Implications of the population structure of the Mycobacterium tuberculosis complex in Benin for tuberculosis presentation, diagnosis and outcome

The vast majority (95%) of global tuberculosis (TB) occurs in limitedresource countries [4], including Benin, a west-African country. In West-Africa, up to 40% of TB is caused by Mycobacterium africanum (MAF) [7,8], a species consisting of two distinct lineages within the Mycobacterium tuberculosis complex (MTBc). Recent results suggest that the MAF prevalence is decreasing in some countries, but not others [13,14]. The one and only study on strain diversity in Benin was conducted in 2006 [5]. Overall aim: Determine the population structure of the MTBc in Benin, and implications for tuberculosis presentation, diagnosis and outcome. Method: The proposed study is a prospective observational analytical cohort study, which builds on the nationwide system of continuous surveillance of drug-resistance already established in Benin. Sputa from 1490 (retreatment and new) TB patients will be collected from the 80 TB centers and shipped to the National Reference Laboratory for further laboratory analyses. Spoligotype analysis will be used to determine the MTBc lineage. Clinical characteristics of patients, outcome of TB treatment, and performance of various diagnostic tests will be determined for each MTBc lineage. The whole genome sequences of 30 MAF isolates from Benin will be analysed.