The objectives of this study were to determine drug resistance pattern in new and previously treated tuberculosis (TB) patients, to assess function of TB control program, and to characterize multidrug resistant TB (MDR-TB) by molecular fingerprinting methods. Anti-microbial susceptibility testing (AST) to the first line anti-TB drugs was performed on Löwenstein-Jensen (middlebrook 7H10) medium according to the proportion method. Molecular fingerprinting of all MDR strains was performed by spoligotyping and MIRU-VNTR. Mycobacterium tuberculosis strains were isolated from 53 Iraqi patients with pulmonary TB. Thirty eight patients (71.7%) tested cases, and 15 (28.3%) were previously treated. Four of the 38 new cases (10.5%) had resistant, of which 3 (7.9%) were MDR. Eight (53.3%) of the 15 previously treated patients had resistant strains, of which 7 (46.7%) were MDR. Spoligotyping of MDR strains showed CAS family (40%) as the predominant genotype. Using MIRU-VNTR typing, all isolates had a unique profile. MDR-TB prevalence is higher among previously treated patients than among the new cases. The many drug resistant strains, in absence of evidence of recent transmission and in combination with the many previously treated cases, highlight the need for an improved control program, coupled with a need to improve detection rate and early diagnosis of MDR-TB.

Background: The aim of this study was to identify prevalent spoligopatterns of Mycobacterium tuberculosis (MTB) strains within Iran and its neighboring countries. Methods: The spacer oligonucleotide typing (spoligotyping) was performed on 1,742 MTB strains isolated from Iranian and Afghan patients. Subsequently, these results were compared with published results of Pakistan and Turkey. Results: Based on the international spoligotyping database T, Central Asian Strain (CAS), East African-Indian and Latin American and Mediterranean families were prevalent in the region. T was dominant amongIranian (32.3%) and Turkish (36.5%), whereas CAS was more prevalent among Pakistani (61.3%) and Afghan-immigrant (27.4%) TB patients. Conclusion: The majority of strains isolated from Pakistan and Afghanistan belonged to ancient MTB genotypes (principal genetic group, PGG, I). In contrast, in Turkey there was prevalence of modern TB (PGG II and III), whereas in Iran, the prevalence of ancient and modern TB was almost equal. Therefore, Iran may be considered as the connecting geographical location between ancient and modern TB.

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