Bacteriology Department

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    Antimicrobial Resistance Levels of Non-Tuberculous Bacteria Isolates from Sputum of TB Patients in Ghana.
    (Dove Medical Press Limited, 2024-12-18) Morgan, P.A.; Ntiamoah, D.O.; Asare, P.; Mintah, I.S.; Osei-Wusu, S.; et al
    Background: Patients with tuberculosis (TB) often harbor diverse bacteria in their sputum, including both commensal and opportunistic pathogens. This study aimed to characterize the sputum microbiota of TB patients before and after the intensive phase of anti-TB treatment and assess changes in bacterial diversity and antibiotic resistance profiles. Methods: A total of 162 patients with TB (128 males, 34 females; age range 18–82 years) provided sputum samples at baseline, of which 72 provided follow-up sputum after two months of intensive phase treatment. Sputum samples were cultured on standard agar plates, and distinct colonies were identified by Gram staining and bio-typing using MALDI-TOF mass spectrometry. Antibiotic susceptibility testing of the identified Gram-positive and Gram-negative bacteria was performed using the Kirby–Bauer method according to the CLSI guidelines. Results: At baseline, 209 bacterial isolates were recovered, dominated by Gram-positive bacteria (GPB), particularly Streptococcus oralis (19.6%) and Staphylococcus aureus (13.9%). After treatment, the isolation rate significantly decreased (from 129% to 95.8%; p = 0.000002), with a shift towards Gram-negative bacteria (GNB) dominated by E. coli. High rates of antibiotic resistance were observed for both the GNB and GPB, notably to ampicillin (86.7%), tetracycline (74%), amoxicillin (70.3%), and sulfamethoxazole (63%) for GNP, and PEN (76.9%) for the GPB. 53% of S. aureus isolates were phenotypic Methicillin-resistant S. aureus (MRSA) and 57.7% of suspected extended-spectrum Beta-lactamase (ESBL) producers were confirmed positive, predominantly carrying the blaCTX-M-1 gene. Conclusion: The observed antibiotic resistance among the identified isolates, including MRSA and ESBL, underscores the need for routine antibiotic susceptibility testing and judicious antibiotic use in Ghana. Further research is needed to explore the long-term consequences of these microbiome shifts on TB treatment outcomes and risk of secondary infections. Plain Language Summary: Tuberculosis (TB) continues to be the leading cause of adult mortality owing to a single infectious disease. The interplay between TB, diabetes, and HIV has become prominent in current TB research. However, the influence of these interactions on lung microflora, other than TB bacilli, has not been extensively explored. Notwithstanding, there is a potential interaction between these non-tuberculous bacteria and TB bacilli, which may impact disease progression and treatment outcomes of TB disease, irrespective of co-infection with HIV or comorbid diabetes. We observed antibiotic resistance among identified non tuberculous bacteria isolated from the lungs of TB patients in Ghana, irrespective of co-infection with HIV or comorbidity with diabetes, including resistance to the commonly used drugs for treating bacterial diseases. This underscores the need for routine antibiotic susceptibility testing and judicious antibiotic use in Ghana.
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    Tuberculosis patients with diabetes co-morbidity experience reduced Mycobacterium tuberculosis complex clearance
    (Heliyon, 2024) Danso, E. K.; Asare, P.; Osei-Wusu, S.; et al.
    Objective: This study aimed to investigate the impact of diabetes mellitus (DM) on tuberculosis (TB) treatment response using bacterial clearance as a surrogate marker. Method: We compared smear microscopy, culture, and tuberculosis molecular bacterial load assay (TB-MBLA) for treatment monitoring. Following that, bacterial clearance was longitudinally monitored among TB-only (TB without DM) and TB-diabetes (TBDM) patients using TB-MBLA. Results: Ninety-three participants, including 59 TB-only and 34 TBDM patients, were enrolled. TB only patients exhibited higher upper zone infiltrations (32/35 vs 16/22, p = 0.059) suggesting a trend towards significance, and significantly more cavitation in the same zone (16/18 vs 7/13, p = 0.028). There was a high proportion of Mycobacterium africanum (Maf) among the TBDM cohort (p = 0.0044). At baseline, TB-only patients exhibited a higher average bacterial burden (4.49 logeCFU/mL) compared to the TBDM group (3.91 logeCFU/mL) (p = 0.042). The bacterial load in the TB-only group decreased significantly during treatment but the TBDM group experienced delayed clearance throughout the intensive phase of anti-TB treatment even at day 56 (p = 0.028). The TB-only group demonstrated a shorter median time to TB-MBLA conversion to negative (57 days) compared to the TBDM group (62 days) (p = 0.022). Conclusion: These findings underscore the urgent call for understanding the interplay between diabetes and TB, emphasizing the need for tailored interventions in optimizing TB care for individuals comorbid with diabetes.
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    Impact of COVID-19 lockdown measures on mother and child health – the case of Ghana
    (BMC Public Health, 2024) Koka, E.; Asante-Poku, A.; Siam, M.; et al.
    Background The lockdown measures in response to the coronavirus disease (COVID-19) have led to a wide range of unintended consequences for women and children. Until the outbreak of COVID-19, attention was on reducing maternal and infant mortality due to pregnancy and delivery complications. The aim of this study was to interrogate the impact of lockdown measures on women and children in two contrasting districts in Ghana – Krobo Odumase and Ayawaso West Wuogon. Methods This study adopted the mixed-method approach using both qualitative and quantitative data. The qualitative study relied on two data collection methods to explore the impacts of COVID-19 control measures on women and children in Ghana. These were: Focus Group Discussions (FGDs; n=12) and Key Informant Interviews (KIIs; n=18). The study complemented the qualitative data with survey data - household surveys (n=78) which were used to support the nutrition and school closure data; and policy data gathered from government websites consisting of government responses to COVID-19. The qualitative data was analysed using the thematic approach with codes generated apriori with the NVIVO software. The quantitative data used percentages and frequencies. Results Engagements with participants in the study revealed that the lockdown measures implemented in Ghana had consequences on child and maternal health, and the health care system as a whole. Our study revealed, for example, that there was a decrease in antenatal and postnatal attendance in hospitals. Childhood vaccinations also came to a halt. Obesity and malnutrition were found to be common among children depending on the location of our study participants (urban and rural areas respectively). Our study also revealed that TB, Malaria and HIV treatment seeking reduced due to the fear of going to health facilities since those ailments manifest similar symptoms as COVID 19. Conclusion Government responded to COVID-19 using different strategies however the policy response resulted in both intended and unintended consequences especially for women and children in Ghana. It is recommended that national policy directions should ensure the continuous provision of child and maternal healthcare services which are essential health services during lockdowns.
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    Epidemiology, antimicrobial resistance profile and management of carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia
    (Annals of Clinical Microbiology and Antimicrobials, 2024) Gadisa, E.; Egyir, B.; Adu, B.; Ahmed, H.; Disasa, G.; Tessema, T.S.
    Background Early detection and proper management of maternal sepsis caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) can significantly reduce severe complications and maternal mortality. This study aimed to describe the epidemiology, antimicrobial resistance profile, and management of carbapenem-resistant K. pneumoniae among sepsis-suspected maternal cases in Ethiopia. Methods A prospective cross-sectional study was conducted in five tertiary hospitals from June 2021 to December 2023. Isolation, identification, and antimicrobial susceptibility testing of the isolates were carried out following standard microbiological procedures as stated in the CLSI guidelines. Data on socio-demographics, risk factors, and management strategies were collected with structured questionnaires. Associations between variables were determined using logistic regression analysis in STATA-21. A p-value of less than 0.05 was statistically significant. Results Of the 5613 total women suspected of having maternal sepsis, 609 (10.8%) of them were infected with K. pneumoniae. The prevalence rates of MDR, XDR, and PDR K. pneumoniae strains were 93.9%, 24.3%, and 10.9%, respectively. The resistance rates for the last-resort antibiotics; amikacin, tigecycline, carbapenem, and third generation cephalosporin were 16.4%, 29.1%, 31.9%, and 93.0%, respectively. The combination of carbapenem with tigecycline or amikacin therapy was used to manage maternal sepsis caused by cephalosporin-and carbapenem resistant strains. Sepsis associated risk factors, including septic abortion [AOR=5.3; 95%CI:2.2–14.4]; extended hospitalization [AOR=3.7; 95%CI: 1.6–19.4]; dilatation and curettage [AOR=2.2; 95%CI:1.3–13.4]; cesarean wound infection [AOR=4.1; 95%CI:2.0–9.2]; indwelling catheterization [AOR=2.1;95%CI: 1.4–6.2]; ICU admission [AOR=4.3; 95%CI:2.4–11.2]; post abortion [AOR=9.8; 95%CI:5.7–16.3], and recurrent UTI [AOR=3.3; 95%CI: 1.6–13.2] were significantly associated with maternal sepsis caused by K. pneumoniae. Conclusions The prevalence of maternal sepsis caused by carbapenem- resistant K. pneumoniae is high and serious attention needs to be given to combat transmission. Therefore, improving awareness, early diagnosis, IPC, integrated maternal surveillance, improved sanitation and efficient antimicrobial stewardship are crucial to combating bacterial maternal sepsis.
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    Rare Serovars Of Non-Typhoidal Salmonella Enterica Isolated From Humans, Beef Cattle And Abattoir Environments In Nigeria
    (PLOS ONE, 2024) Aworh, M.K.; Egyir, B.; Owusu, F.A.; et al.
    Introduction Salmonella is considered one of the most significant pathogens in public health since it is a bacterium that is frequently linked to food-borne illnesses in humans. Some Salmonella serovars are responsible for outbreaks that are connected to the consumption of animal products. Cattle are connected to humans through a shared environment and the food chain. a significant source of animal protein. In Nigeria, antimicrobial medications are easily accessible for use in food-producing animals. Abattoir environments are reservoirs of foodborne bacteria like non-typhoidal Salmonella enterica (NTS) that have become resistant to antibiotics used for prophylaxis or treatment in animals. This study investigated the prevalence of and resistance patterns of Salmonella enterica serovars in abattoir employees, beef cattle and abattoir environments in Abuja and Lagos, Nigeria. Methods A total of 448 samples were collected from healthy personnel, slaughtered cattle, and abattoir environments between May and December 2020. Using Kirby-Bauer disk diffusion method, the resistance profile of NTS isolates was determined. Multidrug resistance (MDR) was considered when NTS was resistant to three antimicrobial drug classes. We performed phenotypic and genotypic characterizations of all Salmonella isolates, including serotyping. Descriptive statistics were used to analyze the data. Results Twenty-seven (6%) NTS isolates were obtained. The prevalence of NTS was highest in abattoir environments (15.5%; 9/58), followed by cattle (4.8%; 13/272) and abattoir employees (4.2%; 5/118). A high prevalence of resistance was observed for gentamicin (85.2%; 23/27) and tetracycline (77.8%; 21/27). Whole-genome sequencing of 22 NTS showed dissemination of aac (6')-laa (22/22), qnrB19 (1/22), fosA7 (1/22), and tetA (1/22) genes. Serovar divergence of NTS varied with source. S. Anatum, a rare serovar, predominated with a prevalence of 18.2% (4/22). Chromosomal point mutations showed ParC T57S substitution in 22 NTS analyzed. Among 22 NTS, 131 mobile genetic elements (MGEs) were detected, including insertion sequences (56.5%) and miniature inverted repeats (43.5%). Two integrating MGEs IS6 and IS21 were observed to carry the tetA gene and Incl-1 on the same contig in NTS originates from cattle. Rare serovars, namely S. Abony and S. Stormont with MDR phenotypes recovered from cattle and abattoir environments were closely related with a pairwise distance of 5 SNPs. Conclusions The first report of rare serovars in Nigeria with MDR phenotypes in humans, cattle, and abattoir environments. This study demonstrates the spread of resistance in the abattoir environment possibly by MGEs, and emphasizes the importance of genomic surveillance. Beef cattle may be a risk to public health because they spread a variety of rare Salmonella serovars. Therefore, encouraging hand hygiene among abattoir employees while processing beef cattle will further reduce NTS colonization in this population. This requires a One Health collaborative effort among various stakeholders in human health, animal health, and environmental health
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    From research to health policy: The Noguchi story in the past, present and next 25 years
    (Frontiers in Tropical Diseases, 2023) Yeboah-Manu, D.; Odoom, J.K.; Osei-Wusu, S.; et al.
    The Noguchi Memorial Institute for Medical Research (NMIMR) is a semi-autonomous institute of the College of Health Sciences, University of Ghana. Legon. Founded in 1979, the Institute was built with grant aid from the Government of Japan as a gift to the people of Ghana in memory of the renowned Japanese medical scientist, Dr. Hideyo Noguchi, who died from Yellow fever infection while conducting research on the disease in Ghana. The The institute has a three-pronged mandate to conduct health-related research, build human capacity and provide specialized diagnostic and disease monitoring services in support of the Ghana Health Service. Over the past 40 years, the Institute has grown to be a leading biomedical research institute in the African region. It has strong and long-standing collaborations with scientists and institutions in Africa, Japan, Europe, Australia and North America on several projects on diseases of public health importance. The Institute also hosts several regional and national centers, such as the Regional Influenza Laboratory. The The institute's research activities are relevant to the control and prevention of infectious diseases in Ghana, particularly HIV/AIDS, Tuberculosis, Buruli ulcer, Polio, malaria, and emerging infectious diseases. The Institute also plays a technical/advisory role to government through collaborations with disease control programmes and has since inception provided the country with needed critical evidence in support of health policy as well as laboratory diagnostic services, among others. Going forward, the Institute seeks to expand and consolidate its activities in areas of antimicrobial resistance (AMR), clinical trials, genomic surveillance and academic programs, and in the next 25 years, NMIMR hopes to approach every research area using one health approach.
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    Inflammasome-triggered IL-18 controls skin inflammation in the progression of Buruli ulcer
    (PLOS Pathogens, 2023) Suzuki, T.; Boonyaleka, K.; Ablordey, A.S.; et al.
    Buruli ulcer is an emerging chronic infectious skin disease caused by Mycobacterium ulcerans. Mycolactone, an exotoxin produced by the bacterium, is the only identified virulence factor so far, but the functions of this toxin and the mechanisms of disease progression remain unclear. By interfering with the Sec61 translocon, mycolactone inhibits the Sec61-dependent co-translational translocation of newly synthesized proteins, such as induced cytokines and immune cell receptors into the endoplasmic reticulum. However, in regard to IL-1β, which is Secreted by a Sec61-independent mechanism, mycolactone has been shown to induce IL-1β secretion via activation of inflammasomes. In this study, we clarified that cytokine induction, including that of IL-1β, in infected macrophages was suppressed by mycolactone produced by M. ulcerans subsp. shinshuense, despite the activation of caspase-1 through the Inflammasome activation is triggered in a manner independent of mycolactone. Intriguingly, mycolactone suppressed the expression of proIL-1β as well as TNF-α at the transcriptional level, suggesting that mycolactone of M. ulcerans subsp. shinshuense may exert additional inhibitory effect on proIL-1β expression. Remarkably, constitutively produced IL-18 was cleaved and mature IL-18 was actually released from macrophages infected with the causative mycobacterium. IL-18-deficient mice infected subcutaneously with M. ulcerans experienced exacerbated skin inflammation during the course of disease progression. On the other On the other hand, IL-1β controls bacterial multiplication in skin tissues. These results provide information regarding the mechanisms and functions of the induced cytokines in the pathology of Buruli ulcer.
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    Management of diseases in a ruminant livestock production system: a participatory appraisal of the performance of veterinary services delivery, and utilization in Ghana
    (BMC Veterinary Research, 2023) Nuvey, F.S.; Mensah, G.I.; Addo, K.K.; et al.
    Introduction Sustainable livestock production remains crucial for the attainment of food security globally and for safeguarding the livelihoods of many households in low- and middle-income countries. However, the high prevalence of infectious livestock diseases, coupled with inadequate provision and adoption of effective control measures, leads to reduced livestock productivity, increased animal mortalities, and the emergence of antimicrobial-resistant pathogens. This study sought to assess the management strategies employed by farmers for priority diseases affecting their animals and the utilization and performance of veterinary services. Methods We conducted the study in three districts, namely, Mion, Pru East, and Kwahu Afram Plains South Districts. which represent the main livestock production belts in Ghana. We used questionnaires in surveys to collect pertinent data from 350 ruminant livestock farmers and 13 professional veterinary ofcers (VOs) in the study districts. Additionally, we conducted seven focus group discussions (FGDs) with 65 livestock farmers in the study districts. The survey data was analyzed, and we describe the distribution of the priority livestock diseases, the disease management strategies employed, and the performance of veterinary services in Ghana. We also analyzed the raw FGD transcript texts deductively based on the study objectives. To validate findings across the different datasets, we used triangulation. Results Almost all the farmers (98%) reared small ruminants, with about 25% also rearing cattle. The main priority livestock diseases identified includes pestes-des-petits-ruminants and mange infection in sheep and goats. as well as contagious bovine pleuropneumonia and foot-and-mouth disease in cattle. We found that majority (82%) of the farmers relied on treatment, while only 20% opted for vaccination services. Additionally, the veterinary system in Ghana did not adequately regulate the antimicrobial medications employed by farmers to manage diseases. Thus, In most of the cases, the medicines applied by farmers were not useful for the target diseases. Although our findings show the farmers perceived VOs to perform highly compared to informal providers on most of the attributes evaluated, including medicine availability and quality, treatment effectiveness, advisory services, service affordability, and competence, only 33% utilized VOs services. The majority of the farmers (51%) used the services of informal providers, who were better in proximity and popularity with farm
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    Farmers’ valuation and willingness to pay for vaccines to protect livestock resources against priority infectious diseases in Ghana
    (Preventive Veterinary Medicine, 2023) Nuvey, F.S.; Hanley, N.; Addo, K.K.; et al.
    Introduction: Livestock vaccination coverage rates remain low in many lower and middle income countries despite effective vaccines being commonly available. Consequently, many preventable infectious livestock dis eases remain highly prevalent, causing significant animal mortalities and threatening farmers’ livelihood and food security. This study sought to assess farmers’ maximum willingness to pay (WTP) for contagious bovine pleuropneumonia (CBPP), and peste-des-petits-ruminants (PPR) vaccination of cattle, and sheep and goats, respectively. Methods: Overall, 350 ruminant livestock farmers were randomly selected from three districts located in the northern, middle and southern farming belts of Ghana. We implemented a double-bounded dichotomous contingent valuation experiment, where farmers indicated their WTP for vaccinating each livestock specie(s) owned at randomly assigned price points. WTP responses were analyzed using maximum likelihood estimation, and factors influencing WTP were assessed using censored regression analysis accounting for village-level clustering. Results: Mean WTP for CBPP vaccination was USD 1.43 or Ghanaian Cedi (GHC) 8.63 (95% CI: GHC 7.08–GHC 10.19) per cattle. Mean WTP for PPR vaccination was USD 1.17 or GHC 7.02 (95% CI: GHC 5.99–GHC 8.05) per sheep, and USD 1.1 or GHC 6.66 (95% CI: GHC 5.89–GHC 7.44) per goat. WTP was positively associated with resilience, limited knowledge about vaccines (assessed prior to WTP experiment), farmland size, and male gender, after adjusting for other covariates. To attain 70% vaccination coverage in Ghana, vaccination costs should be no larger than GHC 5.30 (USD 0.88) for CBPP per cattle and GHC 3.89 (USD 0.65) and GHC 3.67 (USD 0.61), respectively, for PPR vaccines per sheep and goat. Conclusions: Ruminant livestock farmers in Ghana value vaccination highly, and are, on average, willing to pay vaccination costs that exceed the prevailing market prices (GHC 6 for CBPP and GHC 5 for PPR vaccination) to protect their livestock resources. To achieve 70% coverage, only minor subsidies would likely be required. These results suggest that effective disease control in these settings should be possible with appropriate distribution strategies.
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    Farmers’ valuation and willingness to pay for vaccines to protect livestock resources against priority infectious diseases in Ghana
    (Preventive Veterinary Medicine, 2023) Nuvey, F.S.
    Introduction: Livestock vaccination coverage rates remain low in many lower and middle income countries despite effective vaccines being commonly available. Consequently, many preventable infectious livestock dis eases remain highly prevalent, causing significant animal mortalities and threatening farmers’ livelihood and food security. This study sought to assess farmers’ maximum willingness to pay (WTP) for contagious bovine pleuropneumonia (CBPP), and peste-des-petits-ruminants (PPR) vaccination of cattle, and sheep and goats, respectively. Methods: Overall, 350 ruminant livestock farmers were randomly selected from three districts located in the northern, middle and southern farming belts of Ghana. We implemented a double-bounded dichotomous contingent valuation experiment, where farmers indicated their WTP for vaccinating each livestock specie(s) owned at randomly assigned price points. WTP responses were analyzed using maximum likelihood estimation, and factors influencing WTP were assessed using censored regression analysis accounting for village-level clustering. Results: Mean WTP for CBPP vaccination was USD 1.43 or Ghanaian Cedi (GHC) 8.63 (95% CI: GHC 7.08–GHC 10.19) per cattle. Mean WTP for PPR vaccination was USD 1.17 or GHC 7.02 (95% CI: GHC 5.99–GHC 8.05) per sheep, and USD 1.1 or GHC 6.66 (95% CI: GHC 5.89–GHC 7.44) per goat. WTP was positively associated with resilience, limited knowledge about vaccines (assessed prior to WTP experiment), farmland size, and male gender, after adjusting for other covariates. To attain 70% vaccination coverage in Ghana, vaccination costs should be no larger than GHC 5.30 (USD 0.88) for CBPP per cattle and GHC 3.89 (USD 0.65) and GHC 3.67 (USD 0.61), respectively, for PPR vaccines per sheep and goat. Conclusions: Ruminant livestock farmers in Ghana value vaccination highly, and are, on average, willing to pay vaccination costs that exceed the prevailing market prices (GHC 6 for CBPP and GHC 5 for PPR vaccination) to protect their livestock resources. To achieve 70% coverage, only minor subsidies would likely be required. These results suggest that effective disease control in these settings should be possible with appropriate distribution strategie