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

Tuberculosis remains a significant public health concern in Central African Republic (REPUBLIQUE CENTRAFRICAINE), yet there has been a lack of data on whole-genome-based identification and typing of the Mycobacterium tuberculosis complex strains circulating in populations in that country. In this study, we investigated a set of 68 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 predicted to be susceptible, while 59/68 (86.7%) exhibited at least one predicted antibiotic resistance. These unprecedented data provide new insights into tuberculosis transmission in REPUBLIQUE CENTRAFRICAINE in contrast to reports from neighboring countries, including the absence of evidence for zoonotic tuberculosis and other factors. This preliminary study paves the way for a genome-based survey of tuberculosis in REPUBLIQUE CENTRAFRICAINE, which is essential for enhancing the management and control of the deadly tuberculosis that is a public health concern in the country.