الفهرس 
Definitions of tuberculosisOnly 14 pages are availabe for public view
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Abstract
Tuberculosis is a disease that has been known since antiquity, and it
remains one of the leading causes of morbidity and mortality worldwide.
Its management has become more complex because of increased
resistance to commonly used antituberculosis drugs.
Tuberculosis (TB) is a major infectious disease killing nearly two
million people, mostly in developing countries, every year.
The increasing incidence of resistance of Mycobacterium
tuberculosis strains to the most-effective (first-line) anti-TB drugs is a major
factor contributing to the current TB epidemic.
Drug-resistant strains have evolved mainly due to incomplete or
improper treatment of TB patients.
Resistance of M. tuberculosis to anti-TB drugs is caused by
chromosomal mutations in genes encoding drug targets. Multidrug resistant
(resistant at least to rifampin and isoniazid) strains of M. tuberculosis
(MDR-TB) evolve due to sequential accumulation of mutations in target
genes.
Emergence and spreading of MDR-TB strains is hampering efforts
for the control and management of TB.
The MDR-TB is also threatening World Health Organization’s target
of tuberculosis elimination by 2050.
Proper management of MDR-TB relies on early recognition of such
patients.
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Several diagnostic methods, both phenotypic and molecular, have
been developed recently for rapid identification of MDR-TB strains from
suspected patients and some are also suitable for resource-poor countries.
Close contacts of MDR-TB patients are defined as people living in
the same household or spending many hours a day together with the patient
in the same indoor living space.
The available data indicate that close contacts of MDR-TB patients
who develop active TB most commonly have drug-resistant disease.
Once identified, successful treatment of MDR-TB requires therapy
with several effective drugs some of which are highly toxic, less efficacious
and expensive.
Proper drug susceptibility test, proper choice of drugs at the
beginning of treatment and modification of treatment after knowing drug
susceptibility testing results are important for the prevention of MDR-TB.
Ensuring patient adherence to treatment is important in the medical
institutions where drug susceptibility test is not properly done, in particular,
for INH-resistant RMP-susceptible cases, and guidance to these institutions
by the public health centers should be intensified.
Minimum treatment duration of 18e24 months is also long, making it
difficult for health care providers to ensure adherence to treatment.
Successful treatment has been achieved by supervised therapy with
appropriate drugs at institutions equipped with facilities for culture, drug
susceptibility testing of MDR-TB strains to second-line drugs and regular
monitoring of patients for adverse drug reactions and bacteriological and
clinical improvement.
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Conclusions
from the present study, it was concluded that:
· Resistance to anti- tuberculous drugs is a major health threat in our country.
· The highest figures of resistance were to Isoniazid and Rifampicin which is
probably attributed to the abuse of Rifampicin.
· The lowest figures of resistance were to Ethambutol.
· Resistance to drugs is very high among previously treated group.
· The most common type of resistance was acquired resistance because of
lack of adherence to treatment or inappropriate treatment.
· MDR-TB is an increasing problem with higher figures of resistance in
retreated patients.
· The more extensive the radiological lesion, the more incidence of resistance
· The most common complications of anti. TB drugs was GIT
manifestations and the least complications was electrolytes disturbance