patterns are rotating in Tehran. Unique patterns suggest that distribution of samples in each province and population differs. HGDI is higher than previous studies for MIRU-VNTR typing in Iran. We suggest MIRU-15 because it is a valid epidemiological background for clustering defined. Limited data is available on the genetic diversity and transmission dynamics of MTB in Iran. To examine the genetic diversity and transmission dynamics of MTB strains we genotyped a collection of isolates from four different parts of Iran. The method of 15-loci MIRU-VNTR demonstrated high discriminatory power and may be applied as a first-line genotyping instrumentation in investigating the molecular epidemiology of M. tuberculosis in Iran.

MIRU-VNTR analysis of Mycobacterium tuberculosis from Tehran, Sistan-Baluchestan, Kermanshah and Hormozgan during 2014 and 2015.

Standard 15-locus Mycobacterial Interspersed Repetitive Unit Variable Number Tandem Repeat (MIRU-VNTR) typing of Mycobacterium tuberculosis (MTB) is a valuable instrumentation for TB control. Our knowledge about the genetic diversity of MTB and population structure of MTB circulating in Iran is limited. During 2014-2015, 98 MTB isolates were collected from the TB centers of four provinces of Iran. Isolates were genetically characterized using 15-locus based MIRU-VNTR typing. Ninety-five distinct mycobacterial interspersed repetitive unit MIRU-VNTR patterns were found among 98 isolates. 5 (5.1%) isolates grouped into 2 clusters and 93 (94.89%) isolates had a unique pattern. The HGDI was as high as 0.99 and 10 of loci were designated as highly discriminative. Clusters belonged to Tehran only. This indicates these patterns are rotating in Tehran. Unique patterns suggest that distribution of samples in each province and population differs. HGDI is higher than previous studies for MIRU-VNTR typing in Iran. We suggest MIRU-15 because it is a valid epidemiological background for clustering defined. Limited data is available on the genetic diversity and transmission dynamics of MTB in Iran. To examine the genetic diversity and transmission dynamics of MTB strains we genotyped a collection of isolates from four different parts of Iran. The method of 15-loci MIRU-VNTR demonstrated high discriminatory power and may be applied as a first-line genotyping instrumentation in investigating the molecular epidemiology of M. tuberculosis in Iran.

Susceptibility to mycobacterial disease due to mutations in IL-12R\u03b21 in three Iranian patients

In the last decade, autosomal recessive interleukin-12 receptor β1 (IL-12Rβ1) deficiency, the most common cause of Mendelian susceptibility to mycobacterial disease (MSMD), has been diagnosed in a few children and adults with severe tuberculosis in Iran. Here, we report three cases referred to the Immunology, Asthma and Allergy ward at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) at Masih Daneshvari Hospital from 2012 to 2017 with Mycobacterium tuberculosis and non-tuberculous mycobacteria infections due to defects in IL-12Rβ1 but with different clinical manifestations. All three were homozygous for either an IL-12Rβ1 missense or nonsense mutation that caused the IL-12Rβ1 protein not to be expressed on the cell membrane and completely abolished the cellular response to recombinant IL-12. Our findings suggest that the presence of IL-12Rβ1 deficiency should be determined in children with mycobacterial infections at least in countries with a high prevalence of parental consanguinity and in areas endemic for TB like Iran.

High rates of nontuberculous mycobacteria isolation from patients with presumptive tuberculosis in Iran.

Nontuberculous mycobacteria (NTM) can cause disease which can be indistinguishable from tuberculosis (TB), posing a diagnostic and therapeutic challenge, particularly in low- and middle-income settings. We aimed to investigate the mycobacterial agents associated with presumptive clinical pulmonary TB in Iran. A total of 410 mycobacterial isolates, obtained between March 2014 and January 2016, from 7600 clinical samples taken from consecutive cases of presumptive diagnosis of TB were identified. Phenotypic and molecular tests were used to identify the isolated organisms to the species level. Single-locus and multilocus sequence analysis based on 16S rRNA, rpoB, hsp65 and ITS locus were used to confirm the results. Of 410 consecutive strains isolated from suspected TB subjects, 62 isolates (15.1%) were identified as NTM. Patients with positive NTM cultures met American Thoracic Society diagnostic criteria for NTM disease. Mycobacterium simiae was the most frequently encountered (38.7%), followed by Mycobacterium fortuitum (19.3%), M. kansasii (17.7%) and M. avium complex (8.0%). Isolation of NTM, including M. simiae, from suspected TB cases is a serious public health problem and merits further attention by health authorities, physicians and microbiologists

Incidence and Prevalence of Tuberculosis in Iran and Neighboring Countries

Background: Tuberculosis is one of the major public health concerns in many countries, however the available and effective treatment is known. Tuberculosis typically determined with socio-economic problems such as war, malnutrition and HIV prevalence. In Iran, many progresses are carried to control tuberculosis but, different factors such as immigration from neighboring countries are affective to tuberculosis infection. Objectives: In this paper, the incidence and prevalence of tuberculosis is evaluated in different regions of Iran and neighboring countries. Methods: The data are collected from different and valid sources such as Scopus, Pubmed and also many reports from world health organization (WHO) and center of disease control and prevention (CDC) for a period of 25 years (1990 - 2015) evaluated for Iran and neighboring countries. Results: This study as a descriptive- analytical research is conducted cross- sectional among Iran and neighboring countries since 1990. The information is obtained from exact and valid informative data from web of sciences. The east and west border countries of Iran which are faced with war and immigration in Afghanistan, Pakistan and Iraq are source of tuberculosis infection that effect on tuberculosis prevalence in Iran. The data were analyzed by SPSS 22 and Excel 2013. Conclusions: The incidence of tuberculosis in Iran has been decreased because of many controlling actions such as BCG vaccination, electronic reporting system for tuberculosis and free access to tuberculosis medication. Some of Iran neighboring countries such as Tajikistan and Pakistan have the highest incidence of tuberculosis which known as a challenge for tuberculosis control in Iran while Saudi Arabia and Turkey have the lowest incidence.

Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis.

Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.

Epidemiologic Trend of Smear-Positive, Smear-Negative, Extra Pulmonary and Relapse of Tuberculosis in Iran (2001-2015); A Repeated Cross-Sectional Study.

Trend analysis is an important tool to monitor epidemiological changes of disease over time to guide resource allocation. This study aimed to study incidence trends and change-points of smear positive, smear negative, extra-pulmonary and relapse of tuberculosis (TB) in Iran from 2001 to 2015. Repeated cross-sectional study METHODS: Nonlinear segmented regression was used to describe TB incidence trends; annual percent change (APC), average annual percent changes (AAPC) and change points for each disease separately. Of 154930 TB cases, 49.8% were smear positive, 19.7% smear negative, 27.32% extra-pulmonary and 3.18% relapse. For all TB types, the peak of incidence was in 2001. Two change point were estimated for all TB types (P<0.05). The APC of all TB types were -6.51 (95% CI: -7.4, -5.4) for first and 2.4 (95% CI: 0. 7, 4.1) for second segment. Although the trends were significantly decreasing from 2001 to 2015 for smear positive (AAPC=2.06%), smear negative (AAPC=3.57%), extra pulmonary (AAPC=3.2%) and relapse (AAPC=3.3%), the AAPCs of trends were not significant from 2006 to 2015. Except for Extra pulmonary TB (APC=4-.9%, 95%CI:-10, 1.2), the APCs of the last segments were significant. Even though the TB incidence rates were decreasing, the amount of reductions seem inadequate, to reach the goals of TB control in Iran. Especially, the increase in the extra-pulmonary TB rates is a point of concern that highlights more attention is required for these cases. It is essential to improve economic supports toward TB control, illegal immigrants, data registry systems and physician's sensitivity in TB detection.

Challenges of Tuberculosis in Iran

Background: Despite the implementation of the national control program, tuberculosis is one of the greatest health problems in Iran. The prevalence of different strains in specific ethnic populations suggests that Mycobacterium tuberculosis transmission has been limited and restricted to close contact. Objectives: In the present review, we describe the epidemiology of tuberculosis in Iran. Methods: In this review article, databases including Scopus, PubMed, and Google scholar were used to search for the epidemiology of tuberculosis in Iran. Results: Since 1996, tuberculosis incidence has been decreased as the national tuberculosis control program was established in Iran. However, due to the emergence of drug-resistant strains, recurrence of the disease, and association of tuberculosis with HIV pandemic, tuberculosis is becoming a health problem in Iran like many other parts of the world. Moreover, several other factors such as poverty, homelessness, inadequate access to health services, and lack of infrastructure in public health play an important role in worsening the situation. The distribution of the disease is not similar in all parts of Iran and it is higher in the western and eastern parts than the central areas. Conclusions: Review of the studies revealed that levels of multidrug-resistant tuberculosis among new tuberculosis patients are increasing in Iran and the vaccination system needs to be reformed. Because of the increasing number of patients coming from neighboring countries with multidrug-resistant tuberculosis, this area needs more stewardship and control in order to prevent the outbreak of multidrug-resistant tuberculosis. Finally, by improving the healthcare system, it is trusted that a more noteworthy number of these patients will be cured in Iran.

Silent changes of tuberculosis in Iran (2005-2015): A joinpoint regression analysis.

Introduction and Aim:Tuberculosis (TB) poses a severe risk to public health through the world but excessively distresses low-income nations. The aim of this study is to analyze silent changes of TB in Iran (2005–2015): A joinpoint regression analysis.Materials and Methods:This is a trend study conducted on all patients (n = 70) that register in control disease center of Joibar (one of coastal cities and tourism destination in Northern Iran which was recognized as an independent town since 1998) during 2005–2015. The characteristics of patients imported to the SPSS 19 and variation in incidence rate of different forms of pulmonary TB (PTB) (PTB+ or PTB–) and extra-PTB (EPTB)/year was analyzed. Variation in incidence rate of TB for male and female groups and different age groups (0–14, 15–24, 25–34, 35–44, 45–54, 55–64, and above 65 years) was analyzed, variation in trend of this diseases for different groups was compared in intended years, and also, variation in incidence rate of TB was analyzed by Joinpoint Regression Software.Results:The total number of TB was 70 cases during 2005–2015. The mean age of patients was 42.31 ± 21.26 years and median age was 40 years. About 71.4% of patients were PTB (55.7% for with PTB+ and 15.7% with PTB–) and rest of them (28.4%) were EPTB. In regard to classification of cases, 97.1% of them were new cases, 1.45% of them were relapsed cases, and 1.45% of them imported cases. In addition, history of hospitalization due to TB was observed in 44.3%.Conclusion:Despite recent developments of governmental health-care system in Iran and proper access to it and considering this fact that identification of TB cases with passive surveillance is possible. Hence, developing certain programs for sensitization of the covered population is essential.

First-Line Anti-Tubercular Drug Resistance of Mycobacterium tuberculosis in IRAN: A Systematic Review.

Background: The spread of drug-resistant tuberculosis (TB) is one of the major public health problems through the world. Surveillance of anti-TB drug resistance is essential for monitoring of TB control strategies. The occurrence of drug resistance, particularly multi-drug resistance Mycobacterium tuberculosis (MDR), defined as resistance to at least rifampicin (RIF) and isoniazid (INH), has become a significant public health dilemma. The status of drug-resistance TB in Iran, one of the eastern Mediterranean countries locating between Azerbaijan and Armenia and high-TB burden countries (such as Afghanistan and Pakistan) has been reported inconsistently. Therefore, the aim of this study was to summarize reports of first-line anti-tubercular drug resistance in M. tuberculosis in Iran.Material and Methods: We systematically reviewed published studies on drug-resistant M. tuberculosis in Iran. The search terms were “Mycobacterium tuberculosis susceptibility” or “Mycobacterium tuberculosis resistant” and Iran.Results: Fifty-two eligible articles, published during 1998–2014, were included in this review. Most of the studies were conducted in Tehran. The most common used laboratory method for detecting M. tuberculosis drug resistant was Agar proportion. The highest resistance to first-line drugs was seen in Tehran, the capital city of Iran. The average prevalence of isoniazid (INH), rifampin (RIF), streptomycin (SM), and ethambotol (EMB) resistance via Agar proportion method in Tehran was 26, 23, 22.5, and 16%, respectively. In general, resistance to INH was more common than RIF, SM, and EMB in TehranConclusions: In conclusion, this systematic review summarized the prevalence and distribution of first-line anti-tubercular drug resistance of M. tuberculosis in Iran. Our results suggested that effective strategies to minimize the acquired drug resistance, to control the transmission of resistance and improve the diagnosis measures for TB control in Iran.

Trend of some Tuberculosis Indices in Iran during 25 yr Period (1990-2014).

Investigation of tuberculosis (TB)-specific indices including prevalence of TB, mortality of TB cases excluding HIV, HIV/TB mortality, incidence of TB (all forms), HIV/TB incidence as well as case detection and related trends is a crucial step in evaluation of program performance and strategies success. Besides, estimating the number and time of change points for TB incidence can help to detect effective factors in TB control. Therefore, the current study aimed to determine the trend of aforementioned indices in Iran during a 25 yr period (1990 to 2014). Data on trend of TB in Iran was extracted from WHO regional office reports during 1990-2014. For determining the trend of TB indices, Annual Percent Changes (APC) and Average Annual Percent Changes (AAPC) was estimated using segmented regression model. AAPC (95% CI) for HIV/TB mortality and HIV/TB incidence were 11.5 (9.3, 13.6) and 14.8 (13.6, 16.1), respectively, which are sign of increasing trend during the period (P<0.05). Other indices showed significantly decreasing trend (P<0.05), except for case detection rate (P =0.803). The incidence, prevalence, and death rates of TB had shown a decreasing trend in general population, regarded as a useful indicator of achievements of Millennium Development Goals (MDGs) and effectiveness of interventional programs. Increasing trend of incidence and mortality of TB in HIV infected patients, needs conducting more intervention strategies in health care programs.

Cigarette smoking in patients newly diagnosed with pulmonary tuberculosis in Iran.

The association between pulmonary tuberculosis (PTB) and tobacco smoke has been verified by most studies on the subject; figures from different countries for the prevalence of smoking among PTB patients vary. To assess the prevalence of and factors associated with smoking among TB patients in Iran. In this cross-sectional study, subjects were included on a first-come, first-served basis from among newly diagnosed PTB patients using a multistage cluster sampling method during 2012-2014. Data were collected during face-to-face interviews and a questionnaire was used to gather information on smoking habits. Of 1127 newly diagnosed PTB patients included in the study (mean age 50.0 ± 19.8 years), 228 (20.2%) were daily smokers, 20 (1.8%) were occasional smokers and 93 (8.9%) had quit before diagnosis. Simultaneous drug use (P < 0.001, OR 75.21), increasing age (P = 0.001), being single (P < 0.001, OR 16.95), being an Iranian national (P < 0.001, OR 6.26) and living in a rural area (P < 0.001, OR 5.85) were found to be independent risk factors for smoking in study patients. The prevalence of smoking among PTB patients in Iran is relatively high. It is therefore necessary to include smoking cessation interventions in the National TB Programme.

Frequency of mutational changes in the embB among the ethambutol-resistant strains of Mycobacterium tuberculosis in Iran.

Early detection of drug resistant tuberculosis is one of the main priorities of TB control program. Ethambutol (EMB) is a first-line anti-TB drug that is effective for preventing treatment failures caused by Mycobacterium tuberculosis strains that are resistant to other drugs. The aim of this study was to sequence the embB gene to characterize the mutations causing resistance to EMB and to analyze the relationship between bacterial genotype and EMB resistance among M. tuberculosis isolates in Iran. A total of 20 M. tuberculosis isolates comprising 10 multidrug-resistant (MDR) and 10 non-MDR isolates, recovered from TB patients in four regions: Tehran, Isfahan, Zahedan, Khorasan, were analyzed. Mutational profiling was performed by amplifying and sequencing the embB gene. Spoligotyping was carried out to characterize the bacterial genotype. Phenotypic EMB resistance was found in 13 strains. Mutations affecting ethambutol resistance-determining region (ERDR) of the embB were identified in 6 of 13 EMB-resistant isolates. The majority of these mutations resulted in amino acid substitution at position 306 (M306V). A novel mutation at codon 366 was identified (S366L) in one isolate. Ural was the most predominant genotype in the studied population. Beijing genotype was associated with both MDR and EMB resistance in which all mutations occurred at codon 306 of the embB gene. A significant association between Beijing genotype and EMB resistance was found, mainly due to mutations at embB306. Results of this study can be used as a basis to develop or improve rapid molecular tests to monitor drug-resistant strains in this country.