title: Molecular epidemiology of Mycobacterium africanum in Ghana.
abstract: Mycobacterium africanum comprises two phylogenetic lineages within the M. tuberculosis complex (MTBC) and is an important cause of human tuberculosis (TB) in West Africa. The reasons for this geographic restriction of M. africanum remain unclear. Here, we performed a prospective study to explore associations between the characteristics of TB patients and the MTBC lineages circulating in Ghana.
  
  
  
  We genotyped 1,211 MTBC isolates recovered from pulmonary TB patients recruited between 2012 and 2014 using single nucleotide polymorphism typing and spoligotyping. Associations between patient and pathogen variables were assessed using univariate and multivariate logistic regression.
  
  
  
  Of the 1,211 MTBC isolates analysed, 71.9 % (871) belonged to Lineage 4; 12.6 % (152) to Lineage 5 (also known as M. africanum West-Africa 1), 9.2 % (112) to Lineage 6 (also known as M. africanum West-Africa 2) and 0.6 % (7) to Mycobacterium bovis. Univariate analysis revealed that Lineage 6 strains were less likely to be isoniazid resistant compared to other strains (odds ratio = 0.25, 95 % confidence interval (CI): 0.05-0.77, P < 0.01). Multivariate analysis showed that Lineage 5 was significantly more common in patients from the Ewe ethnic group (adjusted odds ratio (adjOR): 2.79; 95 % CI: 1.47-5.29, P < 0.001) and Lineage 6 more likely to be found among HIV-co-infected TB patients (adjOR = 2.2; 95 % confidence interval (CI: 1.32-3.7, P < 0.001).
  
  
  
  Our findings confirm the importance of M. africanum in Ghana and highlight the need to differentiate between Lineage 5 and Lineage 6, as these lineages differ in associated patient variables.
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.|Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors: Adwoa
authors: A
authors: Asante-Poku
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Isaac Darko
authors: ID
authors: Otchere
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Stephen
authors: S
authors: Osei-Wusu
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Esther
authors: E
authors: Sarpong
authors: Department of Chest Diseases, Korle-Bu Teaching Hospital, Korle-bu, Accra, Ghana.
authors: Akosua
authors: A
authors: Baddoo
authors: Department of Chest Diseases, Korle-Bu Teaching Hospital, Korle-bu, Accra, Ghana.
authors: Audrey
authors: A
authors: Forson
authors: 37 Military Hospital, Accra, Ghana.
authors: Clement
authors: C
authors: Laryea
authors: Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors: Sonia
authors: S
authors: Borrell
authors: National Tuberculosis Programme, Ghana health Service, Accra, Ghana.
authors: Frank
authors: F
authors: Bonsu
authors: University of Basel, Basel, Switzerland.|Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors: Jan
authors: J
authors: Hattendorf
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Collins
authors: C
authors: Ahorlu
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
authors: Kwadwo A
authors: KA
authors: Koram
authors: Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors: Sebastien
authors: S
authors: Gagneux
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana. Dyeboah-Manu@noguchi.ug.edu.gh.
authors: Dorothy
authors: 0000-0002-1663-6287
authors: D
authors: Yeboah-Manu
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000235:genetics; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology / Q000379:methods*; D009161:Mycobacterium / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000453:epidemiology*; D009163:Mycobacterium bovis / Q000235:genetics; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D011446:Prospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult