The Open Microbiology Journal




ISSN: 1874-2858 ― Volume 13, 2019

Susceptibility Pattern and Epidemiology of Mycobacterium tuberculosis in United Emirati Hospital



Mubarak Saif Alfaresi*, Mohammed Hag-Ali
Department of Pathology & Laboratory Medicine, Zayed Military Hospital, Abu Dhabi, UAE

Abstract

Objective:

Human tuberculosis (TB) has re-emerged at an alarming rate as one of the deadliest contagious diseases; not only in the developing world, but also in the developed countries. Its re-emergence indicates failure to control its transmission. What causes part of the alarm is the growing number of isolates displaying resistance to the first line drugs used in its control. The very high volume of travel to the United Arab Emirates (UAE) is yet another reason for concern over the spread of the disease. This study reports on the pattern of multiple drug (MDR) resistance exhibited by Mycobacterium tuberculosis (MTB) isolates from a major hospital in the UAE.

Methods:

All pulmonary and extrapulmonary tuberculosis patients with positive culture results from January 2001 to December 2008 were included in the study. Cultures were performed at the mycobacteriology laboratory of the Emirati Hospital, Abu Dhabi, UAE, using the conventional Lewes-Johnson media. M. tuberculosis was isolated by standard procedures. M. tuberculosis complex was identified by conventional biochemical tests. Anti-mycobacterial sensitivity testing was done by the disk method as described by Wayne & Krasnow.

Results:

From 2002 to 2008, 43 nonrepetitive culture-positive cases were identified. The resistance rates of M. tuberculosis to tested first-line agents were as follows: isoniazid, 34.5%; pyrazinamide, 34.8%; rifampin, 32.5%; streptomycin, 25.6%; and ethambutol, 20.9%. The resistance rate to isoniazid, rifampin and pyrazinamide was 7%; to isoniazid, rifampin and streptomycin was 2.3%; and to isoniazid, rifampin, streptomycin and pyrazinamide was 2.3%. The resistance rate to all the five agents together was 4.6%.

Conclusion:

This study is the first in the UAE to report such high levels of resistance to anti-TB drugs; 27.7% for anti-tuberculosis Drugs such as isoniazid and pyrazinamide are of great significance to achieve proper treatment in M. tuberculosis infections in future. Indeed, isoniazid and rifampicin are important components of any regimen for the treatment of drug susceptible TB.

Keywords: MDR, United Arab Emirates, tuberculosis, resistance.


Article Information


Identifiers and Pagination:

Year: 2010
Volume: 4
First Page: 1
Last Page: 4
Publisher Id: TOMICROJ-4-1
DOI: 10.2174/1874285801004010001

Article History:

Received Date: 29/1/2010
Revision Received Date: 5/2/2010
Acceptance Date: 8/2/2010
Electronic publication date: 8/3/2010
Collection year: 2010

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 810
Abstract HTML Views: 672
PDF Downloads: 204
Total Views/Downloads: 1686

Unique Statistics:

Full-Text HTML Views: 525
Abstract HTML Views: 412
PDF Downloads: 129
Total Views/Downloads: 1066
Geographical View

© Alfaresi and Hag-Ali.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/),which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Department of Pathology &Laboratory Medicine, Zayed Military Hospital, Abu Dhabi, UAE; Tel: +9712-4055489; Fax: +9712-4492075; E-mail: uaenow@eim.ae




INTRODUCTION

Human tuberculosis (TB) continues to be the deadliest contagious infectious disease. It is estimated that one third of the world population is infected with the aerobic pathogenic bacterium, Mycobacterium tuberculosis, which usually establishes its infection in the lungs. TB is transmitted mainly by inhalation of infectious droplets produced during coughing, sneezing, laughing or shouting, by persons with pulmonary or laryngeal disease. The TB bacilli invade the body through mucous membrane and/or damaged skin [1Alfaresi MS, Abdulsalam AI, Elkoush A. Comparison of the automated Cobas Amplicor Mycobacterium tuberculosis assay with the conventional methods for direct detection of Mycobacterium tuberculosis complex in respiratory and extrapulmonary specimens Saudi Med J 2006; 27(9): 1346-51.].

The impact of tuberculosis (TB) on global health has grasped the international attention after the increase in the number of cases worldwide, including the developed countries [2Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis, morbidity and mortality of a worldwide epidemic JAMA 1995; 273: 220-6.].There are approximately 10 million new cases and three million deaths annually throughout the world. More than 90% of the cases occur in developing countries. In 1993, TB was declared by the WHO as a global public health emergency [1Alfaresi MS, Abdulsalam AI, Elkoush A. Comparison of the automated Cobas Amplicor Mycobacterium tuberculosis assay with the conventional methods for direct detection of Mycobacterium tuberculosis complex in respiratory and extrapulmonary specimens Saudi Med J 2006; 27(9): 1346-51.].

The number of cases of tuberculosis showed an initial decline in the United States from 84,304 in 1953 to 22,201 in 1985. The number of reported cases of tuberculosis in the United States increased in 1992 by 18% [3Cantwell MF, Snider DE Jr, Cauthen G, Onorato IM. Epidemiology of tuberculosis in the United States, 1985 through 1992 JAMA 1994; 272: 535-9.]. The reversal of the downward trend was due to multiple factors, including the AIDS epidemic and the emergence of drug resistance.

Treatment consists of a combination from the six essential anti-TB drugs, namely; isoniazid, rifampicin, pyrazinamide, streptomycin, ethambutol and thioacetazone. Strains of M. tuberculosis resistant to chemotherapeutic agents have been recovered with increasing frequency [2Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis, morbidity and mortality of a worldwide epidemic JAMA 1995; 273: 220-6.].

Control measures and program implementation had several obstacles that limited their targeted achievements [4Raviglione MC, Dye C, Schmidt S, Kochi A. Assessment of worldwide tuberculosis control. WHO Global Surveillance and Monitoring Project Lancet 1997; 350: 624-9.]. Complicating the matters more, the resurgence of TB in many areas was also associated with increasing rates of drug resistant Mycobacterium tuberculosis (M. tuberculosis). Multidrug-resistant tuberculosis (MDR-TB) is associated with higher rates of failure and death than in drug-susceptible TB [3Cantwell MF, Snider DE Jr, Cauthen G, Onorato IM. Epidemiology of tuberculosis in the United States, 1985 through 1992 JAMA 1994; 272: 535-9.] and it is more difficult and expensive to treat [2Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis, morbidity and mortality of a worldwide epidemic JAMA 1995; 273: 220-6.]. A survey on global anti-TB drug resistance was conducted by the World Health Organization (WHO) and the International Union against Tuberculosis and Lung Disease (IUATLD); the released report indicated that the data obtained represent all geographical areas of the world except the Eastern Mediterranean Region [5Anti-tuberculosis Drug Resistance in the World The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance Geneva: World Health Organization (WHO) 1994-1997 51.]. United Arab emirates (UAE) is one of the countries in this region. It receives millions of visitors a year for commerce and work purposes. No information was reported on the pattern of MDR resistance. Thus, we undertook this study to evaluate the prevalence and trends of resistance of M. tuberculosis in a major hospital in the United Arab Emirates.

MATERIALS AND METHODS

All pulmonary and extrapulmonary tuberculosis patients with positive culture results from January 2001 to December 2008 were included in the study. The medical records were reviewed for the age, sex, nationality, and the site of the culture.Cultures were performed at the mycobacteriology laboratory of the Emirati Hospital, Abu Dhabi, UAE, using the conventional Lowwenstein-Johnson media [6US Department of Health and Human Services. Public health mycobacteriology: a guide for the level III laboratory Washington DC: US Government Printing Office 1985; 71-120.]. M. tuberculosis was isolated by standard procedures [6US Department of Health and Human Services. Public health mycobacteriology: a guide for the level III laboratory Washington DC: US Government Printing Office 1985; 71-120.]. M. tuberculosis complex was identified by conventional biochemical tests. Anti-mycobacterial sensitivity testing was done by the disk method as described by Wayne & Krasnow [7Wayne LG, Krasnow I. Preparation of tuberculosis susceptibility testing media by impregnated discs Am J Pathol 1996; 45: 769-1.]. Although this is a retrospective study, quality control was usually performed during susceptibility testing using the reference strain provided by the College of American Pathologists. The concentrations of the drugs used were as follows: isoniazid, 1 µg/mL and 5 µg/mL; rifampin, 5 µg/mL; streptomycin, 10 µg/mL; and ethambutol, 25 µg/mL. The tested isolate was considered resistant if the proportion of the tested isolate was > 1% of the control population. Drug-resistant tuberculosis was calculated for single first-line agents. Multidrug-resistant M. tuberculosis (MDR-TB) was defined as resistance to two or more first-line drugs.

RESULT

From 2002 to 2008, a total of 37 distinct positive culture findings for M. tuberculosis were identified. The annual incidence rates per 100,000 outpatient population are shown in Fig. (1) and Table 1. The incidence in 2002 was 0.64/100,000, increased to 1.22/100,000 in 2004 and reached 1.29/100,000 in 2008. An increasing trend in incidence rates of culture-positive tuberculosis was observed during the study period. This was not stastistically significant (P=0.064).

Fig.(1)

Line graph showing the annual incidence of culture-positive tuberculosis from 2002 to 2008.



Table 1.

Incidence / 100,000 Outpatient Population of M. tuberculosis




Table 2.

Rates of Resistance of M. tuberculosis to Single First-Line Medications




Table 3.

Rates of Resistance of M. tuberculosis to two or More First-Line Medications




Of the total patients, there were 33 Emirati (76.7%), and the remaining 10 patients (23.3%) were non-Emirati. Of the total patients, 34 were male (79%) and 9 were female (21%). The isolates were obtained from pulmonary specimens (n= 30, 69.7%) and the extrapulmonary sites (n= 13, 30.3%). The majority of the extrapulmoary isolates were obtained from abscesses.

Resistance to Single Antituberculsis Medication

The resistance rate of M. tuberculosis to any single drug was 23% (n=10) (Table 1). The resistance rate of M. tuberculosis to the tested first-line agents were as follows: Isoniazid, 34.8%; ethambutol, 20.9% (n=9); streptomycin, 25.6 (n=11); rifampin, 32.5% (n=14); and pyrazinamide, 34.8% (n=15). The rates are shown in Table 2. There was no statistical difference in the rate of resistance between Emirati and non-Emirati patients. In addition, there was no difference in the rate of resistance between pulmonary and extrapulmonary isolates.

MDR-TB

MDR-TB was defined as resistance to two or more first-line agents. The rates of MDR-TB are shown in Table 3. The resistance rate for any combination of MDR was 16.2% (n=7). The resistance rate to isoniazid , rifampin and pyrazinamide was 7%(n=3), to isoniazid , rifampin and streptomycin was 2.3%(n=1), and to isoniazid, rifampin, streptomycin and pyrazinamide was 2.3%(n=1). The resistance rate to all the five agents together was 4.6%(n=2).

DISCUSSION

Tuberculosis continues to be a major concern for health-care workers throughout the world. The numbers of tuberculosis cases have declined steadily in western and central Europe, North and South America, and the Middle East, and have increased in countries of the former Soviet Union and in sub-Saharan Africa [8World Health Organization. Global tuberculosis control: surveillance, planning, financing; WHO report 2003 Geneva, Switzerland: World Health Organization 2003; 316.]. In the United States, there were a total of 14,871 tuberculosis cases (5.1/100,000 population) during 2003, representing a 1.9% decline in the rate from 2002 [9Trends in tuberculosis, United States, 1998-2003 MMWR Morb Mortal Wkly Rep 2004; 53: 209-14.]; however, tuberculosis rates have increased in certain states in the United States [9Trends in tuberculosis, United States, 1998-2003 MMWR Morb Mortal Wkly Rep 2004; 53: 209-14.].

The incidence of smear-positive tuberculosis in Saudi Arabia was estimated to be 20 per 100,000 populations [10Global tuberculosis control: WHO reports 1996-2002 Available at: www.emro.who.int/stb/TBSituation-CountryProfilesaa.htm [[Accessed Aug 1, 2009]];]. The incidence of smear-positive tuberculosis in The United Arab emirates was estimated to be 20 per 100,000 populations [10Global tuberculosis control: WHO reports 1996-2002 Available at: www.emro.who.int/stb/TBSituation-CountryProfilesaa.htm [[Accessed Aug 1, 2009]];]. The incidence rates of culture-positive tuberculosis in our study per 100,000 populations were 0.64 in 2002, 1.22 in 2004, and 1.29 in 2008. Thus, the incidence of tuberculosis in the current study showed an increasing linear trend over the study period from 2002 to 2008; however it was not statistically significant (p=0.064).

The prevalence of drug resistance of tuberculosis varies from one part of the world to another. In the United States, drug-resistant tuberculosis was detected in 14.2% in 1991 [10Global tuberculosis control: WHO reports 1996-2002 Available at: www.emro.who.int/stb/TBSituation-CountryProfilesaa.htm [[Accessed Aug 1, 2009]];] and 10% in 1997 [11Bloch AB, Cauthen GM, Onorato IM. Nationwide survey of drug-resistant tuberculosis in the United States JAMA 1994; 271: 665-71.]. In the United States, isoniazid resistance was the most prevalent and accounted for 8% [12Espinal MA, Laszlo A, Simonsen L. Global trends in resistance to antituberculosis drugs: world health organization-international union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance N Engl J Med 2001; 344: 1294-303.]. Isoniazid resistance has ranged from 0% in New Caledonia to 7.9% in Mozambique [12Espinal MA, Laszlo A, Simonsen L. Global trends in resistance to antituberculosis drugs: world health organization-international union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance N Engl J Med 2001; 344: 1294-303.], and is 10% in India [13Pereira M, Tripathy S, Inamdar V. Drug resistance pattern of Mycobacterium tuberculosis in seropositive and seronegative HIV-TB patients in Pune, India Indian J Med Res 2005; 121: 235-9.]. In Saudi Arabia, isoniazed resistance was the most prevalent and it varied from one part of the country to another. The highest rate (41%) was observed in Gizan [14Zaman R. Tuberculosis in Saudi Arabia: initial and secondary drug resistance among indigenous and non-indigenous populations Tubercle 1991; 72: 51-.-16Khan MY, Kinsara AG, Osoba AO. Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia Int J Antimicrob Agents Chemother 2001; 17: 415-8.].

In the current study, isoniazid and pyrazinamide resistance was 34.7% each. The second most common resistance pattern in our study was found in rifampin (32.5). A high rate of rifampin resistance was reported from Riyadh-KSA (9%) [17Al-Orainey IO. Resistance to antituberculosis drugs in Riyadh, Saudi Arabia Tubercle 1989; 70: 207-10., 18Shanks NJ, Khalifa I, Al-Kalai D. Tuberculosis in Saudi Arabia Saudi Med J 1983; 4: 151-6.]. In other parts of the world, the prevalence of rifampin resistance was 0% in New Zealand and New Caledonia, 1.7% in the United States, and 1.8% in Mozambique [12Espinal MA, Laszlo A, Simonsen L. Global trends in resistance to antituberculosis drugs: world health organization-international union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance N Engl J Med 2001; 344: 1294-303.].

In our study, the rate of resistance of M. tuberculosis to streptomycin was 25.6%. Similarly, in a study from Jeddah-KSA, streptomycin resistance was 22.7% [16Khan MY, Kinsara AG, Osoba AO. Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia Int J Antimicrob Agents Chemother 2001; 17: 415-8.]. The rates were 14.5% in Sierra Leone and 6.6% in India.

The resistance rate to ethambutol was 20.9% in our study. This is much higher than other reports worldwide. A high rate of ethambutol resistance was observed in Uganda (2.4%) and Thailand (3%). In a study from India, the rate of ethambutol resistance was 6.6%.

The rate of MDR-TB in our study was high. The highest rate of resistance was to isoniazid, rifampin and pyrazinamide (7%). The prevalence of MDR-TB among new cases of tuberculosis was 44% Gizan-KSA, 14% in Estonia, 10.8% in Henan Province in China, 9% in Latvia, 9% in Ivanovo Province in Russia, 5% in Iran, and 4.5% in Zhejiang Province in China [11Bloch AB, Cauthen GM, Onorato IM. Nationwide survey of drug-resistant tuberculosis in the United States JAMA 1994; 271: 665-71.].

The importance of knowing susceptibility results for M. tuberculosis became more significant especially in our region of the world, because of the increase in resistance rates, high travel activity of hosts and the limited available agents. Appreciating the importance of documenting the susceptibility findings of M. tuberculosis, the WHO has inaugurated a worldwide program for surveillance [6US Department of Health and Human Services. Public health mycobacteriology: a guide for the level III laboratory Washington DC: US Government Printing Office 1985; 71-120.].

Multi-drug-resistant M. tuberculosis (MDR-TB) as defined by Centers for Diseases Control and Prevention, the World Health Organization, and the International Union against Tuberculosis and Lung Disease is resistance to at least isoniazid and rifampin with or without resistance to other agents [9Trends in tuberculosis, United States, 1998-2003 MMWR Morb Mortal Wkly Rep 2004; 53: 209-14.-10Global tuberculosis control: WHO reports 1996-2002 Available at: www.emro.who.int/stb/TBSituation-CountryProfilesaa.htm [[Accessed Aug 1, 2009]];]. First-line agents are isoniazid, rifampin, streptomycin, ethambutol, and pyrazinamide. We have adopted the definitions recommended by WHO and IUATLD for anti-TB drug resistance surveillance [11Bloch AB, Cauthen GM, Onorato IM. Nationwide survey of drug-resistant tuberculosis in the United States JAMA 1994; 271: 665-71.].

We are well aware of the limitations of meta-analysis as an evidence-based approach in the field of infectious diseases [12Espinal MA, Laszlo A, Simonsen L. Global trends in resistance to antituberculosis drugs: world health organization-international union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance N Engl J Med 2001; 344: 1294-303.]. It was indicated that there was only one report on M. tuberculosis susceptibility from Saudi Arabia [13Pereira M, Tripathy S, Inamdar V. Drug resistance pattern of Mycobacterium tuberculosis in seropositive and seronegative HIV-TB patients in Pune, India Indian J Med Res 2005; 121: 235-9.]. In fact, Al-Jama et al. [19Al-Jama AA, Borgio FG, Al-Qatari KM. Patterns of resistance to antituberculous drugs in Eastern Province, Saudi Arabia Saudi Med J 1999; 20: 927-30.] also reported on the susceptibility of isolates of M. tuberculosis from the Eastern province in 1999.

This study is the first in the UAE to report such high levels of resistance to anti TB drugs; 21% for Anti tuberculosis Drugs such as isoniazid and pyrazinamide are of great significance to achieve proper treatment in M. tuberculosis infections in future. Indeed, isoniazid and rifampicin are important components of any regimen for the treatment of drug susceptible TB. Resistance to those two agents, by definition, indicates MDR-TB [20Espinal MA. The global situation of MDR-TB Tuberculosis 2003; 83: 44-51.]. This definition marks the threshold for grave consequences of resistance to those agents in TB treatment [21Crofton J, Chaulet P, Maher D. Guidelines for the management of drug-resistant tuberculosis. 1st. Geneva, Switzerland: World Health Organization 1997 1997.].

In conclusion, in this study we examined the pattern and incidence of resistance of tuberculosis to first-line agents over time. The resistance rate to isoniazid and pyrazinamide showed a significant decline over the study period, whereas the resistance rate of ethambutol remained low and stable. Further studies and continued surveillance of the resistance pattern of M. tuberculosis is needed to further delineate the risk factors and to formulate the plans for the future management of tuberculosis.

ABBREVIATION

MDR-TB = Multidrug-resistance Mycobacterium tuberculosis

REFERENCES

[1] Alfaresi MS, Abdulsalam AI, Elkoush A. Comparison of the automated Cobas Amplicor Mycobacterium tuberculosis assay with the conventional methods for direct detection of Mycobacterium tuberculosis complex in respiratory and extrapulmonary specimens Saudi Med J 2006; 27(9): 1346-51.
[2] Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis, morbidity and mortality of a worldwide epidemic JAMA 1995; 273: 220-6.
[3] Cantwell MF, Snider DE Jr, Cauthen G, Onorato IM. Epidemiology of tuberculosis in the United States, 1985 through 1992 JAMA 1994; 272: 535-9.
[4] Raviglione MC, Dye C, Schmidt S, Kochi A. Assessment of worldwide tuberculosis control. WHO Global Surveillance and Monitoring Project Lancet 1997; 350: 624-9.
[5] Anti-tuberculosis Drug Resistance in the World The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance Geneva: World Health Organization (WHO) 1994-1997 51.
[6] US Department of Health and Human Services. Public health mycobacteriology: a guide for the level III laboratory Washington DC: US Government Printing Office 1985; 71-120.
[7] Wayne LG, Krasnow I. Preparation of tuberculosis susceptibility testing media by impregnated discs Am J Pathol 1996; 45: 769-1.
[8] World Health Organization. Global tuberculosis control: surveillance, planning, financing; WHO report 2003 Geneva, Switzerland: World Health Organization 2003; 316.
[9] Trends in tuberculosis, United States, 1998-2003 MMWR Morb Mortal Wkly Rep 2004; 53: 209-14.
[10] Global tuberculosis control: WHO reports 1996-2002 Available at: www.emro.who.int/stb/TBSituation-CountryProfilesaa.htm [[Accessed Aug 1, 2009]];
[11] Bloch AB, Cauthen GM, Onorato IM. Nationwide survey of drug-resistant tuberculosis in the United States JAMA 1994; 271: 665-71.
[12] Espinal MA, Laszlo A, Simonsen L. Global trends in resistance to antituberculosis drugs: world health organization-international union against tuberculosis and lung disease working group on anti-tuberculosis drug resistance surveillance N Engl J Med 2001; 344: 1294-303.
[13] Pereira M, Tripathy S, Inamdar V. Drug resistance pattern of Mycobacterium tuberculosis in seropositive and seronegative HIV-TB patients in Pune, India Indian J Med Res 2005; 121: 235-9.
[14] Zaman R. Tuberculosis in Saudi Arabia: initial and secondary drug resistance among indigenous and non-indigenous populations Tubercle 1991; 72: 51-.
[15] Kinsara AJ. Review of non-tuberculous mycobacteria: King Khalid National Guard Hospital, Jeddah, Saudi Arabia Saudi Med J 1997; 19: 212-4.
[16] Khan MY, Kinsara AG, Osoba AO. Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia Int J Antimicrob Agents Chemother 2001; 17: 415-8.
[17] Al-Orainey IO. Resistance to antituberculosis drugs in Riyadh, Saudi Arabia Tubercle 1989; 70: 207-10.
[18] Shanks NJ, Khalifa I, Al-Kalai D. Tuberculosis in Saudi Arabia Saudi Med J 1983; 4: 151-6.
[19] Al-Jama AA, Borgio FG, Al-Qatari KM. Patterns of resistance to antituberculous drugs in Eastern Province, Saudi Arabia Saudi Med J 1999; 20: 927-30.
[20] Espinal MA. The global situation of MDR-TB Tuberculosis 2003; 83: 44-51.
[21] Crofton J, Chaulet P, Maher D. Guidelines for the management of drug-resistant tuberculosis. 1st. Geneva, Switzerland: World Health Organization 1997 1997.

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open