Geno-Spatial Distribution of Mycobacterium Tuberculosis and Drug Resistance Profiles in Myanmar–Thai Border Area

Abstract

Worldwide, studies investigating the relationship between the lineage of Mycobacterium tuberculosis (MTB) across geographic areas has empowered the “End TB” program and understand transmission across national boundaries. Genomic diversity of MTB varies with geographical locations and ethnicity. Genomic diversity can also affect the emergence of drug resistance. In Myanmar, we still have limited genetic information about geographical, ethnicity, and drug resistance linkage to MTB genetic information. This study aimed to describe the geno-spatial distribution of MTB and drug resistance profiles in Myanmar–Thailand border areas. A cross-sectional study was conducted with a total of 109 sequenced isolates. The lineages of MTB and the potential associated socio-demographic, geographic and clinical factors were analyzed using Fisher’s exact tests. p value of statistically significance was set at < 0.05. We found that 67% of the isolates were lineage 1 (L1)/East-African-Indian (EAI) (n = 73), followed by lineage 2 (L2)/Beijing (n = 26), lineage 4 (L4)/European American (n = 6) and lineage 3 (L3)/Delhi/Central Asian (n = 4). “Gender”, “type of TB patient”, “sputum smear grading” and “streptomycin resistance” were significantly different with the lineages of MTB. Sublineages of L1, which had never been reported elsewhere in Myanmar, were detected in this study area. Moreover, both ethnicity and lineage of MTB significantly differed in distribution by patient location. Diversity of the lineage of MTB and detection of new sublineages suggested that this small area had been resided by a heterogeneous population group who actively transmitted the disease. This information on distribution of lineage of MTB can be linked in the future with those on the other side of the border to evaluate cross-border transmission.

Whole-genome single nucleotide variant phylogenetic analysis of Mycobacterium tuberculosis Lineage 1 in endemic regions of Asia and Africa

“…1 ). The first three have been reported in many Asian studies 5 , 8 , 13 . L1.1.3.4, was identified mostly among African samples (Supplementary Table S3 ), particularly in Malawi (69%).…”

“…Associations between each of these sublineages with geography have been studied. For example, L1.1.1.1 is predominant in Vietnam 7 , L1.1.3 is common in Myanmar 8 , Bangladesh 9 and East Africa 10 while L1.1.2.2 and L1.2.2 (previous L1.2.1) are associated with India and Southeast Asia, respectively 5 . Interestingly, around 80% of Mtb isolates in the Philippines, a high TB burden country, belonged to the last sublineage 11 .…”

Whole Genome Sequencing of Drug Resistant and Drug Susceptible Mycobacterium tuberculosis Isolates From Tigray Region, Ethiopia

“…The geographic distribution of lineages revealed that strain diversity varied among the hospitals of the region. This difference could reflect patient-location differences ( Maung et al, 2020 ). As whole-genome sequencing is very expensive, we could not sequence all of the Mtb isolates identified from participants attending the respective study sites (hospitals) in the study area.…”

High-resolution characterization of recent tuberculosis transmission in Botswana using geospatial and genomic data – the Kopanyo Study

“…Our results also align with recent studies combining spatial and WGS data to study TB transmission in several other high burden settings, including China (33,34), Ghana (41), and along the Thai-Myanmar border (36). Observed spatial patterns among related Mtb strains have included local and regional distributions of genotypic cluster groups (39,41) and lineages (42), and associations between residential proximity and genetic similarity (33,34) In contrast, a study in China found the majority of genotypic groups included participants from separate geographic districts (43). However, that study differed from ours because it specifically analyzed MDR-TB, and included a majority of participants (70%) that had migrated from other provinces (43).…”