Lineages of Mycobacterium tuberculosis complex associated with pulmonary drug-resistant tuberculosis in Africa: a systematic review

Introduction The emergence of multidrug-resistant tuberculosis has eroded the gains made in the fight against tuberculosis. This review aims to provide current perspectives on the lineages of the Mycobacterium tuberculosis complex (MTBC) associated with drug-resistant tuberculosis (DR-TB) in Africa. Method Primary studies were retrieved from PubMed, AJOL, Scopus and Africa Index Medicus databases, including worldwide science and Bielefeld Academic Search Engine websites. Retrieved articles were imported into Rayyan.ai for the selection and screening process. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical and cross-sectional studies. Articles published between 2013–2023, studies conducted among humans with pulmonary DR-TB that reported MTBC lineages or species were included. On the other hand, studies that reported lineages or species in animals and studies conducted outside Africa were excluded. An Excel sheet was developed and used for data extraction by two independent reviewers, and the extracted data were compared and discrepancies resolved through discussion. Two independent reviewers assessed the risk of bias by applying the eight items on the JBI checklist to each of the included studies. Result A total of 491 articles were retrieved; however, 73 eligible articles were included in the final analysis after the selection and screening process. The characteristics of the selected studies show that the studies were from 21 countries, and varieties of molecular methods (IS6110-RFLP, MIRU-VNTR-16, Spoiligotyping and whole genome sequencing) were used in the included studies. Of the included studies, 75% were assessed to have low risk of bias using the JBI checklist, indicating that the overall quality of evidence is moderate to high. Across the continent, L4 was the dominant lineage 51% (8244/16 172) associated with DR-TB infection, which was followed by L2 41% (6649/16 172), L3 4.6% (741/16 172). Conclusion M. tuberculosis genotypes associated with drug-resistant pulmonary tuberculosis in Africa are L4, along with L2 and L3. The review included only studies published in the English language, and authors received no external funding for the review, authorship or publication. PROSPERO registration number CRD42024512834.