A snapshot of genomic diversity and transmission clusters of rifampin-resistant Mycobacterium tuberculosis complex in the Central African Republic

Tuberculosis, a significant public health concern in Central African Republic lacks whole-genome-based identification and typing of the Mycobacterium tuberculosis complex strains circulating in populations in that country. Here, we investigated 68 rifampin-resistant clinical isolates collected in 2024 from eight districts in Bangui and surrounding regions. The analysis revealed that all isolates were M. tuberculosis stricto sensu, distributed across nine lineages: L4.1.2.1 Haarlem (n = 20), L4.6 Euro-American (n = 17), L4.6.1.2 Uganda (n = 13), L4.6.2.2 Cameroon (n = 12), and L4.1.1.1 X-Type (n = 2), and single isolates in L4.1 (Euro-American), L4.6.1 (Uganda), L4.3.1 (LAM), and L3 (Delhi-CAS). The antibiotic resistance profile showed that 9/68 (13.2 %) of the M. tuberculosis isolates were susceptible, while 59/68 (86.7 %) exhibited at least one predicted antibiotic resistance. These data provide new insights into tuberculosis transmission in Central African Republic in contrast to reports from neighboring countries, including the absence of Mycobacterium bovis, hence zoonotic tuberculosis and other factors. This preliminary study limited to rifampin-resistant isolates, nevertheless paves the way for a genome-based survey of tuberculosis in Central African Republic which is essential for enhancing the management and control of the deadly tuberculosis that is a public health concern in the country.