title: Burden of Multidrug Resistant Mycobacterium tuberculosis Among New Cases in Al-Madinah Al-Monawarah, Saudi Arabia.
abstract: BACKGROUND
  The pattern of Mycobacterium tuberculosis susceptibility to first line drugs and multidrug resistance in Al-Madinah Al-Munawarah, a seasonally overcrowded are during Hajj and Omrah, is not well studied.
  
  
  OBJECTIVE
  This study aimed to investigate anti-tuberculosis drug resistance and its distribution among new cases in Al-Madinah Al-Monawarah.
  
  
  METHODS
  Study subjects included 622 patients with first time confirmed TB referred to the central tuberculosis laboratory in Al-Madinah between January 2012 and December 2014.
  
  
  RESULTS
  Out of the 622 isolates, 99 (15.9%) were Mycobacteria Other Than Tuberculosis (MOTTS) and 25 (4.0%), three of which (12%) were children under five years of age, revealed multidrug resistance (MDR). Monoresistance to isoniazid (H) was (1.8%), to rifampin (R) was (1.4%), to streptomycin (S) was (1.9 %) to ethambutol (E) was (1.1 %) and to pyrazinamide (Z) was (2.1%).
  
  
  CONCLUSIONS
  Being among the new cases, multidrug resistant tuberculosis (MDR TB) is supposed to be caused by strains which are originally multidrug resistant. Neither nationality nor gender was found to be associated with MDR TB. Since 12% of MDR cases were among children, a probability of primary infection with MDR strains is to be considered. Moreover, mass gathering during Hajj and Omrah seasons does not seem to increase the burden of MDR in the region. However, further investigation is needed to molecularly characterize MDR isolates and their phylogenetics and geographical origin.
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Monawrah. Saudi Arabia.
authors.forename: Mogahid M
authors.initials: MM
authors.lastname: Elhassan
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Al Madenah Al Monawarah. Saudi Arabia.
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Hemeg
authors.affiliation: Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Al Madenah Al Monawarah. Saudi Arabia.
authors.forename: Miskelyemen A
authors.initials: MA
authors.lastname: Elmekki
authors.affiliation: TB central Lab, Almadinah Almonawwara. Saudi Arabia.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Turkistani
authors.affiliation: Department of Medical Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Omdurman. Sudan.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Abdul-Aziz
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007514:Islam; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D010802:Phylogeny; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D012529:Saudi Arabia / Q000453:epidemiology; D013307:Streptomycin / Q000494:pharmacology / Q000627:therapeutic use; D014195:Travel; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin
keywords: Al-madinah Almonawarah; BACTEC MGIT 960; Genexpert; MDR TB; antituberculosis
  drug; mycobacterium; phylogenetics