Genetic diversity of Mycobacterium tuberculosis strains isolated from spiritual holy water site attendees in Ethiopia.

The genetic diversity and drug susceptibility profiles of Mycobacterium tuberculosis (M.tb) strains were characterized among isolates from individuals with pulmonary tuberculosis (PTB) symptoms attending spiritual holy water sites (HWSs) in the Amhara region, Ethiopia. A cross-sectional study was done from June 2019 to March 2020 to investigate mycobacterial diversity and drug-resistance profiles of isolates. Of 560 PTB symptomatic participants, 122 (21.8%) were culture-positive cases(Löwenstein-Jensen culture). Spoligotyping of 116 isolates revealed diverse M.tb genotypes, with CAS1-Delhi (30.2%), T3-ETH (14.7%), T2 (10.3%), T1 (8.6%), and CAS1-Kili (6.9%) predominating. SIT149/T3-ETH and SIT26/CAS1-Delhi (with 17 and 16 clustered isolates) were prevalent in Euro-American, and East-African Indian lineages, respectively. Of the 122 culture-positive isolates tested with GenoType®MTBDR plus v2 and GenoType®MTBDR sl v2, 16.4% were resistant to rifampicin (RIF) and/or isoniazid (INH). Multidrug-resistant TB (MDR-TB) was detected in 12.3% of isolates, five of which were pre-extensively drug-resistant (pre-XDR). SIT149/T3-ETH and SIT21/CAS1-Kili sublineages showed a higher proportion of drug resistance. Diverse genotypes and a high prevalence of drug-resistant TB were observed amongst the HWS attendee target group in the study, with SIT149 and SIT21 sublineages accounting for a greater share of drug resistance. This underlines the importance of strengthening TB control programmes, and TB case detection in HWSs.