الفهرس 
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Abstract
The incidence of TB has steadily risen in the last years. It is the world’s second most common cause of death due to an infectious disease. It is estimated that one- third of the world’s population is infected with TB. Only 5-10% of people who are infected with TB may progress to disease at some time during their life. Multidrug-resistant tuberculosis is a serious health hazard with high morbidity and mortality rates. A history of prior TB treatment remains the most important risk factor for MDR-TB. In addition, poor compliance of the patients is a leading cause. Human Immunodeficiency Virus infection is a major risk factor for the development of TB. The AIDS pandemic further promoted the emergence of MDR-TB. Better integration of TB and HIV services are urgently needed. Exposure of HCWs to MTB constitutes a potential health hazard. Inadequate isolation facilities and delayed diagnosis contribute to the nosocomial transmission. Also, MDR-TB can be transmitted within the hospital setting which needs an effective TB infection control programs. In contrast to other bacterial species, MDR-TB is mainly caused by mutations in chromosomal genes. RIF resistance serves as a surrogate marker for the detection of MDR-TB. Genetic methods have provided rapid diagnosis of TB particularly when the organism can not be grown in culture. Genetic sequencing is considered the “gold” standard for identification of MTB. One of the most significant developments in the diagnosis of TB seems to be the assays based on IFN-γ determination. They offers a more accurate approach than TST for the identification of TB infection. Early detection of drug resistance constitutes one of the priorities of TB control programs. Genotypic methods detect resistance associated mutations in target genes of MTB and provide results within 1-2 days. The MODS assay has been described for the early detection of growth and rapid drug susceptibility testing method for MTB in sputum specimens. The treatment of MDR-TB infections is very difficult. It often requires 18–24 months of therapy with four to eight different medications, including daily injection for at least 6 months. A new and effective drugs are urgently needed. Surgery for cavitary pulmonary MDR-TB can be considered as a neo-adjuvant procedure to remove a major focal burden of tubercle bacilli contained within necrotic lung tissue. Also, There are other new approaches in the treatment of MDR-TB. These include the concurrent application of immunotherapy. In the last years, many vaccine candidates have been developed for eradication of TB. They include subunit vaccines, modified BCG, and attenuated MTB vaccine. Close monitoring of MDR-TB patients by DOTS-plus strategy is mandatory for disease prevention and control especially in low and middle-income countries.