Genomic epidemiological analysis identifies high relapse among individuals with recurring tuberculosis and provides evidence of recent household-related transmission of tuberculosis in Ghana

•Unresolved previous infection as major cause of recurring tuberculosis (TB) in Ghana.•Genomic epidemiology identifies high relapse among recurrent TB cases in Ghana.•15-locus MIRU-VNTR typing is sufficient to predict the cause of TB recurrence.•Evidence of recent household-related TB transmission i...

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Bibliographic Details
Published in:International journal of infectious diseases 2021-05, Vol.106, p.13-22
Main Authors: Asare, Prince, Osei-Wusu, Stephen, Baddoo, Nyonuku Akosua, Bedeley, Edmund, Otchere, Isaac Darko, Brites, Daniela, Loiseau, Chloé, Asante-Poku, Adwoa, Prah, Diana Ahu, Borrell, Sonia, Reinhard, Miriam, Omari, Michael Amo, Forson, Audrey, Koram, Kwadwo Ansah, Gagneux, Sebastien, Yeboah-Manu, Dorothy
Format: Article
Language:English
Subjects:
Molecular epidemiology
Mycobacterium africanum
Mycobacterium tuberculosis
Relapse
Tuberculosis
Whole-genome sequencing
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Summary:•Unresolved previous infection as major cause of recurring tuberculosis (TB) in Ghana.•Genomic epidemiology identifies high relapse among recurrent TB cases in Ghana.•15-locus MIRU-VNTR typing is sufficient to predict the cause of TB recurrence.•Evidence of recent household-related TB transmission in Ghana.•Need for increased education by national TB control program. To retrospectively investigate the cause of recurring tuberculosis (rcTB) among participants with pulmonary TB recruited from a prospective population-based study conducted between July 2012 and December 2015. Mycobacterium tuberculosis complex isolates obtained from rcTB cases were characterized by standard mycobacterial genotyping tools, whole-genome sequencing, and phylogenetic analysis carried out to assess strain relatedness. The majority (58.3%, 21/36) of study participants with rcTB episodes had TB recurrence within 12 months post treatment. TB strains with isoniazid (INH) resistance were found in 19.4% (7/36) of participants at the primary episode, of which 29% (2/7) were also rifampicin-resistant. On TB recurrence, an INH-resistant strain was found in a larger proportion of participants, 27.8% (10/36), of which 40% (4/10) were MDR-TB strains. rcTB was attributed to relapse (same strain) in 75.0% (27/36) of participants and 25.0% (9/36) to re-infection. Our findings indicate that previous unresolved infectiondue to inadequate treatment, may be the major cause of rcTB.
ISSN:1201-9712
1878-3511
DOI:10.1016/j.ijid.2021.02.110