Multidrug-Resistant Tuberculosis in Central Asia and Predominant Beijing Lineage, Challenges in Diagnosis, Treatment Barriers, and Infection Control Strategies: An Integrative Review
Abstract
1. Introduction
2. Results
Author/Year/Country | Research Design/Genotype and Resistance | Aims | Data Collection Sampling Population | Analysis | Findings |
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Akhmetova et al. [4], Kazakhstan | Genotypic study using MIRU-VNTR analysis Cluster Beijing 94-32; rpoB (S531L), katG, fabG-inhA, oxyR-ahpC genes of M. tuberculosis | To determine the prevalence and genetic characteristics of the Beijing Central Asian/Russian Cluster 94-32 among MDR-TB cases in Kazakhstan | Genotyping of M. tuberculosis and MDR-TB strains using mycobacterial interspersed repetitive units–variable number tandem repeats (MIRU-VNTR) analysis n = 540 strains New TB cases and MDR-TB patients from multiple regions in Kazakhstan | Genotypic classification of MDR-TB strains, prevalence assessment of Beijing Central Asian/Russian Cluster 94-32 | The Beijing Central Asian/Russian Cluster 94-32 was the predominant MDR-TB strain in Kazakhstan, highlighting its role in sustained transmission and drug resistance. The Beijing genotype was associated with drug-resistant TB (p < 0.0001), including multidrug-resistant TB (p < 0.0001). Among the Beijing isolates, cluster 94-32 showed an association with MDR-TB (p = 0.021). |
Aye et al. [16], Tajikistan | Descriptive study | To describe the common healthcare-seeking behaviors of new pulmonary TB patients and identify the determinants of delay | Questionnaire and interviews n = 204 patients | Principal component analysis and Cox proportional hazards models | The study found that patients who initially sought care from private healthcare providers experienced longer delays in TB treatment than those who accessed the public health system. Private healthcare providers included doctors, pharmacies, and traditional healers. Patients who accessed the public health system, such as district hospitals or health centers, experienced shorter delays in receiving TB treatment. This indicates that the public health system in Tajikistan plays a crucial role in early TB detection and the prompt initiation of treatment. The study identified socioeconomic factors, such as lower education levels and rural residence, as additional barriers to timely TB treatment. These factors contribute to delayed healthcare-seeking behaviors and limited access to healthcare facilities. |
Bastard et al. [10], Kyrgyzstan, Uzbekistan (others) | Retrospective multicentric analysis | To analyze and contrast the results of treatment between individuals with HIV-positive and HIV-negative drug-resistant tuberculosis (DR-TB) | Drug susceptibility testing (DST) n = 1369 TB patients | Descriptive statistics | The study found that HIV-infected patients with drug-resistant TB had lower treatment success rates, a higher risk of mortality during TB treatment, experienced more frequent and severe adverse events during TB treatment, and experienced longer delays in initiating appropriate treatment compared to HIV-noninfected patients. |
Cox et al. [6], Uzbekistan and Turkmenistan | Cross-sectional design Beijing; not specified | To assess the extent of drug resistance in a DOTS program | Survey questionnaire n = 213 | Univariate and multivariable logistic regression analysis | The data revealed variations in MDR-TB rates between the two regions of Karakalpakstan and Dashoguz. Different proportions of new and previously treated patients were found to have MDR-TB in each region, suggesting potential differences in healthcare access, treatment effectiveness, or disease control measures. |
Cox et al. [7], Uzbekistan and Turkmenistan | Cross-sectional design Beijing genotype; non-Beijing strains | To evaluate the prevalence, distribution, and characteristics of the TB Beijing genotype strain | Culture and drug susceptibility testing (DST), IS6110 fingerprinting, and spoligotyping n = 397 TB strains | Logistic regression | Fifteen isolates showed mixed banding patterns, indicating the presence of two distinct TB strains in their infections. A total of 382 strains were analyzed, 152 isolates (40%) were grouped in 42 clusters, each consisting of that shared the same fingerprint and spoligotype patterns. The Beijing genotype accounted for approximately half of all isolates. As drug resistance has developed, the prevalence of the Beijing genotype has increased. Of the MDR-TB strains, 75% were genotyped in Beijing, compared to 38% of the completely susceptible isolates. |
Cox et al. [17], Uzbekistan and Turkmenistan | Cross-sectional design | To analyzed treatment results of TB patients enrolled in a DOTS program | Sputum smear results n = 382 TB patients | Descriptive statistics | In total, 62 of the 382 patients with TB did not respond favorably to treatment. Retesting tests revealed that these patients had the same strain of M. tuberculosis, indicating that the therapy had failed. A total of 19 patients had strains that developed new or extra medication resistance. This implies that during treatment, TB strains developed resistance to other medications. In particular, polyresistant Beijing-genotype bacteria exhibited amplified drug resistance. |
Cox et al. [18], Uzbekistan | Retrospective observational study | To establish the link between DOTS end-of-treatment outcomes, subsequent TB rediagnosis, mortality, and other factors | Sputum smear-TB positive n = 213 patients who were sputum smear-positive | Pearson’s Chi square test, multivariate models | This study revealed a high mortality rate among patients diagnosed with TB. On average, 15% of the patients died per year following diagnosis, with a confidence interval ranging from 11% to 19%. The mortality rate was even higher for cases of MDR-TB, with 43% of MDR-TB patients dying annually. Pansusceptible TB cases have a low mortality rate of 6% per year. Among the new TB cases, 74% were successfully treated. Among the 99 new cases, 25 (34%) were rediagnosed as recurrent TB. Notably, 13 of these individuals were smear-positive upon rediagnosis, indicating an active and potentially infectious form of the disease. The recurrence rate varied depending on the type of TB and the treatment history. Pansusceptible cases had a recurrence rate of 23%, while previously treated MDR-TB cases had a much higher recurrence rate of 60%. |
du Cros et al. [19], Tajikistan | Discussion paper systematic framework | To describe the difficulties faced while setting up the TB program and the solutions to these challenges | Case finding within the pediatric hospital and DR-TB facilities | Culture and drug-susceptibility testing analysis | There is a lack of pediatric-specific drug formulations for the treatment of MDR-TB. Healthcare providers often lack sufficient knowledge and training regarding pediatric drug-resistant TB. Central Asian countries may have weak health systems and infrastructure including limited laboratory capacity, inadequate drug supply chains, and poor monitoring and evaluation systems. These factors contribute to the challenges of implementing comprehensive drug-resistant TB programs for children. Recommendations were strengthened for health systems and infrastructure, including laboratory capacity, drug supply chains, and monitoring and evaluation systems. |
Daniyarov et al. [11], Kazakhstan | Whole-genome sequencing investigation Beijing; SNPs in resistance-related genes | To assess and describe mutations associated with anti-TB drugs among MDR-TB M. tuberculosis clinical isolates | MDR isolates from TB patients, specifically the identification and isolation of pure culture of the pathogen n = 8 multidrug-resistant clinical isolates | Whole-genome sequencing and analysis | According to spoligotyping and mycobacterial interspersed repetitive units–variable number tandem repeats (MIRU-VNTR) genotyping, the strains in question are members of the Beijing family. Annotated single-nucleotide polymorphisms, insertions, and deletions of new genomic variations linked to drug resistance have been identified. Genomic variants linked to drug resistance detected. |
Darisheva et al. [20], Kazakhstan | Case–control study | To assess the perspective of TB patients household contacts and community dwellers toward ambulatory TB treatment | Index cases based on recently diagnosed pulmonary TB cases (within a 90-day period) n = 1083 new pulmonary TB case | Univariate statistics | In total, 24.9% of respondents believed that ambulatory treatment for tuberculosis (TB) was suitable. Favorable views regarding ambulatory TB treatment were connected to factors such as the region where individuals lived, higher educational levels, receiving support from family members, and having previous TB experience. The relationship between TB knowledge and holding a positive attitude towards ambulatory treatment was more pronounced among community controls to TB patients and their family members. |
Davis et al. [21], Kazakhstan | Case–control study | To assess the relationship between a history of incarceration, tobacco, alcohol, and drug consumption, and HIV infection and diabetes mellitus with TB | Case–control study n = 1600 participant (TB cases = 562, household controls = 515, community controls = 523) | Descriptive statistics a bivariate analysis | Variables such as DM, HIV infection, tobacco use, alcohol use, and incarceration history were associated with TB. |
Engström et al. [22], Kyrgyzstan, Tajikistan, and Uzbekistan | Population structure of TB isolates Cluster M. tuberculosis Beijing 94-32, 100-32; non-Beijing genotypes | To provide a population overview of M. tuberculosis strains’ structure | Solid culture on L-J medium to heat lysis n = 607 clinical M. tuberculosis (235 from Uzbekistan, 206 from Tajikistan, and 166 from Kyrgyzstan) | Unique multiple 24-loci VNTR analysis (MLVA) MtbC15-9 haplotype | The primary genetic types responsible for the population growth of Beijing strains in Kyrgyzstan, Uzbekistan, and Tajikistan are clusters 94-32 and 100-32, respectively, which play crucial roles in the current MTB epidemic in Central Asia. |
Feuerriegel et al. [23], Uzbekistan | Cross-sectional mutations in genes gyrA, gyrB, rrs, and tlyA that confer resistance to second-line drugs | To ascertain whether molecular analyses of targeted genes can serve as rapid, specific, and sensitive means of detecting resistance to TB drugs. | All mycobacterial strains from a program for the treatment of MDR-TB n = 266 MDR-TB patients (resistant to ofloxacin strains-26 and to capreomycin and/or amikacin-48: Control susceptible to ofloxacin-49 and capreomycin-39) | DNA isolation, PCR, and sequencing | Mutations in gyrA or gyrB were found in 96% (25/26 strains) of the ofloxacin-resistant strains, while none of the susceptible strains displayed mutations in those two genes. The most frequent mutation in strains resistant to both amikacin and capreomycin was A1401G in rrs (34/40 strains (85.0%). Three strains had mutations in tlyA, of which two (at codons 18 and 118) were associated with resistance to capreomycin alone. Sequence analysis of short regions within specific target genes is a powerful tool for the rapid detection of resistance to second-line drugs in patients undergoing treatment for MDR-TB. |
Hermosilla et al. [24], Kazakhstan | Cross-sectional study | To provide an epidemiological profile of TB among individuals who inject drugs | Baseline interview using questionnaire and biological testing n = 728 individuals | Univariate analyses | Older adult males with a history of incarceration and recent drug injection use were more likely to test positive for TB. |
Hillemann et al. [25] Kazakhstan, | Surveillance study Beijing and non-Beijing; rpoB (RMP), katG /inhA/ahpC gene analysis (INH) | To analyze the specific mutations responsible for resistance to rifampicin (RMP) and isoniazid (INH) and strains of MTB | Culture and sensitivity n = 142 resistant M. tuberculosis strain (92 MDR and 50 INH-resistant, but not RMP-resistant (INHr/RMPs) strains) | Molecular typing, drug-resistance genotyping | The strong similarity of the mutations provides evidence that the transmission of resistant strains plays a significant role in drug-resistance development. A significantly higher proportion of the rpoB S531L mutation was found among Beijing genotype strains compared with non-Beijing strains (71.2% vs. 46.2%, p = 0.027). In the INHr/RMPs control group, the S315T mutation was significantly more prevalent in the Beijing than in the non-Beijing group (96.9% vs. 71.4%, p = 0.012). Strong link between mutations and transmission. |
Ibrayeva et al. [26], Kazakhstan | Cross-sectional study Beijing genotype; rpoB, katG, fabG-inhA, and oxyR-ahpC genes of M. tuberculosis | To assessed the genetic variability of MTB strains and examined their anti-TB drug-resistance profiles | Collection of biological samples, such as sputum or other respiratory specimens n = 60 M. tuberculosis isolates from prisons n = 125 M. tuberculosis isolates from the civilian sector | DNA sequencing and analysis, MIRU-VNTR analysis | The percentage of TB strains with unique genotypes collected from civilian patients was 50.4%, whereas among prison patients, it accounted for 31.7%. The discrepancy was found to be statistically significant (χ2 4.42, p = 0.035), suggesting a reduced genetic diversity of the TB strain isolates. There was a low genetic diversity of M. tuberculosis strains isolated from prison patients compared to civilian patients. |
Kaliakbarova et al. [27], Kazakhstan | Descriptive study | To evaluate the impacts of the patient support program on the rates of patient treatment non-adherence | Survey on Psychological and Social Support Provision n = 426 MDR-TB patients | Descriptive statistics | Not all TB patients in Kazakhstan have equal access to comprehensive patient support including medical and psychological and counseling, DOT support, social, legal advice, and provision of food packages. |
Lalor et al. [13], Uzbekistan | Retrospective cohort | To identify the factors associated with treatment default among patients with multi-drug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis who started treatment | Patient forms and registers n = 710 patients | Univariate analysis, multivariate analysis with logistic regression | The treatment rate increased as the TB treatment program expanded. Patients who had previously interrupted their treatment were more likely to experience adverse outcomes such as death. Health education and high-risk patients’ support, especially after the first 5 months of treatment, may help to reduce treatment default rates. |
Merker et al. [15], Uzbekistan | Cross-sectional Beijing; various MDR markers | To study the evolutionary history of M. tuberculosis lineage, chronological development of drug resistance, and MDR-TB complex isolates’ transmission networks | Collected M. tuberculosis isolates from Karakalpakstan, Uzbekistan n = 277 patients | Genome sequencing and Bayesian statistics | The genetic composition of MDR strains poses a significant challenge to the effectiveness of MDR-TB treatments, including the short MDR-TB regimen by the WHO. |
Mokrousov et al. [28], Kyrgyzstan | MDR population structure Beijing and non-Beijing genotypes; rpoB, katG315 and inhA promoter region | To evaluate the TB population structure and drug resistance within the civilian population | Culture and sensitivity n = 133 adult HIV-negative newly diagnosed pulmonary TB patients n = 103 M. tuberculosis isolates | Drug-resistance mutation analysis and spoligotyping | The primary families defined by spoligotyping were as follows: Beijing (with 62 isolates), T (with 14 isolates), LAM (with 9 isolates), Ural-2 (with 6 isolates), and Ural-1 (with 3 isolates). Genotypically, 20 isolates exhibited resistance to rifampicin (RIF), 28 displayed resistance to isoniazid (INH), and 17 were identified as having MDR. Then, the drug-resistant isolates were more prevalent in the Beijing group in comparison to the non-Beijing group (p = 0.03). Moreover, there was a higher occurrence of the Asia-specific Ural-2 type among individuals in the oldest age group (aged 68 to 85 years; p < 0.0001). |
Moe et al. [29], Uzbekistan | Retrospective study using programmatic approach | Assess prevalence and risk factors of second-line drug-resistant TB (SLDR-TB) in Karakalpakstan, Uzbekistan | Phenotypic drug susceptibility testing (pDST) data from 2019-2023 n = 2405 TB patients who underwent pDST | Multivariable logistic regression models (Allen-Cady approach) | SLDR-TB prevalence: 24%. Risk factors include rifampicin/isoniazid resistance, clofazimine exposure, retreatment status, DR-TB contact, and diabetes |
Safaev et al. [30], Uzbekistan | Retrospective observational approach | To record and analyze the trends, attributes, and results of MDR-TB treatment in patients who were enrolled in treatment programs | TB surveillance system that primarily relies on paper records. n = 2347 and 2653 MDR-TB patients from 2013 to 2018 | Descriptive analysis | The incidence of MDR-TB remained unstable between 2013 and 2018, ranging from 2347 to 2653 cases annually. In contrast, the annual number of extensively drug-resistant tuberculosis (XDR-TB) cases increased sharply from 33 to 433. The annual percentage of MDR-TB patients who successfully completed therapy has declined from 63% to 57% on a nationwide scale. In contrast, the XDR-TB treatment success rate showed a promising upward trend, rising from 24% to 57% annually. |
Skiba et al. [14], Kazakhstan | Cross-sectional Beijing 94-32, KAZ-1 | To determine the population configuration of the geographic distribution of Mycobacterium tuberculosis | Genotyping of M. tuberculosis isolates using 24-loci MIRU-VNTR complemented by spoligotyping n = 159 clinical isolates of M. tuberculosis | Genotyping by using 24-MIRU-VNTR and spoligotyping | The Beijing genotype M. tuberculosis, which is associated with MDR, clonal cluster 94-32, and other comparable types, demonstrated a robust MTB population structure, and further research revealed that a recently discovered cluster of viruses known as KAZ-1 may be endemic to the nation. The distribution of KAZ-1 across the nation, with the exception of the south, and the circulation of the NEW-1 family only in the southern region of Kazakhstan suggest a gradient tendency for non-Beijing families. Beijing dominant; KAZ-1 cluster possibly endemic. |
Terlikbayeva et al. [31], Kazakhstan | Descriptive study | To identify the significant risk factors of TB including MDR-TB. | Surveillance data from the NTP and the National Institute of Geography (NIG) years 2006–2010 | Correlational and descriptive analyses | The study findings revealed contrasting trends between tuberculosis cultures and drug susceptibility testing negatives (CNRs) and MDR-TB cases. Over the study period, there was a decrease in CNRs for tuberculosis, indicating a decline in individuals who tested negative for active TB. In contrast, there was an increase in MDR-TB cases, signifying an increase in tuberculosis strains resistant to multiple drugs. Notably, two specific types of oblasts, Atyrauskaya and Mangystauskaya, displayed significant deviations from the overall trend. These regions experienced substantial decreases in CNRs for TB incidents, indicating a reduction in individuals who tested negative for active TB. Simultaneously, they also observed comparatively large increases in CNRs for MDR-TB incidents, suggesting a notable increase in cases of tuberculosis strains resistant to multiple drugs. |
Tilloeva et al. [32], Tajikistan | Cross-sectional study Beijing; not specified | To measure the primary demographic groups within Tajikistan that constituted the new TB cases reported in the year 2017 | TB registration data for all new TB case notification n = 5182 | Descriptive analysis | This study identified several subpopulations among newly reported tuberculosis (TB) cases in Tajikistan in 2017. These subpopulations included migrant workers (728 cases, 70.7%), individuals with diabetes (162 cases, 15.7%), HIV-positive individuals (138 cases, 13.4%), heavy drinkers (74 cases, 7.2%), drug users (50 cases, 4.8%), ex-prisoners (50 cases, 4.8%), and homeless individuals (9 cases, 0.9%). Among these key populations, 307 patients (29.8%) had smear-positive TB, 145 patients (14.1%) had drug-sensitive TB, and 116 patients (11.3%) had MonoDR/MDR-TB. The majority of smear-positive cases (303 patients, 98.7%) initiated treatment within five days. |
Ulmasova et al. [5], Uzbekistan | Nationwide survey | To establish the frequency of MDR-TB among TB patients | Survey questionnaire n = 1037 patients | Meta-analysis | Several factors were significantly linked to MDR-TB such as being 45 years of age and below (adjusted odds ratio: 2.24; 95% CI: 1.45–3.45), incarceration history (1.93; 95% CI: 1.01–3.70), previous treatment (4.45; 95% CI: 2.66–7.43), and homelessness (1.79; 95% CI: 1.01–3.16). |
Usmanova et al. [9], Uzbekistan | Cohort study | To assess the application of treatment regimens for MDR and rifampicin-resistant (RR)-TB | Survey questionnaire n = 1481 patients | Log-binomial regression, adjusted risk ratios | Standardized regimen utilization showed a significant increasing trend, from 2% in 2012 to 44% in 2018. Compliance with weight-based drug dosages was observed in 85% of the patients during the intensive phase and 84% during the continuation phase. Approximately 42% of the patients had a prolonged intensive phase. Treatment modifications were made in 44% of the patients during the intensive phase and 34% during the continuation phase. The documentation of treatment document changes was initially suboptimal, ranging from 42% to 75% from 2012 to 2014 but significantly improved in later years, ranging from 86% to 100%. |
Van den Hof et al. [33], Kazakhstan (others) | Cross-sectional survey | To measure the financial expenses incurred by patients with MDR-TB | Survey questionnaire and structured interviews n = 406 MDR-TB patients | Descriptive analysis | The approximate overall cost for patients with TB amounted to USD 929. The financial burden was further intensified by income reduction, ranging from 38% to 92% of TB patients reporting a decline in earnings and job loss due to the illness. |
van Kampen et al. [8], Kazakhstan | Descriptive study | To measure the effectiveness of Xpert as compared to traditional diagnostic techniques in detecting rifampicin-resistant tuberculosis (RR-TB) cases across different risk groups | Smear microscopy, solid media culture n = 5611 Xpert MTB/RIF | Descriptive analysis | A total of 5611 Xpert tests were conducted, primarily focusing on who had been in contact with MDR-TB patients, those categorized as “other” presumptive MDR-TB cases, and patients undergoing retreatment (accounting for 26%, 24%, and 22% of the tests, respectively). The Xpert test demonstrated a positive predictive value of 93.1% and 96.4% for detecting rifampicin-resistant TB (RR-TB), while the negative predictive value was 94.6% and 92.7% using solid and liquid culture media. |
2.1. Theme 1: Genetic Variability and Resistance Patterns of MDR-TB Strains
2.2. Theme 2: Barriers to Effective Treatment
2.3. Theme 3: Diagnostic Tools
2.4. Theme 4: Infection Control Strategies
3. Discussion
4. Materials and Methods
4.1. Inclusion and Exclusion Criteria
- Focused on MDR-TB in at least one Central Asian country;
- Employed empirical research methodologies, including quantitative, qualitative, mixed-methods, randomized controlled trials (RCTs), retrospective cohort studies, or observational studies;
- Peer-reviewed and published in English.
- Focused on drug-resistant TB in regions outside of Central Asia;
- Did not present original research data (e.g., reviews, editorials, opinion papers, or discussion-only frameworks);
- Were published as conference abstracts, book chapters, dissertations, or unpublished theses;
- Did not address at least one of the specified review themes.
4.2. Search Strategy
4.3. Study Selection
- Title and abstract screening: Two independent reviewers screened 12,584 titles and 8115 abstracts.
- Full-text review: Selected articles underwent full-text evaluation based on eligibility criteria.
- Final inclusion: 29 articles met the criteria.
4.4. Software and Equipment
4.5. Quality Assessment and Synthesis
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Country | Challenges and Barriers | Molecular Diagnostic Tools | Strategies for Infection Control and Treatment Approaches |
---|---|---|---|
Kazakhstan [11,14,20,25,29,31] | Rural underuse; cartridge shortages; training gaps High out-of-pocket costs (avg. USD 900); 92% report income loss; limited psychosocial support [29,31,33] | GeneXpert, LPA, WGS | Implementation of N95 masks, UVGI, HEPA filtration, and negative-pressure isolation rooms in major hospitals. Adoption of WHO-recommended all-oral MDR-TB regimens. Integration of DST and GeneXpert MTB/RIF for early detection [2,11,12,19,24,29,31,33]. |
Tajikistan [16,19,22] | Stockouts; poor maintenance; uneven rural coverage Delayed diagnosis from informal provider use; weak public–private linkage; stigma; diagnostic infrastructure gaps | GeneXpert | Hospital-based protocols involving isolation practices and ventilation improvements. Integration of TB-HIV care with ART. Progressive scale-up of oral treatment regimens per WHO guidelines [13,16,19,24,29,30,31]. |
Kyrgyzstan [10,22,28] | Limited sequencing capacity; ongoing phenotypic DST reliance. Continued use of conventional diagnostics; limited lab and HR capacity; inadequate staffing; disrupted supply chains | GeneXpert, LPA | GeneXpert introduction in central facilities. Airborne infection prevention via improved infrastructure and staff training. DOTS continuation with tailored second-line treatment [8,19,22,28]. |
Uzbekistan [6,9,13,23,30,31] [9,10,31] | Widespread reliance on phenotypic DST in remote regions Limited access to TB centers in rural areas; 24% SLDR-TB among RR-TB patients; reliance on phenotypic DST Stigma; treatment misconceptions; low health literacy | GeneXpert, LPA, limited WGS | Expansion of molecular diagnostics (GeneXpert, WGS), facility-based infection control (ventilation, PPE), and DOTS strategy reinforcement. Use of all-oral treatment with second-line agents like bedaquiline and linezolid [8,10,11,12,19,31]. |
Turkmenistan [6,7] | Diagnostic capacity likely limited; Beijing strains reported only | Unclear; likely phenotypic DST No recent data published; gaps remain undocumented | Basic infection control strategies reported. Beijing strain monitoring ongoing. Limited but increasing alignment with WHO recommendations on diagnostics and treatment regimens [7,19]. |
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Kozhamkulov, U.; Iglikova, S.; Rakisheva, A.; Almazan, J. Multidrug-Resistant Tuberculosis in Central Asia and Predominant Beijing Lineage, Challenges in Diagnosis, Treatment Barriers, and Infection Control Strategies: An Integrative Review. Antibiotics 2025, 14, 673. https://doi.org/10.3390/antibiotics14070673
Kozhamkulov U, Iglikova S, Rakisheva A, Almazan J. Multidrug-Resistant Tuberculosis in Central Asia and Predominant Beijing Lineage, Challenges in Diagnosis, Treatment Barriers, and Infection Control Strategies: An Integrative Review. Antibiotics. 2025; 14(7):673. https://doi.org/10.3390/antibiotics14070673
Chicago/Turabian StyleKozhamkulov, Ulan, Sholpan Iglikova, Anar Rakisheva, and Joseph Almazan. 2025. "Multidrug-Resistant Tuberculosis in Central Asia and Predominant Beijing Lineage, Challenges in Diagnosis, Treatment Barriers, and Infection Control Strategies: An Integrative Review" Antibiotics 14, no. 7: 673. https://doi.org/10.3390/antibiotics14070673
APA StyleKozhamkulov, U., Iglikova, S., Rakisheva, A., & Almazan, J. (2025). Multidrug-Resistant Tuberculosis in Central Asia and Predominant Beijing Lineage, Challenges in Diagnosis, Treatment Barriers, and Infection Control Strategies: An Integrative Review. Antibiotics, 14(7), 673. https://doi.org/10.3390/antibiotics14070673