Department of Microbiology
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Item Onchocerca volvulus microfilariae in the anterior chambers of the eye and ocular adverse events after a single dose of 8 mg moxidectin or 150 μg/kg ivermectin: results of a randomized double‑blind Phase 3 trial in the Democratic Republic of the Congo, Ghana and Liberia(Parasites & Vectors, 2024) Kanza, E.M.; Nyathirombo, A.; Attah, S.K.; et al.Background After ivermectin became available, diethylcarbamazine (DEC) use was discontinued because of severe adverse reactions, including ocular reactions, in individuals with high Onchocerca volvulus microfilaridermia (microfilariae/ mg skin, SmfD). Assuming long-term ivermectin use led to < 5 SmfD with little or no eye involvement, DEC + ivermectin + albendazole treatment a few months after ivermectin was proposed. In 2018, the US FDA approved moxidectin for treatment of O. volvulus infection. The Phase 3 study evaluated SmfD, microfilariae in the anterior chamber (mfAC) and adverse events (AEs) in ivermectin-naïve individuals with ≥ 10 SmfD after 8 mg moxidectin (n = 978) or 150 μg/kg ivermectin (n = 494) treatment. Methods We analyzed the data from 1463 participants with both eyes evaluated using six (0, 1–5, 6–10, 11–20, 21–40, > 40) mfAC and three pre-treatment (< 20, 20 to < 50, ≥ 50) and post-treatment (0, > 0–5, > 5) SmfD categories. A linear mixed model evaluated factors and covariates impacting mfAC levels. Ocular AEs were summarized by type and start post-treatment. Logistic models evaluated factors and covariates impacting the risk for ocular AEs. Results Moxidectin and ivermectin had the same effect on mfAC levels. These increased from pre-treatment to Day 4 and Month 1 in 20% and 16% of participants, respectively. Six and 12 months post-treatment, mfAC were detected in ≈5% and ≈3% of participants, respectively. Ocular Mazzotti reactions occurred in 12.4% of moxidectin- and 10.2% of ivermectin-treated participants without difference in type or severity. The risk for ≥ 1 ocular Mazzotti reaction increased for women (OR 1.537, 95% CI 1.096–2.157) and with mfAC levels pre- and 4 days post-treatment (OR 0: > 10 mfAC 2.704, 95% CI 1.27–5.749 and 1.619, 95% CI 0.80–3.280, respectively). Conclusions The impact of SmfD and mfAC levels before and early after treatment on ocular AEs needs to be better understood before making decisions on the risk-benefit of strategies including DEC. Such decisions should take into account interindividual variability in SmfD, mfAC levels and treatment response and risks to even a small percentage of individuals.Item COVID-19 in patients presenting with malaria like symptoms at a primary healthcare facility in Accra, Ghana(COVID-19 in patients presenting with malaria-like symptoms at a primary healthcare in Ghana, 2024) Asamoah, I.; Adusei-Poku, M.; Turkson, A.; Mohkta, Q.; et al.Background Malaria is a common and severe public health problem in Ghana and is largely responsible for febrile symptoms presented at health facilities in the country. Other infectious diseases, including COVID-19, may mimic malaria due to their shared non-specific symptoms, such as fever and headache, thus leading to misdiagnosis. This study therefore investigated COVID-19 among patients presenting with malaria-like symptoms at Korle-Bu Polyclinic, Accra, Ghana. Methods This study enrolled 300 patients presenting with malaria-like symptoms aged 18 years. After consent was obtained from study patients, Two to three millilitres of whole blood, nasopharyngeal and oropharyngeal swab samples, were collected for screening of Plasmodium falciparum using malaria rapid diagnostic test, microscopy, nested PCR, and SARS-CoV-2 using SARS-CoV-2 antigen test and Real-time PCR, respectively. The plasma and whole blood were also used for COVID-19 antibody testing and full blood counts using a hematological analyzer. SARS-CoV-2 whole genome sequencing was performed using MinIon sequencing. Results The prevalence of malaria by microscopy, RDT and nested PCR were 2.3%, 2.3% and 2.7% respectively. The detection of SARS-CoV-2 by COVID-19 Rapid Antigen Test and Real-time PCR were 8.7% and 20%, respectively. The Delta variant was reported in 23 of 25 SARS-CoV-2 positives with CT values below 30. Headache was the most common syndrome presented by study participants (95%). comorbidities reported were hypertension,asthma and diabetes. One hundred and thirteen (37.8%) of the study participants had prior exposure to SARS-CoV-2 and (34/51) 66.7% of Astrazeneca-vaccinated patients had no IgG antibody. Conclusion It may be difficult to use clinical characteristics to distinguish between patients with COVID-19 having malaria-like symptoms. Detection of IgM using RDTs may be useful in predicting CT values for SARS-CoV-2 real-time PCR and therefore transmission.Item Baseline Susceptibility Of Anopheles Gambiae To Clothianidin In Northern Ghana(Malaria Journal, 2024) Pambit Zong, C.M.; Coleman, S.; Owusu‑Asenso, C.M.; et al.Background: Clothianidin, an insecticide with a novel mode of action, has been deployed in the annual indoor residual spraying programme in northern Ghana since March 2021. To inform pragmatic management strategies and guide future studies, baseline data on local Anopheles gambiae sensu lato (s.l.) susceptibility to clothianidin insecticides were collected in Kpalsogu, a village in the northern region of Ghana. Methods The phenotypic susceptibility of An. gambiae mosquitoes to clothianidin was assessed using the World Health Organization Organization (WHO) insecticide resistance monitoring bioassay. The WHO cone bioassays were conducted on mud and cement walls sprayed with Sumishield 50 wettable granules (WG) (with clothianidin as an active ingredient). Daily Mortalities were recorded for up to 7 days to observe for delayed mortalities. Polymerase chain reaction (PCR) technique nique was used to differentiate the sibling species of the An. gambiae complex and also for the detection of knock down resistance genes (kdr) and the insensitive acetylcholinesterase mutation (ace-1). Results The WHO susceptibility bioassay revealed a delayed killing effect of clothianidin. Mosquitoes exposed to the cone bioassays for 5 minutes and died 120 hours after exposure. Slightly higher mortalities were observed in mosquitoes. toes exposed to clothianidin-treated cement wall surfaces than mosquitoes exposed to mud wall surfaces. The kdr target-site mutation L1014F occurred at very high frequencies (0.89–0.94) across all vector species identified, whereas The ace-1 mutation occurred at moderate levels (0.32–0.44). Anopheles gambiae sensu stricto was the most abundant species observed at 63%, whereas Anopheles arabiensis was the least observed at 9%. Conclusions Anopheles gambiae s.l. mosquitoes in northern Ghana were susceptible to clothianidin. They harboured kdr mutations at high frequencies. The ace-1 mutation occurred in moderation. The results of this study confirm that clothianidin is an effective active ingredient and should be utilized in malaria vector control interventionsItem Mosquito Control By Abatement Programmes In The United States: Perspectives And Lessons For Countries In Sub-Saharan Africa(Malaria Journal, 2023) Ochomo, E.; Rund, S.S.C.; Afrane, Y.; et al.Africa and the United States are both large, heterogeneous geographies with a diverse range of ecologies and climates and mosquito species diversity, which contribute to disease transmission and nuisance biting. In the United States, mosquito control is nationally and regionally coordinated, much as the Centers for Disease Control (CDC) provides guidance, the Environmental Protection Agency (EPA) provides pesticide registration, and the states provide legal authority and oversight, the implementation is usually decentralized to the state, county, or city level. Mosquito control operations are organized, in most instances, into fully independent mosquito abatement districts, public works departments, local health departments. In some cases, municipalities engage independent private contractors. to undertake mosquito control within their jurisdictions. In sub-Saharan Africa (SSA), where most vector-borne In disease-endemic countries, mosquito control is organized centrally at the national level. In this model, the disease control programmes (national malaria control programs) or national malaria elimination programmes (NMCP) NMEP) are embedded within the central governments’ ministries of health (MoHs) and drive vector control policy development and implementation. Because of the high disease burden and limited resources, the primary endpoint of mosquito control in these settings is the reduction of mosquito-borne diseases, primarily malaria. In the United States, however, the endpoint is mosquito control; therefore, significant (or even greater) emphasis is laid on nuisance mosquitoes. quitoes as much as disease vectors. The authors detail experiences and learnings gathered by the delegation of Afri‑ can vector control professionals that participated in a formal exchange programme initiated by the Pan-African Mos quito Control Association (PAMCA), the University of Notre Dame, and members of the American Mosquito Control Association (AMCA) in the United States between the years 2021 and 2022. The authors highlight the key components of mosquito control operations in the United States and compare them to mosquito control programmes in SSA countries endemic for vector-borne diseases, deriving important lessons that could be useful for vector control in SSA.Item ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance(Wellcome Open Research, 2023) Mo, Y.; Ding, Y.; Opintan, J.; et al.Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discoveries. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data and not widely implemented, especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicenter protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health and economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during the 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity, which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. The relative ease of data collection promotes sustainability and maximises participation and scalability. With As an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.Item Challenges to the implementation of STEM education in the Bono East Region of Ghana(Heliyon, 2023) Bardoe, D.; Hayford, D.; Bio, R.B.; Gyabeng, J.STEM education interrelates science, technology, engineering, and mathematics, ensuring that all interrelated contents are taught in coherence instead of in isolation. This promotes collaboration, critical thinking, and active engagement among students. The study ascertained the factors that compromise the implementation of STEM practices in the Bono East Region of Ghana to gain a moderately broad and deep understanding, allowing for a critical analysis of outcomes. It adopted a descriptive survey design to explore information concerning STEM education as it existed from May to October 2022. The study was carried out in Public Senior High and Vocational-Technical Schools in the Bono East Region of Ghana. The schools were split into STEM-related schools and non-STEM-related schools using a stratified sampling technique. Ten STEM-related schools were chosen using a purposive sampling method. 271 instructors from the departments of Science, Mathematics, and Information Communication Technology made up the study’s population. A survey using a well-structured closed-ended questionnaire was administered online and the response obtained was transformed into frequencies and percentages in tabular forms using Microsoft Excel version 2016 (Microsoft, USA). Software Package for Social Sciences (SPSS) version 25 (IBM, USA) was used to perform a chi-square test to determine differences between responses obtained at the test significance of 5%. The study revealed that the general imple mentation of STEM practices throughout the studied Senior High Schools was below the mark. Inadequate STEM teaching-learning materials, limited certified STEM teachers, lack of STEM dedicated infrastructure, inadequate professional development opportunities, absence of STEM documented standards and curriculum, limited access to technology, and limited time for teaching STEM-related subjects were some of the major factors contributing to the unsuccessful implementation of STEM practices in studied Public Senior High and Vocational-Technical Schools. Be that as it may, the study, therefore, recommended some measures including comprehensive STEM policies, adoptions of systematic STEM framework, and rigorous curricu lum overhaul to be considered by the various stakeholders of education to realize the aspirations of inclusive STEM education.Item Diferences in malaria vector biting behavior and changing vulnerability to malaria transmission in contrasting ecosystems of western Kenya(Parasites & Vectors, 2023) Nzioki, I.; Machani, M.G.; Afrane, Y.A.; et al.Background Designing, implementing, and upscaling of efective malaria vector control strategies necessitates an understanding of when and where transmission occurs. This study assessed the biting patterns of potentially infectious malaria vectors at various hours, locations, and associated human behaviors in diferent ecological settings in western Kenya. Methods Hourly indoor and outdoor catches of human-biting mosquitoes were sampled from 19:00 to 07:00 for four consecutive nights in four houses per village. The human behavior study was conducted via questionnaire surveys and observations. Species within the Anopheles gambiae complex and Anopheles funestus group were distinguished by polymerase chain reaction (PCR) and the presence of Plasmodium falciparum circumsporozoite proteins (CSP) determined by enzyme-linked immunosorbent assay (ELISA). Results Altogether, 2037 adult female anophelines were collected comprising the An. funestus group (76.7%), An. gambiae sensu lato (22.8%), and Anopheles coustani (0.5%). PCR results revealed that Anopheles arabiensis consti tuted 80.5% and 79% of the An. gambiae s.l. samples analyzed from the lowland sites (Ahero and Kisian, respectively). Anopheles gambiae sensu stricto (hereafter An. gambiae) (98.1%) was the dominant species in the highland site (Kimaeti). All the An. funestus s.l. analyzed belonged to An. funestus s.s. (hereafter An. funestus). Indoor biting densities of An. gambiae s.l. and An. funestus exceeded the outdoor biting densities in all sites. The peak biting occurred in early morning between 04:30 and 06:30 in the lowlands for An. funestus both indoors and outdoors. In the highlands, the peak biting of An. gambiae occurred between 01:00 and 02:00 indoors. Over 50% of the study population stayed outdoors from 18:00 to 22:00 and woke up at 05:00, coinciding with the times when the highest numbers of vectors were collected. The sporozoite rate was higher in vectors collected outdoors, with An. funestus being the main malaria vector in the lowlands and An. gambiae in the highlands. Conclusion This study shows heterogeneity of anopheline distribution, high outdoor malaria transmission, and early morning peak biting activity of An. funestus when humans are not protected by bednets in the lowland sites. Additional vector control eforts targeting the behaviors of these vectors, such as the use of non-pyrethroids for indoor residual spraying and spatial repellents outdoors, are needed.Item Challenges to the implementation of STEM education in the Bono East Region of Ghana(Heliyon, 2023) Bardoe, D.; Hayford, D.; Bio, R.B.; Gyabeng, J.STEM education interrelates science, technology, engineering, and mathematics, ensuring that all interrelated contents are taught in coherence instead of in isolation. This promotes collaboration, critical thinking, and active engagement among students. The study ascertained the factors that compromise the implementation of STEM practices in the Bono East Region of Ghana to gain a moderately broad and deep understanding, allowing for a critical analysis of outcomes. It adopted a descriptive survey design to explore information concerning STEM education as it existed from May to October 2022. The study was carried out in Public Senior High and Vocational-Technical Schools in the Bono East Region of Ghana. The schools were split into STEM-related schools and non-STEM-related schools using a stratified sampling technique. Ten STEM-related schools were chosen using a purposive sampling method. 271 instructors from the departments of Science, Mathematics, and Information Communication Technology made up the study’s population. A survey using a well-structured closed-ended questionnaire was administered online and the response obtained was transformed into frequencies and percentages in tabular forms using Microsoft Excel version 2016 (Microsoft, USA). Software Package for Social Sciences (SPSS) version 25 (IBM, USA) was used to perform a chi-square test to determine differences between responses obtained at the test significance of 5%. The study revealed that the general imple mentation of STEM practices throughout the studied Senior High Schools was below the mark. Inadequate STEM teaching-learning materials, limited certified STEM teachers, lack of STEM dedicated infrastructure, inadequate professional development opportunities, absence of STEM documented standards and curriculum, limited access to technology, and limited time for teaching STEM-related subjects were some of the major factors contributing to the unsuccessful implementation of STEM practices in studied Public Senior High and Vocational-Technical Schools. Be that as it may, the study, therefore, recommended some measures including comprehensive STEM policies, adoptions of systematic STEM framework, and rigorous curricu lum overhaul to be considered by the various stakeholders of education to realize the aspirations of inclusive STEM education.Item Phenotypic and Genotypic Characterization of Carbapenem-Resistant Gram-Negative Bacilli Pathogens from Hospitals in Ghana(MICROBIAL DRUG RESISTANCE, 2019) Codjoe, F.S.; Donkor, E.S.; Smith, T.J.; Miller, K.In Ghana, surveillance efforts on antibiotic resistance so far have not covered carbapenem resistance. In this study, our aim was to apply phenotypic and genotypic methods to identify and characterize carbapenem resistant (CR) Gram-negative bacteria from the hospital environment in Ghana. A collection of 3840 isolates of Gram-negative bacilli infections from various clinical specimens was screened for carbapenem resistance by disc diffusion for imipenem, meropenem, and doripenem. Minimum Inhibitory Concentration (MIC) of the CR isolates was determined by E-test for the three carbapenems. All the CR isolates were further screened for carbapenemase activity by modified Hodge and boronic acid disc synergy tests. The CR isolates were inves tigated for the presence of carbapenemase and extended-spectrum beta-lactamase genes by PCR and confirmed by sequencing. The overall prevalence of CR isolates was 2.9% (111/3840). Based on the disc diffusion test, prevalence of resistance to carbapenems were doripenem (75%), imipenem (66.7%), and meropenem (58%). The highest measurable MIC levels (‡32 mg/mL) were observed in 56.8% of CR isolates with the non fermenters, Pseudomonas aeruginosa (24.3%) and Acinetobacter species (18.9%), disproportionately re presented. Phenotypic identification of carbapenamase activity occurred in 18.9% of the CR isolates by the modified Hodge test and 2.7% by Boronic acid disc synergy test; 21.6% exhibited carbapenemase production by both methods. All the CR isolates carried ESBL genes (blaTEM and blaSHV), whereas 23.4% were carriers of carbapenemase genes, of which 14.4% were blaNDM-1, 7.2% blaVIM-1, and 1.8% blaOXA-48. Phylogen etically, the CR isolates were diverse and showed limited relatedness to isolates from other geographical regions.Item Antimicrobial use in hospitalized patients: a multicentre point prevalence survey across seven hospitals in Ghana(JAC Antimicrob Resist, 2023) Appiah-Korang, L.; Obeng-Nkrumah, N.; Sampane-Donkor, E.; et al.Background: Antimicrobial resistance (AMR) is a public health crisis of global proportions. Data is required to understand the local drivers of antimicrobial resistance and support decision-making processes including implementation of appropriate antimicrobial stewardship strategies. Objectives: To measure antimicrobial usage in hospitals in Ghana. Methods: Using the Global Point Prevalence instruments and processes, we conducted point prevalence surveys across AMR surveillance sentinel hospitals in Ghana, between September and December 2019. Hospital records of all inpatients on admission at 0800 hours on a specific day were reviewed for antimicrobial use at the time of the survey. Data on antibiotic use, including indication for use and quality of prescribing were recorded. Results: Overall prevalence of antibiotic use across the sentinel sites was 54.9% (n " 1591/2897), ranging be tween 48.4% (n " 266/550) and 67.2% (n " 82/122). The highest prevalence of antibiotic use 89.3% (n " 25/28) was observed in adult ICUs. The average number of antibiotics prescribed per patient was 1.7 (n " 1562/2620), with the majority (66%, n " 728/2620) administered via the parenteral route. The five most-commonly used antibiotics were metronidazole (20.6%, n " 541/2620), cefuroxime (12.9%, n " 338/2620), ceftriaxone (11.8%, n " 310/2620), amoxicillin/clavulanic acid (8.8%, n " 231/2620) and ciprofloxacin (7.8%, n " 204/2620). The majority (52.2%; n " 1367/2620) of antibiotics were prescribed to treat an infection, whilst surgical prophylaxis accounted for 26.1% (n " 684/2620). Conclusions: We observed a high use of antibiotics including metronidazole and cephalosporins at the participating hospitals. Most antibiotics were empirically prescribed, with low use of microbiological cultures. High usage of third-generation cephalosporins especially for community-acquired infections offers an opportun ity for antibiotic stewardship interventions.