Genotypic and phenotypic diversity of the multidrug-resistant <i>Mycobacterium tuberculosis</i> strains from eastern India

Abstract Mycobacterium tuberculosis (Mtb) poses a great challenge to human health and wellbeing and hinders economic growth of a region. India along with other south east Asian countries are known as high Tuberculosis burden countries. Adoption of whole genome sequencing in studying genetic diversity, evolution, transmission pattern and drug resistance development provided a great opportunity for developing and improving diagnostic and therapeutic approaches. In our study we have sequenced 118 Mtb whole genome from North East(NE) and Odisha as a representative of the diversity in eastern region of India for the first time. We observed high prevalence of multi-drug resistant(MDR) lineage-2(n=52) strains in NE whereas presence of mostly lineage-1(n=30) &amp; 3 (n=11) strains in Odisha. The MDR strains from Sikkim demonstrated similar resistance profile of fluroquinolones and pair-wise SNP distances showed presence of local transmission clusters. We also detected significant enrichment of short INDELs in MDR samples in contrast to drug susceptible samples. This study provides molecular level insight into Mtb strains of eastern region in comparison with Indian and global perspective.