Tilahun Melaku, Atnafu Abay, Gebresilase Tewodros Tariku, Abebe Muluye, Alemu Mekdes, Neway Sebisib, Letta Taye, Bezabeh Abiot, Assefa Tamiru, Melaku Kalkidan, Alemayehu Dawit Hailu, Moga Shewki, Ayele Abaysew, Fetu Maeruf, Adnew Bethlehem, Mulu Andargachew, Wassie Liya, Bobosha Kidist
Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia.
Ministry of Health (MOH), Addis Ababa, Ethiopia.
PLoS One. 2025 Apr 16;20(4):e0318743. doi: 10.1371/journal.pone.0318743. eCollection 2025.
Human migration significantly contributes to the global spread of infectious diseases. In recent years, Ethiopia has experienced an increased influx of returnees from the Kingdom of Saudi Arabia. These migrants were often held in densely populated and inadequately ventilated detention centers and faced a heightened risk of tuberculosis transmission. This study investigates the genotypic drug resistance and transmission clusters of M. tuberculosis among returnees from various detention centers in the Kingdom of Saudi Arabia. Whole genome sequencing (WGS) is employed to characterize the genotypic drug resistance patterns and transmission clusters of M. tuberculosis isolates in presumptive TB cases.
Following symptom screening for presumptive TB, sputum samples were collected from 161 Xpert MTB/RIF-confirmed returnees between August and December 2022. The samples were further cultured on Lowenstein-Jensen media, with 66.5% (107/161) yielding positive results. The M. tuberculosis strains were classified, and genotypic drug susceptibility was predicted. Transmission clusters were identified using a distance threshold of 12 single nucleotide polymorphisms (SNPs).
Among the 88 isolates, Lineage 4 was the most prevalent, representing 65.9% of M. tuberculosis cases among returnees. Sub-lineage 4.2.2.2 was the most dominant within this group, comprising 33% (29/88) of the isolates. Among the isolates, 40 gene mutations conferring resistance to first- and second-line anti-TB drugs were identified. Sixteen transmission clusters were identified, suggesting possible transmission events and a likely origin within the detention centers of the Kingdom of Saudi Arabia (KSA). The proportion of MDR-TB among newly diagnosed cases was 2.3% (2/88).
The clustering patterns of M. tuberculosis strain among KSA returnees possibly suggest increased transmission rates in congregate settings. Most importantly, the identified prevalence of MDR-TB, particularly among newly diagnosed TB cases, underscores the need to strengthen robust screening practices for returning migrants before they reintegrate into the community to curb TB/DR-TB transmission.
人口迁移对传染病在全球的传播起到了重要作用。近年来，埃塞俄比亚迎来了越来越多从沙特阿拉伯王国返回的人员。这些移民常常被安置在人口密集且通风不良的拘留中心，面临着更高的结核病传播风险。本研究调查了沙特阿拉伯王国各拘留中心返回人员中结核分枝杆菌的基因型耐药性及传播集群情况。采用全基因组测序（WGS）来表征疑似结核病病例中结核分枝杆菌分离株的基因型耐药模式及传播集群。
在对疑似结核病进行症状筛查后，于2022年8月至12月期间从161例经Xpert MTB/RIF确诊的返回人员中采集痰液样本。样本进一步在罗-琴培养基上培养，66.5%（107/161）培养结果呈阳性。对结核分枝杆菌菌株进行分类，并预测基因型药物敏感性。使用12个单核苷酸多态性（SNP）的距离阈值来识别传播集群。
在88株分离株中，4型谱系最为常见，占返回人员中结核分枝杆菌病例的65.9%。4.2.2.2亚谱系在该组中最为占主导，占分离株的33%（29/88）。在分离株中，鉴定出40个赋予对一线和二线抗结核药物耐药性的基因突变。识别出16个传播集群，表明可能存在传播事件，且可能起源于沙特阿拉伯王国（KSA）的拘留中心。新诊断病例中耐多药结核病的比例为2.3%（2/88）。
沙特阿拉伯王国返回人员中结核分枝杆菌菌株的聚类模式可能表明在聚集环境中传播率增加。最重要的是，所确定的耐多药结核病患病率，尤其是在新诊断的结核病病例中，凸显了在返回移民重新融入社区之前加强有力筛查措施以遏制结核病/耐多药结核病传播的必要性。
