Whole-genome Sequencing (WGS) for TB Strain

This pilot study used whole-genome sequencing (WGS) to screen for drug resistance in different Mycobacterium tuberculosis strains in the Indonesia population. The outcome of this study offers WGS as a rapid, affordable and comprehensive diagnostic tool that is also portable, improving the chances of being diagnosed and be given more appropriate treatment. It was also observed that drug-resistant TB strains are more common among those with Indo-Oceanic lineage compared to those with Euro-American and East-Asian lineages. That being said, those of East-Asian lineages are more susceptible to host multiple mutated strains. Therefore, WGS is a promising computational method used to understand the influence of genetic data and mutation consequences of all M. tuberculosis strains with drug resistance. It serves as a good starting point to improve clinical management and TB control efforts in developing countries like Indonesia.

There is a huge gap between multidrug-resistant TB incidence and treatment in Indonesia, leading to delayed detection and inappropriate treatment administration. Existing conventional methods, such as culture-based drug susceptibility testing (DST) and molecular-based DST, are tedious, time-consuming, inconsistent, and has incomplete sensitivity to determine multidrug-resistant TB. WGS is gradually gaining reputation as a reliable tool to predict drug resistance of different Mycobacterium tuberculosis strains, and it is yet to be explored in high-endemic settings. This study provides the first evidential data of M. tuberculosis strains resistant to first- and second-line TB drugs in Indonesia predicted using WGS. It also examines the effectiveness of phenotypic DST when cross-referenced with WGS data of different M. tuberculosis strains.

According to a 2017 report from the World Health Organization (WHO), there is a constant increase of anti-TB drug resistance cases globally, despite increased testing. It was also reported that close to 230 000 people died of TB in that year, mostly in India and China, due to ineffective TB care/treatment. To address the global multidrug-resistant TB crisis, this study contributes evidence to scale up rapid testing and detection procedures by introducing WGS as a reliable diagnostic tool. Proper diagnosis improves effectiveness of treatment, which aligns with the visions of UN SDG 3: Good health and well-being, to end the epidemics of tuberculosis by 2030.