Department of Medicine and Therapeutics
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Item Metallo-Beta-Lactamase-Producing Acinetobacter Spp. From Clinical Isolates at a Tertiary Care Hospital in Accra, Ghana.(University of Ghana, 2017-07) Adetokunbo, M.O.T.Background: One of the most pertinent issues in health-care institutions is the emergence and global spread of metallo-β-lactamase (MBL) producing bacteria of blaVIM-, blaIMP- and blaNDM types. Metallo-β-lactamase producing-Acinetobacter has become a public health concern due to therapeutic treatment challenges associated with nosocomial infections. In Ghana, limited information is available on clinical isolates of MBL-producing-Acinetobacter. Aim: The aim of the study was to determine the prevalence of MBL-producing-Acinetobacter spp. of routinely collected clinical isolates from the Korle-Bu Teaching Hospital, Accra. Methodology: A total of 87 clinical isolates of Acinetobacter were routinely collected from cultures of aspirates, urine, ear, eye and wound swabs between August 2014 to July 2015. Susceptibility pattern was done by Kirby-Bauer disk diffusion method. Meropenem-resistant Acinetobacter isolates were screened for enzymes using Modified Hodge test (MHT) and carbapenem-EDTA combined disc test (CDT). Additionally, multiplex PCR was used to determined MBL genes (blaVIM, blaIMP and blaNDM) in MBL screen positive Acinetobacter isolates. Results: The 87 Acinetobacter isolates showed high levels of antibiotic resistance to cefotaxime (90.8%), ceftadizime (75.9%), co-trimoxazole (70.1%), ciprofloxacin (64.4%), gentamicin (72.4%), levofloxacin (67.8%) and meropenem (59.8%). A total of 54 (62.1%) of Acinetobacter isolates were multidrug-resistant. Out of 52 (59.8%) meropenem-resistant Acinetobacter, 3 (5.8%) were carbapenemase producers by MHT whilst, 23 (44.2%) were MBL screen positive by CDT. There was no significant difference between the resistance pattern of amikacin, ceftazidime, co-trimoxazole, ciprofloxacin and meropenem amongst MBL screen positive and MBL screen negative isolates (p-value >0.05). A total of 7 of 87 (8.1%) MBL screen positive Acinetobcter isolates harboured blaNDM. Of these, 4 (57.1%) were from wound swabs, urine 2 (28.6%) and ear swab 1 (14.3%). However, no blaVIM or blaIMP was detected. Conclusion: PCR analysis for blaVIM, blaIMP and blaNDM showed that less than 9% of 87 Acinetobacter spp. harboured NDM encoding genes. MBL-producing-Acinetobacter isolates showed high levels of resistance to multiple antibiotics. The detection of blaNDM amongst MBL producing-Acinetobacter is a cause for concern, therefore, strict antibiotics usage and infection control measures should be instituted to prevent the spread of these resistance genes. UniversityItem Pneumococcal Carriage Among HIVAIDS Patients in Accra, Ghana.(2017-07) Baffuor-Asare, M.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.Item Phenotypic and Genotypic Analysis of Onchocerca Volvulus Response To Ivermectin Treatment(University of Ghana, 2017-07) Yabani, J.E.Ivermectin remains the only potent drug for the control and mass treatment of onchocerciasis. Nonetheless, recent studies indicate sub-optimal responses and genetic changes in some populations of the adult Onchocerca volvulus. Hence, more studies are required to determine whether resistance is developing. This requires analysis of phenotypic and genotypic responses of O. volvulus to ivermectin treatment to determine the association between worm phenotype and genotype after treatment. Forty archived O. volvulus female worms were obtained from patients hailing from three Ghanaian endemic communities: Asubende, Kyingakrom and Agborlekame. These communities were known to harbour both good and poor ivermectin response groups. The female worms were retrieved from nodules removed from patients who previously had undergone 16-17 rounds of (150 µg/kg) ivermectin treatment with one year interval between treatments. The samples were obtained 3 months after the last round of treatment. Genetic analysis of the beta-tubulin gene of the adult worms and their pooled microfilariae (MF) on a 538 bp DNA fragment of the beta-tubulin gene as well as restriction was done to determine mutations in the beta-tubulin gene. It was detected that 70% (28/40) of the worms harboured greater than 70% of normal stretched MF in their genital tracts; these were considered as poor responders to ivermectin treatment. On the other hand, 30% (12/40) of the worms that harboured less than 10% of the stretched MF in their genital tracts were considered as good responders to ivermectin treatment. Molecular analysis indicated single nucleotide polymorphism (SNP) for both adult worm and their corresponding MF with the heterozygote mutant adult worms showing strong association with the MF. In conclusion, it is found in this study that some of the worms have responded poorly or sub-optimally to ivermectin treatment. This development stems from mutations in the beta-tubulin gene of the adult female worms that have been passed on to their progenies