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INTRODUCTION: Salmonella infections cause significant morbidity and mortality, especially in resource-limited countries. The situation is worsened by widespread presence of multidrug resistant (MDR) strains, largely encoded on conjugative plasmids, but with little knowledge about how these plasmids are identified especially in low-middle income countries. We present findings of various plasmid variants possibly encoding MDR salmonella from Ghana. METHODS: this was a cross-sectional study involving individuals suspected of having salmonella infection presenting at two major hospitals in Ghana. Blood, stool and oropharyngeal specimens (OPS) were taken from consenting individuals between May, 2016 and January, 2018. Identification of salmonella was done using standard microbiological procedures. Total DNA was extracted from MDR salmonella isolates and PCR-based replicon typing (PBRT) performed using 30 replicons representative of the major incompatibility groups among Enterobacteriaceae. RESULTS: of 2,376 samples collected, 101 (4.3%) salmonella were isolated. Multidrug-resistant salmonella was detected in 34 (33.7%) strains; S. Typhi (67.6%), NTS (32.4%). Four different incompatibility (Inc) groups were identified by PBRT. Eleven S. Typhi bacteremic isolates (32.4%), harboured plasmids with Inc group HI1 of target size 534bp. The most predominant replicon (13/34; 38.2%) belonged to IncU plasmid. Non-typhoidal salmonella harboured 1 rare IncX2 plasmid and 8 IncFIIS plasmids known to encode resistance to carbapenems, colistins and several virulence genes. CONCLUSION: this study shows presence of circulating plasmid variants likely to confer MDR in salmonella from clinical isolates. This is the first time Ghana has reported 3 (IncU, IncFIIS, IncX) of 4 variants and these are similar to those circulating in Africa but one (IncFIIS).
BACKGROUND Transfusion‐transmitted malaria (TTM) has not been studied with molecular means in hyperendemic areas where it is assumed to occur frequently. The African Investigation of the Mirasol System (AIMS) trial provided the opportunity to study TTM from standard whole blood (WB) units. STUDY DESIGN AND METHODS The Plasmodium genome in transfused WB units and patient samples both before transfusion and 1, 3, 7, and 28 days after transfusion was screened and quantified using real‐time polymerase chain reaction. Parasitemic samples were confirmed, three alleles were sequenced, and the percentage homology was determined between paired WB units and patient samples. Anti‐ Plasmodium titers were quantified by serial dilution. Clinical symptoms and microscopic detection of malaria were monitored. RESULTS Microscopy was negative below 3 × 10 6 genome copies/mL. Thirty‐seven patients who were nonparasitemic before transfusion were exposed to parasitemic WB. The amount of Plasmodium genome load transfused ranged between 0.1 × 10 6 and 2.0 × 10 9 copies. The parasite load received through transfusion by 13 patients with TTM was higher than that received by patients without TTM (p = 0.01). Patients with a single parasitemic posttransfusion sample were not considered to have TTM. Four elements critical to predict outcome emerged: parasite load, patient anti‐ Plasmodium titer pretransfusion, percentage clearance of parasites at Day 1, and level of anti‐ Plasmodium humoral immune response. Four patients with TTM became parasite‐free at Day 28 (effective control), four patients with TTM maintained relatively stable levels of parasitemia (uncertain control), and five patients reached high levels of parasitemia at Day 28 posttransfusion, indicating ineffective control of malarial infection by semi‐immune individuals. CONCLUSIONS TTM in endemic areas is relatively frequent (13 of 112 donations; 11.6%) and, although largely controlled by semi‐immunity in recipient patients, may require antimalarial treatment.
Patients already colonized with multidrug-resistant (MDR) Gram-negative bacteria (GNB) on admission to critical care units may be an important source of transmission of these bacteria in hospitals. We sought to determine the prevalence of MDR GNB colonization in patients, staff and the ward environment and to assess the risk factors for colonization of patients in wards.The study was conducted from April 2021 to July 2021 in a teaching hospital in Ghana. MDR GNB were isolated from rectal, and hand swabs were taken from patients on admission and after 48 h. Swabs from HCW's hands and the ward environment were also taken. Risk factors for colonization with MDR GNB were assessed using univariate and multivariate analysis.MDR GNB rectal colonization rate among patients was 50.62% on admission and 44.44% after 48 h. MDR GNB were isolated from 6 (5.26%) and 24 (11.54%) of HCW's hand swabs and environmental swabs, respectively. Previous hospitalization (p-value = 0.021, OR, 95% CI= 7.170 (1.345-38.214) was significantly associated with colonization by MDR GNB after 48 h of admission. Age (21-30 years) (p-value = 0.022, OR, 95% CI = 0.103 (0.015-0.716) was significantly identified as a protective factor associated with a reduced risk of rectal MDR GNB colonization.The high colonization of MDR GNB in patients, the carriage of MDR GNB on HCW's hands, and the contamination of hospital environments highlights the need for patient screening and stringent infection prevention and control practices to prevent the spread of MDR GNB in hospitals.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) are a major cause of hospital- and community-acquired infection. They can colonize humans and cause a wide range of infections including pneumonia, endocarditis and bacteraemia. We investigated the molecular mechanism of resistance and virulence of MRSA isolates from a teaching hospital in Ghana.Methodology: A total of 91 S. aureus isolates constituted the initial bacterial sample. Identification of S. aureus was confirmed by the VITEK 2 system. The cefoxitin screen test was used to detect MRSA and antibiotic susceptibility was determined using the VITEK 2 system. The resistance (mecA, blaZ, aac-aph, ermC, and tetK) and virulence (lukS/F-PV, hla, hld and eta) genes were amplified by polymerase chain reaction (PCR) and positive samples subjected to DNA sequencing. Pulsed field gel electrophoresis (PFGE) was used to ascertain the relatedness of the isolates.Results: Fifty-eight of 91 (63.7%) isolates were putatively methicillin resistant by the phenotypic cefoxitin screen test and oxacillin MICs. However, 43 (47%) of the isolates were genotypically confirmed as MRSA based on PCR detection of the mecA gene. Furthermore, 37.9% of isolates displayed resistance to tetracycline, 19% to trimethoprim-sulphamethoxazole, 15.5% to clindamycin, 12.1% to gentamicin, 13.8% to ciprofloxacin and erythromycin, 6.9% to moxifloxacin and 7.0% to rifampicin. None of the isolates was positive for inducible clindamycin resistance. The prevalence of resistance (mecA, blaZ, aac(6')-aph(2''), tetK, and ermC) and virulence (hla and lukS/F-PV) genes respectively were 74%, 33%, 22%, 19%, 3%, 5% and 3%, with isolates organized in two highly related clades.Conclusion: Results indicate a fairly high occurrence of MRSA, which can complicate the effective therapy of S. aureus infections, necessitating surveillance and stringent infection control programmes to forestall its spread.Keywords: MRSA, mecA, blaZ, hla, lukS/F-PV
ObjectivesThis study delineated the clonal lineages, antibiotic resistome and plasmid replicon types in multidrug-resistant K. pneumoniae isolates from a teaching hospital in Ghana.MethodsIdentification and antibiotic susceptibility testing were done using the MALDI-TOF MS and Vitek-2 automated system. Genomic DNA extraction was carried out using the NucliSens easyMAG® (BioMérieux) kits and the DNA was subjected to whole genome sequencing (WGS) using the Illumina MiSeq platform.ResultsOf the 200 isolates obtained, 37 were identified as K. pneumoniae of which 9 were resistant to all second and third-generation cephalosporins. These 9 isolates selected for further genomic analysis were characterized by the presence of 8 diverse sequence types (STs), capsular polysaccharide serotypes (K types and wzi allelic types) and multiple genes encoding resistance to β-lactams (blaCTX-M-15, blaSHV-11, blaTEM-1B, blaOXA-1), aminoglycosides (aac(3)-IIa, strB, strA, aadA16), fluoroquinolones/quinolones (qnrB66, oqxA, oqxB) and other antibiotic classes. Resistance genes were associated with plasmids, predominantly IncFIB(K) and ColRNAI. Multiple and diverse mutations in quinolone resistance-determining regions of gyrA (S83Y, D87A) and parC (S80I, N304S) in isolates resistant to ciprofloxacin (MIC ≥ 4 mg/mL) were found. Global phylogenomic analysis affirmed the diverse clonal clustering and origin of these isolates.ConclusionsThe varied clonal clusters and resistome identified in the multidrug-resistant K. pneumoniae isolates is a major threat to the management of infections in Ghana. The molecular characterization of antibiotic resistance is thus imperative to inform strategies for containment.
Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana.From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros® /Abbott-Architect® algorithm as gold standard.A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%).Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors.
The current burden of Hepatitis C virus infection and the availability of HCV-related services in Ghana are not well described. Previous estimates on HCV seroprevalence in the country are outdated. This study investigated the HCV seroprevalence and testing and treatment capacity in Ghana. A multi-centre cross-sectional study was conducted in which laboratory and blood bank registers from 17 public healthcare institutions in Ghana were reviewed. A survey on cost and availability of HCV-related testing and treatment was also performed. Crude and pooled estimates of HCV seroprevalence, frequency and median cost of available diagnostic tests and medicines were described. The crude HCV seroprevalence was 2.62% (95% CI 2.53-2.72) and the pooled estimate was 4.58% (95% CI 4.06-5.11) among 103,609 persons tested in laboratories. Age (OR 1.02 95% CI 1.01-1.02) and male sex (OR 1.26 95% CI 1.08-1.48) were predictors of a positive anti-HCV RDT test. Northern administrative regions in Ghana had the highest HCV seroprevalence ranging from 8.3-14.4%. Among 55, 458 potential blood donors, crude HCV seroprevalence was 3.57% (95% CI 3.42-3.72). Testing was through Rapid Diagnostic Test (RDT) kits in most facilities, and only 2 of 17 centres were performing HCV RNA testing. The median cost of an anti-HCV RDT test was $0.97 (0-1.61) and $3.23 (1.61-7.58) for persons with and without government health insurance respectively. The median cost of a 12-week course of the pan-genotypic direct-acting antiviral therapy sofosbuvir-daclatasvir was $887.70. In conclusion, there are significant regional differences in HCV burden across Ghana. Limited access to and cost of HCV RNA and DAA therapy hinders testing and treatment capability, and consequently HCV elimination efforts. A national HCV program supported with a sustainable financing plan is required to accelerate HCV elimination in Ghana.
Journal Article Plasma glutamine levels and falciparum malaria Get access G. Cowan, G. Cowan 1Department of Molecular Parasitology, Institute of Molecular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar T. Planche, T. Planche 2Department of Infectious Diseases, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar T. Agbenyega, T. Agbenyega 3Department of Child Health, Komfo-Anokye Teaching Hospital, Kumasi, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar G. Bedu-Addo, G. Bedu-Addo 3Department of Child Health, Komfo-Anokye Teaching Hospital, Kumasi, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar A. Owusu-Ofori, A. Owusu-Ofori 3Department of Child Health, Komfo-Anokye Teaching Hospital, Kumasi, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar J. Adebe-Appiah, J. Adebe-Appiah 3Department of Child Health, Komfo-Anokye Teaching Hospital, Kumasi, Ghana Search for other works by this author on: Oxford Academic PubMed Google Scholar D. Agranoff, D. Agranoff 2Department of Infectious Diseases, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar C. Woodrow, C. Woodrow 2Department of Infectious Diseases, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar L. Castell, L. Castell 4Department of Biochemistry, University of Oxford, Oxford, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar B. Elford, B. Elford 1Department of Molecular Parasitology, Institute of Molecular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more S. Krishna S. Krishna 2Department of Infectious Diseases, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK Address for correspondence: Dr Sanjeev Krishna, Department of Infectious Diseases, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK; phone +44 (0) 181 725 5836, fax +44 (0)181 725 3487, e-mail s.krishna@sghms.ac.uk Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 93, Issue 6, November-December 1999, Pages 616–618, https://doi.org/10.1016/S0035-9203(99)90070-6 Published: 01 November 1999 Article history Received: 08 June 1999 Revision received: 03 September 1999 Accepted: 03 September 1999 Published: 01 November 1999
Objectives:Performing routine lumbar punctures in children with febrile seizures has been controversial. This study aimed to determine the positive yield of lumbar punctures in a setting where routine lumbar puncture is routinely carried out and to determine if any other parameter could help differentiate bacterial meningitis from the various other diagnoses of children who presented with a febrile seizure.Design:A prospective study was carried out among children aged three months to 15 years of age, hospitalized at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between July and August 2000.Results:There was a 10.2% (n = 19) positive yield for bacterial meningitis with a case fatality rate of 36.8% (n = 7). Cerebral malaria, which is not easily distinguishable from bacterial meningitis, accounted for 16.1% (n = 30) of the children. Twenty percent of bacterial meningitis patients had a positive blood smear for malaria. The indication for doing a lumbar puncture was similar in both cerebral malaria and bacterial meningitis patients. Signs of meningism were not the primary reason for carrying out a lumbar puncture, even in the group of children who had bacterial meningitis.Conclusion:Performing routine lumbar punctures may still have a role to play in the management of children with febrile seizures.
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