Pneumococcal Carriage Among HIVAIDS Patients in Accra, Ghana.

Abstract

Background: Streptococcus pneumoniae is part of the normal flora of the upper respiratory tract (nasopharynx) and carriage is a prerequisite for invasive pneumococcal diseases and dissemination of the pathogen from-person-to-person. HIV/AIDS patients are 30-100times more vulnerable to pneumococcal infections compared to HIV negative individuals. General Aim: The aim of the study was to investigate the epidemiology of pneumococcal carriage among HIV/AIDS patients at the Korle Bu Teaching Hospital and Princess Marie Louise Hospital, in Accra, Ghana. Methodology: The research was a prospective cross-sectional study. A total of 245 nasopharyngeal swabs were collected from consenting HIV/AIDS positive patients visiting the Korle Bu Teaching Hospital and the Princess Marie Louise Hospital in Accra, Ghana from November 2016 to March 2017. The samples were transported in Skim milk-tryptone soya broth glucose-glycerol(STGG) media on ice to the Microbiology Laboratory of the University of Ghana School of Biomedical and Allied Health and Sciences, Korle-Bu for processing. Identification and characterization of S. pneumoniae were done based on standard bacteriological methods described by the World Health Organization and the Clinical and Laboratory Standards Institute. Epidemiological data pertaining to demography, household characteristics and medical history were obtained from the study participants using a structured questionnaire.

Results: Overall, pneumococcal carriage amongst the study population was determined to be 11.0%; carriage prevalence among the HIV/AIDS positive children and adults were 25.0% and 7.3% respectively. Pneumococcal antibiotic resistance prevalence was, Levofloxacin (0.0%), Erythromycin (7.4%), Tetracycline (66.7%), Cotrimoxazole (92.6%) and Penicillin non susceptibility defined as partial or complete resistance to penicillin was determined to be 25.9%. The prevalence of multidrug resistance defined as non-susceptibility to penicillin and two or more of the other classes of antibiotics used for this study was 18.5%. History of pneumococcal disease in the past 1year prior to sampling, Gender, School attendance and presence of respiratory symptoms were found to have significant associations with pneumococcal carriage with p-values <0.05 each.

Conclusion: Overall, about one-tenth of the study participants carried pneumococcus and carriage in the children was 3-folds higher than in adults. Tetracycline and Cotrimoxazole may therefore be unsuitable for treating pneumococcal disease in HIV positive people. Several demographic and clinical features were found to have significant associations with pneumococcal carriage.