Browsing by Author "Kotey, N.K."
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Item Antibiotic Treatment Outcomes of Buruli Ulcer in Akwapem South and Suhum-Kraboa-Coaltar Districts(University of Ghana, 2013-06) Kotey, N.K.; Binka, F.N.; Junghanss, T.The World Health Organization (WHO) having recognized Buruli ulcer disease as an important cause of human suffering introduced treatment guidelines of a new protocol of 8-week initial therapy of intramuscular streptomycin and oral rifampicin in 2005. Although there has been some level of success in the treatment of Buruli ulcer with this new antibiotic protocol, some patients do not respond favourably as expected. Also, the response to chemotherapy of BU lesions including large ulcerated forms, which are currently the most common forms in Africa remains insufficiently documented. So this study set out to assess the treatment outcomes of all categories of BU lesions and determine factors that influence the healing of these lesions. This was implemented by employing a non-randomized clinical intervention design by serially recruiting 154 patients over a period of two years. Measurements of lesions were made using tracing sheets to obtain their respective surface areas. Swabs and fine needle aspirates were taken and confirmed by direct smear microscopy for acid-fast bacilli (AFB), polymerase chain reaction or culture. All patients were given a directly observed treatment (DOT) of a daily combination of intramuscular streptomycin (15mg/kg body weight) and oral rifampicin (10mg/kg body weight) for 8 weeks. There was also daily dressing for all wounds irrespective of size and weekly assessment for all forms of lesions. Patients were counseled regularly on BU management and the necessity for adhering to treatment. All patients were followed up for a minimum of 34 weeks. BU lesions were found among ages 2- 84 years. About 37% of the total study participants were less than 15 years and almost equal numbers in the age groups between 15 -49 years and over 50 years old. In those below 15 years of age there was an almost equal gender distribution whilst, in the older age groups more females than males were affected. It was found that 93.5% (144/154) of the study participants presented with ulcers. All those who reported within two months of noticing their lesions for the first time achieved 100% treatment success irrespective of category of lesion. There was 97.4% treatment success rate for all BU lesions with no recurrences within 34 weeks of treatment. About 30% of lesions showed an apparent deterioration response to treatment (paradoxical reactions) after an initial improvement at some points during treatment starting from week 2 to week 18 reaching a peak at week 10. Factors that hastened healing were smaller size of the initial lesion, regular wound dressing, removal of slough, treatment with topical antibiotics and absence of paradoxical reactions. We concluded that the combination of intramuscular streptomycin and oral rifampicin is efficacious in healing all forms of Buruli ulcer disease. Optimal and regular wound dressing regular counseling, consistent wound evaluation and timely interventions play important roles in the healing of BU lesions. In view of these findings we recommended that the National Buruli Ulcer Control Programme in collaboration with the District Assemblies and District Health Management Teams should organize regular health education activities to encourage patients to report early to health institutions and also ensure that drug treatment is combined with wound dressing effectively and efficiently in order to achieve the desired results.Item Detection of cutaneous leishmaniasis in three communities of Oti Region, Ghana(PLOS, 2021) Akuffo, R.; Sanchez, C.; Chicharro, C.; Carrillo, E.; Attram, N.; Mosore, M.; Yeboah, C.; Kotey, N.K.; Boakye, D.; Ruiz-Postigo, J.; Moreno, J.; Wilson, M.; Sarfo, B.; Anto, F.Cutaneous leishmaniasis (CL) is the most common type of leishmaniasis, a neglected tropical disease caused by parasites of the genus Leishmania. In Ghana, some studies in the Volta region have detected Leishmania parasites among persons with skin ulcers. Using a cross-sectional study design, the prevalence of CL in three communities of the Oti Region of Ghana was investigated. Demographic and epidemiological data were obtained by a structured interviewer administered questionnaire. A total of 426 (12.4%) out of 3,440 participants screened had at least one skin ulcer. Of 595 skin ulcers sampled and tested by PCR for Leishmania infection, 150 (25.2%) ulcers from 136 individuals tested positive, accounting for an overall CL prevalence of 31.9% among persons with skin ulcers. Individual community CL prevalence of 23.2%, 29.8%, and 36.8% was observed in Ashiabre, Keri, and Sibi Hilltop respectively among persons with skin ulcers. Confirmation of CL in the study area suggests an active cycle of transmission of Leishmania infection. The observation of skin ulcers which tested negative to Leishmania infection suggests a need to test for additional causes of skin ulcers such as Treponema pallidum pertenue and Mycobacterium ulcerans in the study area.Item Genetic Diversity of Staphylococcus aureus in Buruli Ulcer(Public Library of Science, 2015) Amissah, N.A.; Glasner, C.; Ablordey, A.; Tetteh, C.S.; Kotey, N.K.; Prah, I.; van der Werf, T.S.; Rossen, J.W.; van Dijl, J.M.; Stienstra, Y.Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. Previous studies have shown that wounds of BU patients are colonized with M. ulcerans and several other microorganisms, including Staphylococcus aureus, which may interfere with wound healing. The present study was therefore aimed at investigating the diversity and topography of S. aureus colonizing BU patients during treatment. We investigated the presence, diversity, and spatio-temporal distribution of S. aureus in 30 confirmed BU patients from Ghana during treatment. S. aureus was isolated from nose and wound swabs, and by replica plating of wound dressings collected bi-weekly from patients. S. aureus isolates were characterized by multiple-locus variable number tandem repeat fingerprinting (MLVF) and spa-typing, and antibiotic susceptibility was tested. Nineteen (63%) of the 30 BU patients tested positive for S. aureus at least once during the sampling period, yielding 407 S. aureus isolates. Detailed analysis of 91 isolates grouped these isolates into 13 MLVF clusters and 13 spa-types. Five (26%) S. aureus-positive BU patients carried the same S. aureus genotype in their anterior nares and wounds. S. aureus isolates from the wounds of seven (37%) patients were distributed over two different MLVF clusters. Wounds of three (16%) patients were colonized with isolates belonging to two different genotypes at the same time, and five (26%) patients were colonized with different S. aureus types over time. Five (17%) of the 30 included BU patients tested positive for methicillin-resistant S. aureus (MRSA). The present study showed that the wounds of many BU patients were contaminated with S. aureus, and that many BU patients from the different communities carried the same S. aureus genotype during treatment. This calls for improved wound care and hygiene. © 2015 Amissah et al.Item Susceptibility profiles of mycobacterium Ulcerans isolates to streptomycin and Rifampicin in two districts of the Eastern Region of Ghana(International Journal of Microbiology, 2016-01) Owusu, E.; Newman, M.J.; Kotey, N.K.; Akumwena, A.; Bannerman, E.Background. Drug resistance is a major challenge in antibiotic chemotherapy. Assessing resistance profiles of pathogens constitutes an essential surveillance tool in the epidemiology and control of infectious diseases, including Buruli ulcer (BU) disease. With the successful definitive management of BU using rifampicin and streptomycin, little attention had been paid to monitoring emergence of resistant Mycobacterium ulcerans (M. ulcerans) isolates in endemic communities. This study investigated the susceptibility profiles of M. ulcerans isolates from two BU endemic areas in Ghana to streptomycin and rifampicin. Methods. The antibiotic susceptibility of seventy (70) M. ulcerans isolates to rifampicin and streptomycin was determined simultaneously at critical concentrations of 40 μg/mL and 4 μg/mL, respectively, by the Canetti proportion method. Results. Resistance to rifampicin was observed for 12 (17.1%) M. ulcerans isolates tested, whilst 2 (2.9%) showed resistance to streptomycin. None of the isolates tested showed dual resistance to both rifampicin and streptomycin. Conclusion. Outcomes from this study may not be reflective of all BU endemic communities; it, however, provides information on the resistance status of the isolates, which is useful for monitoring of M. ulcerans, as well as BU disease surveillance and control. © 2016 Enid Owusu et al.