title: High genetic diversity among Mycobacterium tuberculosis complex strains from Sierra Leone.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany. shomolka@fz-borstel.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Homolka
authors.forename: Erik
authors.initials: E
authors.lastname: Post
authors.forename: Barbara
authors.initials: B
authors.lastname: Oberhauser
authors.forename: Abu Garawani
authors.initials: AG
authors.lastname: George
authors.forename: Lars
authors.initials: L
authors.lastname: Westman
authors.forename: Foday
authors.initials: F
authors.lastname: Dafae
authors.forename: Sabine
authors.initials: S
authors.lastname: Rüsch-Gerdes
authors.forename: Stefan
authors.initials: S
authors.lastname: Niemann
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology; D016172:DNA Fingerprinting; D021901:DNA, Intergenic / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D014644:Genetic Variation; D006801:Humans; D018598:Minisatellite Repeats; D009161:Mycobacterium / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies; D012807:Sierra Leone / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents; D021901:DNA, Intergenic