Research Articles (Infectious Diseases)https://scholar.sun.ac.za/handle/10019.1/706292024-03-29T00:19:35Z2024-03-29T00:19:35Z441Telomere length and outcome of treatment for pulmonary tuberculosis in a gold mining communityKatoto, Patrick D. M. C.Kayembe‑Kitenge, TonyPollitt, Krystal J. GodriMartens, Dries S.Ghosh, ManosijNachega, Jean B.Nemery, BenoitNawrot, Tim S.https://scholar.sun.ac.za/handle/10019.1/1267582023-05-27T22:04:03Z2021-02-01T00:00:00Zdc.title: Telomere length and outcome of treatment for pulmonary tuberculosis in a gold mining community
dc.contributor.author: Katoto, Patrick D. M. C.; Kayembe‑Kitenge, Tony; Pollitt, Krystal J. Godri; Martens, Dries S.; Ghosh, Manosij; Nachega, Jean B.; Nemery, Benoit; Nawrot, Tim S.
dc.description.abstract: Telomere length (TL) is a marker of ageing and mitochondrial DNA (mtDNA) is an early marker of inflammation caused by oxidative stress. We determined TL and mtDNA content among active pulmonary tuberculosis (PTB) patients to assess if these cellular biomarkers differed between artisanal miners and non-miners, and to assess if they were predictive of treatment outcome. We conducted a prospective cohort study from August 2018 to May 2019 involving newly diagnosed PTB patients at three outpatient TB clinics in a rural Democratic Republic of Congo. We measured relative TL and mtDNA content in peripheral blood leukocytes (at inclusion) via qPCR and assessed their association with PTB treatment outcome. We included 129 patients (85 miners and 44 non-miners) with PTB (median age 40 years; range 5–71 years, 22% HIV-coinfected). For each increase in year and HIV-coinfection, TL shortened by − 0.85% (− 0.19 to − 0.52) (p ≤ 0.0001) and − 14% (− 28.22 to − 1.79) (p = 0.02) respectively. Independent of these covariates, patients with longer TL were more likely to have successful TB treatment [adjusted hazard ratio; 95% CI 1.27 for a doubling of leucocyte telomere length at baseline; 1.05–1.44] than patients with a shorter TL. Blood mtDNA content was not predictive for PTB outcome. For a given chronological age, PTB patients with longer telomeres at time of diagnosis were more likely to have successful PTB treatment outcome.
dc.description: CITATION: Katoto, P. D. M. C. et al. 2021. Telomere length and outcome of treatment for pulmonary tuberculosis in a gold mining community. Scientific Reports, 11:4031, doi:10.1038/s41598-021-83281-2.; The original publication is available at https://www.nature.com
2021-02-01T00:00:00ZRegression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countriesZaniewski, ElizabethBrazier, EllenOstinelli, Cam Ha DaoWood, RobinOsler, MegTechnau, Karl-GünterVan Oosterhout, Joep JMaxwell, NicolaVan Dijk, JannekeProzesky, HansFox, Matthew PBor, JacobNash, DenisEgger, Matthiashttps://scholar.sun.ac.za/handle/10019.1/1267202023-05-27T22:31:40Z2021-12-01T00:00:00Zdc.title: Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries
dc.contributor.author: Zaniewski, Elizabeth; Brazier, Ellen; Ostinelli, Cam Ha Dao; Wood, Robin; Osler, Meg; Technau, Karl-Günter; Van Oosterhout, Joep J; Maxwell, Nicola; Van Dijk, Janneke; Prozesky, Hans; Fox, Matthew P; Bor, Jacob; Nash, Denis; Egger, Matthias
dc.description.abstract: Objective: To determine whether Treat-All policy impacted laboratory testing practices of antiretroviral therapy (ART) programs in Southern Africa.
Study Design and Setting: We used HIV cohort data from Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in a regression discontinuity design to estimate changes in pre-ART CD4 testing and viral load monitoring following national Treat-all adoption that occurred during 2016–2017. This study included more than 230,000 ART-naïve people living with HIV (PLHIV) aged five years or older who started ART within two years of national Treat-All adoption.
Results: We found pre-ART CD4 testing decreased following adoption of Treat-All recommendations in Malawi (−21.4 percentage points (pp), 95% CI: −26.8, −16.0) and in Mozambique (−8.8pp, 95% CI: −14.9, −2.8), but increased in Zambia (+2.7pp, 95% CI: +0.4, +5.1). Treat-All policy had no effect on viral load monitoring, except among females in South Africa (+7.1pp, 95% CI: +1.1, +13.0).
Conclusion: Treat-All policy expanded ART eligibility, but led to reductions in pre-ART CD4 testing in some countries that may weaken advanced HIV disease management. Continued and expanded support of CD4 and viral load laboratory capacity is needed to further improve treatment successes and allow for uniform evaluation of ART implementation across Southern Africa.
dc.description: CITATION: Zaniewski, E. et al. 2021. Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries. Journal of Clinical Epidemiology 140(2021):20 pages. doi.10.1016/j.jclinepi.2021.09.001; The original publication is available at: sciencedirect.com
2021-12-01T00:00:00ZCOVID-19 travel restrictions and the International Health Regulations – Call for an open debate on easing of travel restrictionsPetersen, EskildMcCloskey, BrianHui, David S.Kock, RichardNtoumi, FrancineMemish, Ziad A.Kapata, NathanAzhar, Esam I.Pollack, MarjorieMadoff, Larry C.Hamer, Davidson H.Nachega, Jean B.Pshenichnaya, N.Zumla, Alimuddinhttps://scholar.sun.ac.za/handle/10019.1/1257302023-05-27T23:24:38Z2020-05-01T00:00:00Zdc.title: COVID-19 travel restrictions and the International Health Regulations – Call for an open debate on easing of travel restrictions
dc.contributor.author: Petersen, Eskild; McCloskey, Brian; Hui, David S.; Kock, Richard; Ntoumi, Francine; Memish, Ziad A.; Kapata, Nathan; Azhar, Esam I.; Pollack, Marjorie; Madoff, Larry C.; Hamer, Davidson H.; Nachega, Jean B.; Pshenichnaya, N.; Zumla, Alimuddin
dc.description.abstract: The COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2) has made national governments worldwide to mandate several generic infection control measures such as physical distancing, self-isolation, and closure of non-essential shops, restaurants schools, among others. Some models suggest physical distancing would have to persist for 3 months to mitigate the peak effects on health systems and could be required on an intermittent basis for 12 to 18 months ( Flaxman et al., 2020 ).
Apart from these control measures travel restrictions during the early phase of the China outbreak were useful to confine it to Wuhan, the major source of the outbreak ( Kraemer et al., 2020 ) although ultimately these measures did not prevent the spread of COVID-19 to other regions of China. The global spread of the SARS-CoV-2 has clearly been associated with regional and international travel which has contributed to the pandemic ( Candido et al., 2020 ). To limit cross-border spread, both regionally and globally, many countries have swiftly adopted sweeping measures, including full lockdowns of shops, companies, shutting down airports, imposing travel restrictions and completely sealing their borders, to contain transmission ( Gostin and Wiley, 2020 ). The grounding of international travel as part of the global response to prevent spread has caused profound disruption of travel and trade and has threatened the survival of many airlines, travel companies, and associated businesses.
dc.description: CITATION: Petersen, E. et al. 2020. COVID-19 travel restrictions and the International Health Regulations - Call for an open debate on easing of travel restrictions. International journal of infectious diseases, 94:88–90. doi:10.1016/j.ijid.2020.04.029; The original publication is available at https://www.journals.elsevier.com/international-journal-of-infectious-diseases
2020-05-01T00:00:00ZCOVID-19 response in low- and middle-income countries : don’t overlook the role of mobile phone communicationVerhagen, Lilly M.de Groot, R.Lawrence, C. A.Taljaard, J.Cotton, M. F.Rabie, H.https://scholar.sun.ac.za/handle/10019.1/1257212023-05-27T22:39:16Z2020-07-26T00:00:00Zdc.title: COVID-19 response in low- and middle-income countries : don’t overlook the role of mobile phone communication
dc.contributor.author: Verhagen, Lilly M.; de Groot, R.; Lawrence, C. A.; Taljaard, J.; Cotton, M. F.; Rabie, H.
dc.description.abstract: Estimates of health capacities in the context of the coronavirus disease 2019 (COVID-19) pandemic indicate that most low- and middle-income countries (LMICs) are not operationally ready to manage this health emergency. Motivated by worldwide successes in other infectious disease epidemics and our experience in Sub-Saharan Africa, we support mobile phone communication to improve data collection and reporting, communication between healthcare workers, public health institutions, and patients, and the implementation of disease tracking and subsequent risk-stratified isolation measures. Programmatic action is needed for centrally coordinated reporting and communication systems facilitating mobile phones in crisis management plans for addressing the COVID-19 pandemic in LMICs. We summarize examples of worldwide mobile phone technology initiatives that have enhanced patient care and public health outcomes in previous epidemics and the current COVID-19 pandemic. In addition, we provide an overview of baseline conditions, including transparency about privacy guarantees, necessary for the successful use of mobile phones in assisting in the fight against COVID-19 spread.
dc.description: CITATION: Verhagen, L. M. et al. 2020.
COVID-19 response in low- and middle-income countries: Don’t overlook the role of mobile phone communication. International Journal of Infectious Diseases, 99: 334-337. doi:10.1016/j.ijid.2020.07.069.; The original publication is available at https://www.journals.elsevier.com/international-journal-of-infectious-diseases
2020-07-26T00:00:00ZXpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implicationsBisimwa, Bertin C.Nachega, Jean B.Warren, Robin M.Theron, GrantMetcalfe, John Z.Shah, MaunankDiacon, Andreas H.Sam-Agudu, Nadia A.Yotebieng, MarcelBulabula, André N. H.Katoto, Patrick D. M. C.Chirambiza, Jean-PaulNyota, RosetteBirembano, Freddy M.Musafiri, Eric M.Byadunia, SifaBahizire, EstoKaswa, Michel K.Callens, StevenKashongwe, Zacharie M.https://scholar.sun.ac.za/handle/10019.1/1253392023-01-03T13:33:41Z2020-06-01T00:00:00Zdc.title: Xpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implications
dc.contributor.author: Bisimwa, Bertin C.; Nachega, Jean B.; Warren, Robin M.; Theron, Grant; Metcalfe, John Z.; Shah, Maunank; Diacon, Andreas H.; Sam-Agudu, Nadia A.; Yotebieng, Marcel; Bulabula, André N. H.; Katoto, Patrick D. M. C.; Chirambiza, Jean-Paul; Nyota, Rosette; Birembano, Freddy M.; Musafiri, Eric M.; Byadunia, Sifa; Bahizire, Esto; Kaswa, Michel K.; Callens, Steven; Kashongwe, Zacharie M.
dc.description.abstract: Background
Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC).
Methods
We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy.
Results
Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively.
Conclusions
In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.
dc.description: CITATION: Bisimwa, B. C. et al. 2020. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clinical Infectious Diseases, 73(2):e362–e370. doi:10.1093/cid/ciaa873; The original publication is available at https://academic.oup.com/cid/
2020-06-01T00:00:00ZThe late arrival of coronavirus disease 2019 (COVID-19) in Africa : mitigating pan-continental spreadNachega, JeanSeydi, MoussaZumla, Alimuddinhttps://scholar.sun.ac.za/handle/10019.1/1253282023-01-04T12:56:38Z2020-07-01T00:00:00Zdc.title: The late arrival of coronavirus disease 2019 (COVID-19) in Africa : mitigating pan-continental spread
dc.contributor.author: Nachega, Jean; Seydi, Moussa; Zumla, Alimuddin
dc.description.abstract: The novel coronavirus disease 2019 (COVID-19) has rapidly spread to all 7 continents. Due to yet unknown reasons, the African continent has remained relatively unaffected. We discuss the importance of mitigating pan-continental spread in light of the fragile healthcare systems.
dc.description: CITATION: Nachega, J.; Seydi, M. & Zumla, A. 2020. The late arrival of Coronavirus disease 2019 (COVID-19) in Africa: mitigating pan-continental spread. Clinical Infectious Diseases, 71(15): 875–878. doi:10.1093/cid/ciaa353; The original publication is available at https://academic.oup.com/cid/
2020-07-01T00:00:00ZFrom easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortalityNachega, Jean B.Grimwood, AshrafMahomed, HassanFatti, GeoffreyPreiser, WolfgangKallay, OscarMbala, Placide K.Muyembe, Jean-Jacques T.Rwagasore, EdsonNsanzimana, SabinNgamije, DanielCondo, JeanineSidat, MohsinNoormahomed, Emilia V.Reid, MichaelLukeni, BeatriceSuleman, FatimaMteta, AlfredZumla, Alimuddinhttps://scholar.sun.ac.za/handle/10019.1/1253082023-01-05T13:19:45Z2020-05-01T00:00:00Zdc.title: From easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortality
dc.contributor.author: Nachega, Jean B.; Grimwood, Ashraf; Mahomed, Hassan; Fatti, Geoffrey; Preiser, Wolfgang; Kallay, Oscar; Mbala, Placide K.; Muyembe, Jean-Jacques T.; Rwagasore, Edson; Nsanzimana, Sabin; Ngamije, Daniel; Condo, Jeanine; Sidat, Mohsin; Noormahomed, Emilia V.; Reid, Michael; Lukeni, Beatrice; Suleman, Fatima; Mteta, Alfred; Zumla, Alimuddin
dc.description.abstract: The arrival of coronavirus disease 2019 (COVID-19) on the African continent resulted in a range of lockdown measures that curtailed the spread of the infection but caused economic hardship. African countries now face difficult choices regarding easing of lockdowns and sustaining effective public health control measures and surveillance. Pandemic control will require efficient community screening, testing, and contact tracing; behavioral change interventions; adequate resources; and well-supported, community-based teams of trained, protected personnel. We discuss COVID-19 control approaches in selected African countries and the need for shared, affordable, innovative methods to overcome challenges and minimize mortality. This crisis presents a unique opportunity to align COVID-19 services with those already in place for human immunodeficiency virus, tuberculosis, malaria, and non communicable diseases through mobilization of Africa's interprofessional healthcare workforce. By addressing the challenges, the detrimental effect of the COVID-19 pandemic on African citizens can be minimized.
dc.description: CITATION: Nachega, J. B. et al. 2021. From easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortality. Clinical infectious diseases, 72(2):327–331. doi:10.1093/cid/ciaa695; The original publication is available at https://academic.oup.com/cid/
2020-05-01T00:00:00ZDiverse Human Immunodeficiency Virus-1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited SettingsWallis, Carole L.Hughes, Michael D.Ritz, JustinViana, Raquelde Jesus, Carlos SilvaSaravanan, Shanmugamvan Schalkwyk, MarijeMngqibisa, RosieSalata, RobertMugyenyi, PeterHogg, EvelynHovind, LauraWieclaw, LindaGross, RobertGodfrey, CatherineCollier, Ann C.Grinsztejn, BeatrizMellors, John W.https://scholar.sun.ac.za/handle/10019.1/1253022022-12-09T08:51:22Z2020-10-01T00:00:00Zdc.title: Diverse Human Immunodeficiency Virus-1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited Settings
dc.contributor.author: Wallis, Carole L.; Hughes, Michael D.; Ritz, Justin; Viana, Raquel; de Jesus, Carlos Silva; Saravanan, Shanmugam; van Schalkwyk, Marije; Mngqibisa, Rosie; Salata, Robert; Mugyenyi, Peter; Hogg, Evelyn; Hovind, Laura; Wieclaw, Linda; Gross, Robert; Godfrey, Catherine; Collier, Ann C.; Grinsztejn, Beatriz; Mellors, John W.
dc.description.abstract: Background: Human immunodeficiency virus (HIV) drug resistance profiles are needed to optimize individual patient management and to develop treatment guidelines. Resistance profiles are not well defined among individuals on failing second-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC).
Methods: Resistance genotypes were performed during screening for enrollment into a trial of third-line ART (AIDS Clinical Trials Group protocol 5288). Prior exposure to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs and confirmed virologic failure on a protease inhibitor-containing regimen were required. Associations of drug resistance with sex, age, treatment history, plasma HIV RNA, nadir CD4+T-cell count, HIV subtype, and country were investigated.
Results: Plasma HIV genotypes were analyzed for 653 screened candidates; most had resistance (508 of 653; 78%) to 1 or more drugs. Genotypes from 133 (20%) showed resistance to at least 1 drug in a drug class, from 206 (32%) showed resistance to at least 1 drug in 2 drug classes, and from 169 (26%) showed resistance to at least 1 drug in all 3 commonly available drug classes. Susceptibility to at least 1 second-line regimen was preserved in 59%, as were susceptibility to etravirine (78%) and darunavir/ritonavir (97%). Susceptibility to a second-line regimen was significantly higher among women, younger individuals, those with higher nadir CD4+ T-cell counts, and those who had received lopinavir/ritonavir, but was lower among prior nevirapine recipients.
Conclusions: Highly divergent HIV drug resistance profiles were observed among candidates screened for third-line ART in LMIC, ranging from no resistance to resistance to 3 drug classes. These findings underscore the need for access to resistance testing and newer antiretrovirals for the optimal management of third-line ART in LMIC.
dc.description: CITATION: Wallis, C. L. et al. Diverse Human Immunodeficiency Virus–1 drug resistance profiles at screening for ACTG A5288 : a study of people experiencing virologic failure on second-line antiretroviral therapy in resource-limited settings. Clinical Infectious Diseases, 71(7): e170–e177. doi:10.1093/cid/ciz1116; The original publication is available at https://academic.oup.com/cid/
2020-10-01T00:00:00ZComparison of antiretroviral therapy adherence among HIV-infected older adults with younger adults in Africa : systematic review and meta-analysisSoomro, NajeebullahFitzgerald, GraceSeeley, JanetSchatz, EnidNachega, Jean B.Negin, Joelhttps://scholar.sun.ac.za/handle/10019.1/1234712024-01-19T12:42:17Z2019-01-01T00:00:00Zdc.title: Comparison of antiretroviral therapy adherence among HIV-infected older adults with younger adults in Africa : systematic review and meta-analysis
dc.contributor.author: Soomro, Najeebullah; Fitzgerald, Grace; Seeley, Janet; Schatz, Enid; Nachega, Jean B.; Negin, Joel
dc.description.abstract: ENGLISH ABSTRACT: As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94–1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02–1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life.
dc.description: CITATION: Soomro, N., et al. 2019. Comparison of antiretroviral therapy adherence among HIV-infected older adults with younger adults in Africa : systematic review and meta-analysis. AIDS and Behavior, 23:445-458, doi:10.1007/s10461-018-2196-0.; https://link.springer.com/article/10.1007/s10461-018-2196-0
2019-01-01T00:00:00ZMultiple introductions of mycobacterium tuberculosis lineage 2–Beijing into Africa over centuriesRutaihwa, Liliana K.Menardo, FabrizioStucki, DavidGygli, Sebastian M.Ley, Serej D.Malla, BijayaFeldmann, JuliaBorrell, SoniaBeisel, ChristianMiddelkoop, KerrenCarter, E. JaneDiero, LameckBallif, MarieJugheli, LevanReither, KlausFenner, LukasBrites, DanielaGagneux, Sebastienhttps://scholar.sun.ac.za/handle/10019.1/1233572024-01-19T12:58:49Z2019-01-01T00:00:00Zdc.title: Multiple introductions of mycobacterium tuberculosis lineage 2–Beijing into Africa over centuries
dc.contributor.author: Rutaihwa, Liliana K.; Menardo, Fabrizio; Stucki, David; Gygli, Sebastian M.; Ley, Serej D.; Malla, Bijaya; Feldmann, Julia; Borrell, Sonia; Beisel, Christian; Middelkoop, Kerren; Carter, E. Jane; Diero, Lameck; Ballif, Marie; Jugheli, Levan; Reither, Klaus; Fenner, Lukas; Brites, Daniela; Gagneux, Sebastien
dc.description.abstract: ENGLISH ABSTRACT: The Lineage 2–Beijing (L2–Beijing) sub-lineage of Mycobacterium tuberculosis has received much attention due to its high virulence, fast disease progression, and association with antibiotic resistance. Despite several reports of the recent emergence of L2–Beijing in Africa, no study has investigated the evolutionary history of this sub-lineage on the continent. In this study, we used whole genome sequences of 781 L2 clinical strains from 14 geographical regions globally distributed to investigate the origins and onward spread of this lineage in Africa. Our results reveal multiple introductions of L2–Beijing into Africa linked to independent bacterial populations from East- and Southeast Asia. Bayesian analyses further indicate that these introductions occurred during the past 300 years, with most of these events pre-dating the antibiotic era. Hence, the success of L2–Beijing in Africa is most likely due to its hypervirulence and high transmissibility rather than drug resistance.
dc.description: CITATION: Rutaihwa, L. K. 2019. Multiple introductions of mycobacterium tuberculosis lineage 2–Beijing into Africa over centuries. Frontiers in Ecology and Evolution, 7:112, doi:10.3389/fevo.2019.00112.; The original publication is available at http://journal.frontiersin.org/journal/ecology-and-evolution
2019-01-01T00:00:00Z