Introduction
The Mycobacterium tuberculosis (MTB) complex may be subdivided
into seven lineages (Comas et al., 2013)
with unequal geographic distribution. Among them, the Beijing lineage
(Lineage 2), has received greater attention because of its successful
global distribution, increased transmissibility and virulence, and
involvement in major outbreaks in some settings
(Bifani, Mathema, Kurepina, & Kreiswirth,
2002; Borrell et al., 2009;
Iwamoto et al., 2012;
Yang et al., 2012). Certain Beijing
clones have been associated to resistance and higher ability to
compensate for the loss of fitness linked to the acquisition of drug
resistance.
The Beijing lineage constitutes around 13% of the global MTB complex
population (Parwati, van Crevel, & van
Soolingen, 2010). Since its discovery in East Asia in 1995
(van Soolingen et al., 1995), many
studies have documented its endemic prevalence in Asia
(~50% of the circulating strains in East Asia)
(Parwati et al., 2010), as well as its
presence in South Africa (27%) (Gandhi et
al., 2014) and northern Eurasia (40-60%)
(Mokrousov, 2013). However, limited
information is available on its representativeness in other geographic
areas worldwide, e.g., the Caribbean and Central America, were an
average of 3.5 % of total tuberculosis (TB) cases in the area
associated to the Beijing lineage have been reported
(Millet, Baboolal, Streit, Akpaka, &
Rastogi, 2014) and some more specific data about its presence (2.1%)
in Guatemala, where the Beijing lineage was involved in a severe
outbreak (Saelens et al., 2015) .
The purpose of this study was to complete a preliminary information
(Dominguez et al., 2019) on the presence
of this lineage in Panama. We focused our efforts on Colon, a Panamanian
province with the highest TB incidence rate
(MINSA, 2018). Based on a modular
strategy that combined Mycobacterial Interspersed
Repetitive-Unit/Variable-Number of Tandem Repeats (MIRU-VNTR)-based
typing (Supply et al., 2006),
strain-specific PCRs, and whole genome sequencing (WGS) we aim to i)
update the data on Beijing strains in Colon, ii) evaluate the role of
Beijing strains in recent transmission active events, and iii) explore
the Beijing phylogeny and history in Panama.