High genetic diversity among Mycobacterium tuberculosis complex strains from Sierra Leone

Susanne Homolka¹ , Erik Post² , Barbara Oberhauser² , Abu Garawani George³ , Lars Westman³ , Foday Dafae⁴ , Sabine Rüsch-Gerdes¹ and Stefan Niemann¹

¹National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany

²German Leprosy and TB Relief Association, Würzburg, Germany

³National Leprosy/TB Reference Laboratory, Freetown, Sierra Leone

⁴National Program Manager for Tuberculosis and Leprosy, Freetown, Sierra Leone

author email corresponding author email

BMC Microbiology 2008, 8:103doi:10.1186/1471-2180-8-103


Published:	25 June 2008

Abstract

Background

Among tuberculosis (TB) high incidence regions, Sub-Saharan Africa is particularly affected with approx. 1.6 million new cases every year. Besides this dramatic situation, data on the diversity of Mycobacterium tuberculosis complex (MTBC) strains causing this epidemic in this area are only sparsely available. Here we analyzed the population structure of strains from Sierra Leone with a special focus on the prevalence of M. africanum.

Results

A total of 97 strains isolated from smear positive cases registered for re-treatment in the Western Area and Kenema districts in years 2003/2004 were investigated by susceptibility testing (first line drugs) and molecular typing (IS6110 fingerprinting, spoligotyping, and MIRU-VNTR typing).

Among the strains analyzed, 32 were resistant to isoniazid, and 11 were multidrug resistant (at least resistant to isoniazid and rifampin). The population diversity was high with two previously described M. africanum lineages (West African-1, n = 6; West African-2, n = 17) and seven M. tuberculosis lineages (Haarlem, n = 14; LAM, n = 15; EAI, n = 4; Beijing, n = 4; S-type, n = 4, X-type, n = 1; Cameroon, n = 4). Furthermore, two new M. tuberculosis genotypes Sierra Leone-1 (n = 7) and -2 (n = 10) were found. Strain classification according to a 7 bp deletion in pks1/15 revealed that the majority of M. tuberculosis strains belonged to the Euro American lineage (66 out of 74).

Conclusion

Resistance rates in Sierra Leone have reached an alarming level. The population structure of MTBC strains shows an intriguing diversity raising the question of possible consequences for TB epidemic and for the introduction of new diagnostic tests or treatment strategies in West Africa.