Culture and sensitivity of mycobacterial isolates from cases of pulmonary tuberculosis classified as treatment failures in a teaching hospital.

BACKGROUND: The level of drug resistance in mycobacterial isolates from previously treated cases in Ghana is not known although drug resistant tuberculosis threatens efforts to control the disease. OBJECTIVE: To identify and determine the susceptibility of mycobacterial isolates from tuberculosis cases with clinical treatment failure. METHODS: This prospective survey was undertaken at the Chest Clinic of Korle Bu Teaching Hospital in Accra, Ghana. The participants were twenty-eight cases referred to the hospital with clinical treatment failure. Two sputum specimens from each case were stained by Ziehl-Neelsen method, cultured, identified and sensitivity tests performed by the proportion method. RESULTS: Eighteen isolates of mycobacteria were identified from 28 failed treatment cases. Five were atypical mycobacteria. Approximately fifty percent (13/28) of cases had Mycobacterium tuberculosis, 5(18%) had atypical mycobacteria, 7(25%) had pure fungal growth and 3(11% 8) had no growth. Fifteen isolates were resistant to two or more drugs, of which 6 were resistant to all four drugs tested. CONCLUSION: Continuous drug resistance monitoring must be instituted as part of the tuberculosis control programme.

Diagnosis of tuberculosis in ghana: the role of laboratory training.

OBJECTIVES: The laboratory is considered the cornerstone of tuberculosis (TB) control programme. International review of Ghana's programme in the late nineties identified the laboratory services as the weakest component. Sputum smear microscopy (SSM) being the main method of diagnosing pulmonary TB in Ghana, the training objectives were to: (i) strengthen the knowledge and skills of laboratory personnel on SSM (ii) impart necessary techniques in biosafety and (iii) introduce a Quality Assurance (QA) system in order to strengthen SSM services. METHODS: Personnel were selected for training during a nationwide situation analysis of SSM centres in 2000/2001. Four training sessions on SSM/QA were held between 2001/2004. RESULTS: A total of 80 personnel were trained: 10 regional TB coordinators and 70 laboratory personnel. The participants upon return to their respective regions also organized training within their districts. This approach resulted in another 100 district TB coordinators and 200 laboratory personnel being trained. Improvement in smear preparation, staining and reading ability of the participants were observed during the post-test and subsequent visit to their respective laboratories. The training has led to strengthening of TB laboratory services in the country and has contributed to increase in case detection from 10,745 in 2000 to 11,827 in 2004 and 14,022 in 2008. It was observed during the post-training follow-up and quarterly supervision visits that morale of the personnel was high. CONCLUSION: Continuous training and re-training of laboratory personnel on SSM and QA at regular intervals do play an important role for effective and efficient TB control programme.