Abstract
In recent years Bamako has been faced with an emerging threat from multidrug resistant TB (MDR-TB). Whole genome sequence analysis was performed on a subset of 76 isolates from a total of 208 isolates recovered from tuberculosis patients in Bamako, Mali between 2006 and 2012. Among the 76 patients, 61(80.3%) new cases and 15(19.7%) retreatment cases, 12 (16%) were infected by MDR-TB. The dominant lineage was the Euro-American lineage, Lineage 4. Within Lineage 4, the Cameroon genotype was the most prevalent genotype (n = 20, 26%), followed by the Ghana genotype (n = 16, 21%). A sub-clade of the Cameroon genotype, which emerged ~22 years ago was likely to be involved in community transmission. A sub-clade of the Ghana genotype that arose approximately 30 years ago was an important cause of MDR-TB in Bamako. The Ghana genotype isolates appeared more likely to be MDR than other genotypes after controlling for treatment history. We identified a clade of four related Beijing isolates that included one MDR-TB isolate. It is a major concern to find the Cameroon and Ghana genotypes involved in community transmission and MDR-TB respectively. The presence of the Beijing genotype in Bamako remains worrying, given its high transmissibility and virulence.
Highlights
In recent years Bamako has been faced with an emerging threat from multidrug resistant TB (MDR-TB)
Tuberculosis is caused by members of the Mycobacterium tuberculosis complex (MTBC)
Our study employs whole genome sequencing to study the evolutionary mechanisms driving the rise of multidrug resistance (MDR)-TB in Mali in recent times and the emergence of virulent lineages of MTBC using a subset of isolates reported in Gehre et al (25)
Summary
In recent years Bamako has been faced with an emerging threat from multidrug resistant TB (MDR-TB). A sub-clade of the Cameroon genotype, which emerged ~22 years ago was likely to be involved in community transmission. A sub-clade of the Ghana genotype that arose approximately 30 years ago was an important cause of MDR-TB in Bamako. It is a major concern to find the Cameroon and Ghana genotypes involved in community transmission and MDR-TB respectively. The East Asian, East-African-Indian and Euro-American lineages (Lineages 2,3 and 4 respectively) form the “modern” clade of tuberculosis[5]. The East Asian (including the Beijing genotype) and Euro-American lineages are the most widespread lineages globally and are probably more virulent than other lineages of the MTBC6. The Euro-American (Lineage 4) and the two M. africanum lineages (Lineages 5 and 6) are the most common causes of human pulmonary TB in West Africa[9]. The survey showed that the estimated prevalence of MDR-TB in West Africa was likely being underestimated and called for urgent measure to tackle the growing threat from MDR-TB in West Africa, one of the poorest regions in the world[20]
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