Chronic cases of tuberculosis in Casablanca, Morocco.
OBJECTIVE
To evaluate the prevalence and patterns of drug resistance of Mycobacterium tuberculosis isolates collected from patients with chronic tuberculosis in Casablanca, Morocco.


METHODS
Between February 1996 and September 2001, 122 isolates were recovered from 112 different patients. The male to female ratio was 2.4.


RESULTS
From February 1996 to May 1997, 77.5% of isolates were multidrug-resistant (MDR-TB), compared to 69.4% from February 1999 to May 2000 and 78.7% from June 2000 to September 2001. The prevalence of MDR-TB is similar from the initial to the last period of this study. Analysis of the 69 bp hypervariable region of the rpoB gene by DNA sequencing on 42 M. tuberculosis isolates (37 resistant, 5 sensitive) showed nine different types of mutations on codons rpoB 513, rpoB 516, rpoB 522, rpoB 523 and rpoB 526. A new point mutation was observed on codon rpoB 523 on one isolate. No mutation was detected on this rpoB region for four resistant isolates.


CONCLUSIONS
The high rate of MDR-TB illustrates a serious problem. The public health authorities have introduced a new regimen protocol consisting of 3 months of kanamycin, ofloxacin, pyrazinamide and ethionamide, followed by 18 months of ofloxacin, pyrazinamide and ethionamide (3KOZEA/18OZEA) for this category of patients, and it is hoped that the additional use of ofloxacin during the intensive phase of treatment will reduce the rate of resistance.
El Baghdadi
J
J
Département de Microbiologie, Institut Pasteur du Maroc, Casablanca, Morocco. jamilla300@hotmail.com
Remus
N
N
Laaboudi
L
L
Benslimane
A
A
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D002908:Chronic Disease; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology
D000995:Antitubercular Agents