title: Spatio-Temporal Distribution of Mycobacterium tuberculosis Complex Strains in Ghana.
abstract: BACKGROUND
  There is a perception that genomic differences in the species/lineages of the nine species making the Mycobacterium tuberculosis complex (MTBC) may affect the efficacy of distinct control tools in certain geographical areas. We therefore analyzed the prevalence and spatial distribution of MTBC species and lineages among isolates from pulmonary TB cases over an 8-year period, 2007-2014.
  
  
  METHODS
  Mycobacterial species isolated by culture from consecutively recruited pulmonary tuberculosis patients presenting at selected district/sub-district health facilities were confirmed as MTBC by IS6110 and rpoß PCR and further assigned lineages and sub lineages by spoligotyping and large sequence polymorphism PCR (RDs 4, 9, 12, 702, 711) assays. Patient characteristics, residency, and risks were obtained with a structured questionnaire. We used SaTScan and ArcMap analyses to identify significantly clustered MTBC lineages within selected districts and spatial display, respectively.
  
  
  RESULTS
  Among 2,551 isolates, 2,019 (79.1%), 516 (20.2%) and 16 (0.6%) were identified as M. tuberculosis sensu stricto (MTBss), M. africanum (Maf), 15 M. bovis and 1 M. caprae, respectively. The proportions of MTBss and Maf were fairly constant within the study period. Maf spoligotypes were dominated by Spoligotype International Type (SIT) 331 (25.42%), SIT 326 (15.25%) and SIT 181 (14.12%). We found M. bovis to be significantly higher in Northern Ghana (1.9% of 212) than Southern Ghana (0.5% of 2339) (p = 0.020). Using the purely spatial and space-time analysis, seven significant MTBC lineage clusters (p< 0.05) were identified. Notable among the clusters were Ghana and Cameroon sub-lineages found to be associated with north and south, respectively.
  
  
  CONCLUSIONS
  This study demonstrated that overall, 79.1% of TB in Ghana is caused by MTBss and 20% by M. africanum. Unlike some West African Countries, we did not observe a decline of Maf prevalence in Ghana.
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: Dorothy
authors: http://orcid.org/0000-0002-1663-6287
authors: D
authors: Yeboah-Manu
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: P
authors: P
authors: Asare
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: A
authors: A
authors: Asante-Poku
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: I D
authors: ID
authors: Otchere
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: S
authors: S
authors: Osei-Wusu
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: E
authors: E
authors: Danso
authors: Department of Chest Diseases, Korle-Bu Teaching Hospital, Korle-bu, Accra, Ghana.
authors: A
authors: A
authors: Forson
authors: Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors: K 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
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic / Q000235:genetics; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000145:classification / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult