Dlamini, Talent C.Mkhize, Brenda T.Sydney, CliveManingi, Nontuthuko ExcellentMalinga, Lesibana Anthony2024-03-182024-03-182023-08-29Dlamini, T.C., Mkhize, B.T., Sydney, C. et al. 2023, 'Molecular investigations of Mycobacterium tuberculosis genotypes among baseline and follow‑up strains circulating in four regions of Eswatini', BMC Infectious Diseases, vol. 23, art. 566, pp. 1-13. https://DOI.org/10.1186/s12879-023-08546-9.1471-2334 (online)10.1186/s12879-023-08546-9http://hdl.handle.net/2263/95243AVAILABILITY OF DATA AND MATERIALS : The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.SUPPLEMENTARY MATERIAL. Baseline findings. SUPPLEMENTARY MATERIAL. Follow-up findings.BACKGROUND : The tuberculosis (TB) epidemic remains a major global health problem and Eswatini is not excluded. Our study investigated the circulating genotypes in Eswatini and compared them at baseline (start of treatment) and follow-up during TB treatment. METHODS : Three hundred and ninety (n = 390) participants were prospectively enrolled from referral clinics and patients who met the inclusion criteria, were included in the study. A total of 103 participants provided specimens at baseline and follow-up within six months. Mycobacterium tuberculosis (M.tb) strains were detected by GeneXpert ® MTB/RIF assay (Cephied, USA) and Ziehl -Neelsen (ZN) microscopy respectively at baseline and follow-up time-points respectively. The 206 collected specimens were decontaminated and cultured on BACTEC™ MGIT™ 960 Mycobacteria Culture System (Becton Dickinson, USA). Drug sensitivity testing was performed at both baseline and follow-up time points. Spoligotyping was performed on both baseline and follow-up strains after DNA extraction. RESULTS : Resistance to at least one first line drug was detected higher at baseline compared to follow-up specimens with most of them developing into multidrug-resistant (MDR)-TB. A total of four lineages and twenty genotypes were detected. The distribution of the lineages varied among the different regions in Eswatini. The Euro-American lineage was the most prevalent with 46.12% (95/206) followed by the East Asian with 24.27% (50/206); Indo-Oceanic at 9.71% (20/206) and Central Asian at 1.94% (4/206). Furthermore, a high proportion of the Beijing genotype at 24.27% (50/206) and S genotype at 16.50% (34/206) were detected. The Beijing genotype was predominant in follow-up specimens collected from the Manzini region with 48.9% (23/47) (p = 0.001). A significant proportion of follow-up specimens developed MDR-TB (p = 0.001) with Beijing being the major genotype in most follow-up specimens (p < 0.000). CONCLUSION : Eswatini has a high M.tb genotypic diversity. A significant proportion of the TB infected participants had the Beijing genotype associated with MDR-TB in follow-up specimens and thus indicate community wide transmission.en© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License.Drug sensitivity testingSpoligotypingLineagesGenotypesTuberculosis (TB)Multidrug-resistant (MDR)SDG-03: Good health and well-beingArticle