Geographical distribution of Mycobacterium tuberculosis complex lineages in sub-Saharan Africa: an interactive review

The capacity of the 49 sub-Saharan African countries, which account for 85% of tuberculosis cases in Africa (WHO, 2025), to monitor the genomic dynamics of Mycobacterium tuberculosis complex strains responsible for the disease was examined for the period 2000-2025. A total of 8141 GenBank entries, supplemented by 163 as yet unreported whole genome sequences prepared at the Institut Hospitalier-Universitaire, Marseille, France and the Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal were analysed using TB-Profiler. M. tuberculosis sub-lineage L2.2.1 dominated the sub-continent, while other lineages and sub-lineages featured a discrete pattern of geographical distribution, here illustrated by interactive maps. Although three-quarters of the genomes showed a predicted antibiotic-susceptibility, the predicted resistant recovered in 80% countries largely comprised multidrug-resistant (MDR) genomes (12.19% of genomes), followed by Rifampicin-susceptible, isoniazid-resistant (HR-TB) genomes (4.47%), Rifampicin-resistant TB (RR-TB) genomes (3.31%), extensively drug-resistant (XDR) genomes (1.78%), and pre-XDR genomes (0.64%). Resistance to second-line antibiotics was observed with prevalence lower than that of first-line drugs. This review gives an updated, accurate, and interactive overview of tuberculosis in sub-Saharan Africa and provides a strong basis for following the current evolution of tuberculosis in African regions.