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

• Published in: International journal of infectious diseases Vol. 106; pp. 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: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.05.2021; Elsevier
• Subjects: Molecular epidemiology; Mycobacterium africanum; Mycobacterium tuberculosis; Relapse; Tuberculosis; Whole-genome sequencing; Molecular epidemiology; Relapse; Tuberculosis; Mycobacterium tuberculosis; Whole-genome sequencing; Mycobacterium africanum
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2021.02.110

•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.