Occurrence and distribution of extended-spectrum ß-lactamase in clinical Escherichia coli isolates at Ho Teaching Hospital in Ghana.

Objective: This study determined the occurrence and distribution of Extended Spectrum ß-Lactamase (ESBL) genotypes of E. coli isolates in Ho Teaching Hospital, Ghana. Design: A cross-sectional study. Setting: A single centre study was conducted at Ho Teaching Hospital of Ghana. Participants: Patients who visited Ho Teaching Hospital Laboratory with the request for culture and susceptibility testing. Main outcome measure: Escherichia coli were isolated, and Extended-Spectrum ß-Lactamase genes were detected. Results: Of the 135 isolates, 56(41.5%,95% CI: 33.1% - 50.3%) were ESBL producers. More males, 14(58.3%), produced ESBL than females, 42(37.8%). The ESBL prevalence was highest among the elderly who were 80 years and above 3(100.0%), with the least prevalence among patients within 50-59 years and 0-9 years age bracket, representing 4(25.0%) and 3(27.3%), respectively. The total prevalence of ESBL was marginally higher among out-patients (41.8% 95% CI: 31.9% - 52.2%) compared to in-patients [40.5% 95% CI: 24.8% - 57.9]. BlaTEM-1 was the predominant ESBL genotype obtained from 83.9% (47/56) of the confirmed ESBL producing isolates, with the least being TOHO-1 4(7.1%). The co-existence of 2 different ESBL genes occurred in 19(33.9%) of the isolates. The single and quadruple carriage were 16(28.6%) and 3(5.4%), respectively. The highest co-existence of the ESBL genotypes was recorded for blaTEM-1 and blaCTXM-1 15(26.8%), followed by blaTEM-1, blaCTXM-1 and blaSHV-73 [12(21.4%)]. Conclusion: The high prevalence of ESBL-producing E. coli isolates with multiple resistant gene carriage is a threat to healthcare in the study area. Funding: This research received no external funding.

Community-based active tuberculosis case finding using a symptom-based screening tool in the Volta Region, Ghana.

BACKGROUND: Early tuberculosis case detection is important for early commencement of treatment to improve treatment outcomes and also to prevent community spread of the disease. However, there is a paucity of data in Ghana on the efficiency of the symptom-based screening tool (SBS tool) to detect Mycobacterium tuberculosis in the communities. Therefore, this study assessed the usefulness of the SBS tool for community-based active case finding in the Volta Region of Ghana. METHODS AND MATERIALS: This cross-sectional study used house-to-house and durbar screening approaches for active tuberculosis (TB) case searching from six communities, three each from the Ketu South (high TB risk) and Akatsi North (low TB risk) districts in the Volta Region of Ghana. Random eligible participants were screened with the SBS tool to identify presumptive TB cases. One sputum sample was collected from each person with presumptive TB for detection of M. tuberculosis by the GeneXpert real-time technique. RESULTS: A total of 1,025 people were screened from a population of 40,462, from which 332 (32.4%) were presumed to have M. tuberculosis infection. Of the 332 presumptive TB cases, 63.9% were obtained through house-to-house screening, while 36.1% were obtained through community durbar screening. Six M. tuberculosis-positive cases (with one rifampicin resistance) were detected by house-to-house screening but not from community durbar samples, yielding an overall prevalence of 15 per 100,000 population. Among TB symptoms screened and analysed, association existed only between night sweat and TB case detection (χ2 = 3.9, P = 0.049). CONCLUSION: Although cumbersome and capital intensive, community-based active case searching through house-to-house screening using the SBS tool proved effective in detecting M. tuberculosis in the communities.

Comparative assessment of anthropometric and bioimpedence methods for determining adiposity.

BACKGROUND: Obesity is a risk factor for different chronic conditions. Over the years, obesity has become a pandemic and it is therefore important that effective diagnostic tools are developed. Obesity is a measure of adiposity and it has become increasingly evident that anthropometric measures such as body mass index (BMI) used to estimate adiposity are inadequate. This study therefore examined the ability of different anthropometric measurements to diagnose obesity within a cross-section of Ghanaian women. METHODS: We obtained anthropometric measurements and used that to generate derived measures of adiposity such as body adiposity index (BAI) and conicity index. Furthermore we also measured adiposity using a bioimpedance analyser. Associations between these measurements and percentage body fat (%BF) were drawn in order to determine the suitability of the various measures to predict obesity. The prevalence of obesity was determined using both %BF and BMI. RESULTS: BMI, Waist and hip circumference and visceral fat (VF) were positively correlated with % BF whereas skeletal muscle mass was negatively correlated. Prevalence of obesity was 16% and 31.6% using BMI and %BF respectively. Receiver operating characteristic (ROC) analysis showed that these differences in prevalence was due to BMI based misclassification of persons who have obesity as overweight. Similar, shortfalls were observed for the other anthropometric measurements using ROC. CONCLUSIONS: No single measure investigated could adequately predict obesity as an accumulation of fat using current established cut-off points within our study population. Large scale epidemiological studies are therefore needed to define appropriate population based cut-off points if anthropometric measurements are to be employed in diagnosing obesity within a particular population.

Multidrug Resistant Enteric Bacterial Pathogens in a Psychiatric Hospital in Ghana: Implications for Control of Nosocomial Infections.

Enteric bacteria are commonly implicated in hospital-acquired or nosocomial infections. In Ghana, these infections constitute an important public health problem but little is known about their contribution to antibiotic resistance. The aim of the study was to determine the extent and pattern of antibiotic resistance of enteric bacteria isolated from patients and environmental sources at the Accra Psychiatric Hospital. A total of 265 samples were collected from the study site including 142 stool and 82 urine samples from patients, 7 swab samples of door handle, and 3 samples of drinking water. Enteric bacteria were isolated using standard microbiological methods. Antibiograms of the isolates were determined using the disc diffusion method. Overall, 232 enteric bacteria were isolated. Escherichia coli was the most common (38.3%), followed by Proteus (19.8%), Klebsiella (17.7%), Citrobacter (14.7%), Morganella (8.2%), and Pseudomonas (1.3%). All isolates were resistant to ampicillin but sensitive to cefotaxime. The resistance ranged from 15.5% to 84.5%. Multidrug resistance was most prevalent (100%) among isolates of Proteus and Morganella and least prevalent among isolates of Pseudomonas (33.3%). Multidrug resistance among enteric bacteria at the study hospital is high and hence there is a need for screening before therapy to ensure prudent use of antibiotics.

Data for discriminating dead/live bacteria in homogenous cell suspensions and the effect of insoluble substrates on turbidimetric measurements.

Estimation of bacterial growth by rapid traditional methods such as spectrophometric measurements at 600 nm (OD600) is not applicable for cultures containing insoluble particles in the growth media. Colony counts are the only suitable alternative but these are laborious and not high-throughput. The data presented in this article is related to the research article entitled "Two-colour fluorescence fluorimetric analysis for direct quantification of bacteria and its application in monitoring bacterial growth in cellulose degradation systems" (Duedu and French, 2017) [1]. This data article presents original primary data describing the discrimination of dead/live bacteria in homogenous cell suspensions and how the presence of insoluble substrates affect the turbidity of the suspensions.

Two-colour fluorescence fluorimetric analysis for direct quantification of bacteria and its application in monitoring bacterial growth in cellulose degradation systems.

Monitoring bacterial growth is an important technique required for many applications such as testing bacteria against compounds (e.g. drugs), evaluating bacterial composition in the environment (e.g. sewage and wastewater or food suspensions) and testing engineered bacteria for various functions (e.g. cellulose degradation). T?=1,^FigItem(1) ^ReloadFigure=Yesraditionally, rapid estimation of bacterial growth is performed using spectrophotometric measurement at 600nm (OD600) but this estimation does not differentiate live and dead cells or other debris. Colony counting enumerates live cells but the process is laborious and not suitable for large numbers of samples. Enumeration of live bacteria by flow cytometry is a more suitable rapid method with the use of dual staining with SYBR I Green nucleic acid gel stain and Propidium Iodide (SYBR-I/PI). Flow cytometry equipment and maintenance costs however are relatively high and this technique is unavailable in many laboratories that may require a rapid method for evaluating bacteria growth. We therefore sought to adapt and evaluate the SYBR-I/PI technique of enumerating live bacterial cells for a cheaper platform, a fluorimeter. The fluorimetry adapted SYBR-I/PI enumeration of bacteria in turbid growth media had direct correlations with OD600 (p>0.001). To enable comparison of fluorescence results across labs and instruments, a fluorescence intensity standard unit, the equivalent fluorescent DNA (EFD) was proposed, evaluated and found useful. The technique was further evaluated for its usefulness in enumerating bacteria in turbid media containing insoluble particles. Reproducible results were obtained which OD600 could not give. An alternative method based on the assessment of total protein using the Pierce Coomassie Plus (Bradford) Assay was also evaluated and compared. In all, the SYBR-I/PI method was found to be the quickest and most reliable. The protocol is potentially useful for high-throughput applications such as monitoring of growth of live bacterial cells in 96-well microplates and in assessing in vivo activity of cellulose degrading enzyme systems.

Characterization of a Cellulomonas fimi exoglucanase/xylanase-endoglucanase gene fusion which improves microbial degradation of cellulosic biomass.

Effective degradation of cellulose requires multiple classes of enzyme working together. However, naturally occurring cellulases with multiple catalytic domains seem to be rather rare in known cellulose-degrading organisms. A fusion protein made from Cellulomonas fimi exo- and endo- glucanases, Cex and CenA which improves breakdown of cellulose is described. A homologous carbohydrate binding module (CBM-2) present in both glucanases was fused to give a fusion protein CxnA. CxnA or unfused constructs (Cex+CenA, Cex, or CenA) were expressed in Escherichia coli and Citrobacter freundii. The latter recombinant strains were cultured at the expense of cellulose filter paper. The expressed CxnA had both exo- and endo- glucanase activities. It was also exported to the supernatant as were the non-fused proteins. In addition, the hybrid CBM from the fusion could bind to microcrystalline cellulose. Growth of C. freundii expressing CxnA was superior to that of cells expressing the unfused proteins. Physical degradation of filter paper was also faster with the cells expressing fusion protein than the other constructs. Our results show that fusion proteins with multiple catalytic domains can improve the efficiency of cellulose degradation. Such fusion proteins could potentially substitute cloning of multiple enzymes as well as improving product yields.

Prevalence of intestinal parasites among patients of a Ghanaian psychiatry hospital.

BACKGROUND: Neglected tropical diseases are of major concern to sub-Saharan African countries. Though efforts to monitor the prevalence and control are in place, these are mostly restricted to groups within the population. This study was performed to determine the prevalence among patients of a Ghanaian psychiatric hospital and find out whether there is a reason for active monitoring in this population. METHODS: A cross-sectional study was performed to determine the prevalence of intestinal parasites among patients of a Ghanaian psychiatric hospital. Stool samples were collected and analyzed in addition to data. RESULTS: Of the 111 patients studied, asymptomatic carriage of parasites was 13.5 % and was higher in males (18.8 %) than in females (4.8 %). Carriage of parasites decreased with age but increase with duration of admission. CONCLUSION: This is the first report of parasitic pathogens among patients of a psychiatric institution in Ghana. The data shows that there are risks of transmission of infectious diseases via the oral route hence, the need for regular monitoring and intervention is emphasized.

A comparative survey of the prevalence of human parasites found in fresh vegetables sold in supermarkets and open-aired markets in Accra, Ghana.

BACKGROUND: Consuming raw vegetables offers essential nutrients that one may not get when such vegetables are usually cooked. However, eating them raw may pose a great risk for transmissions of pathogens. Such risks may be influenced by the sources of the vegetables and washing techniques used. The aim of the study was to compare the prevalence and diversity of parasitic pathogens associated with vegetables sold at the two types of markets in Ghana and compare effectiveness of various washing techniques. METHODS: We purchased two batches of samples of cabbage, sweet bell pepper, carrot, lettuce, tomato and onion within a two week interval. The vegetables were washed by three methods and the wash solution was concentrated and analyzed for parasites. RESULTS: The prevalent parasites detected were Strongyloides stercoralis larvae (43%) and Cryptosporidium parvum oocyst (16%). Others present were Hookworm ova, Entamoeba histolytica cysts, Giardia lamblia cysts, Cyclospora cayetanensis oocysts, Entamoeba coli cysts, Trichuris trichiuria ova, Enterobius vermicularis ova, Isospora belli oocysts and Fasciolopsis buski ova. Contamination was highest in lettuce (61%) and cabbage and the least contaminated was tomato (18%). Contamination of vegetables sold at the open-aired markets was about ten-times that of the supermarkets. CONCLUSIONS: In Ghana, the large open-aired markets are the most patronized and serve as a supply point for most corner shops and stalls. The results thus highlight the potential of fresh vegetables serving as a major source of food-borne disease outbreaks and the contribution of open-aired markets to their transmission. Urgent public education on handling of fresh vegetables is recommended.

A survey of pathogens associated with Cyperus esculentus L (tiger nuts) tubers sold in a Ghanaian city.

BACKGROUND: Cyperus esculentus L, is a minor but important crop in Ghana. They are noted mostly by their aphrodisiac properties among others. The nuts are often eaten raw as an unprocessed snack due to its rich flavour and texture. Though eaten raw, the nuts are sometimes handled unhygienically, posing a public health threat. This study therefore aimed at determining the level and distribution of parasitic and bacterial contaminants associated with the crop as it is sold. RESULTS: Four types of intestinal parasites were identified, and the most prevalent was Cryptosporidium parvum (30.0%). Nuts contaminated with parasites were found only among street vendors. Bacteriological examination showed three different groups of bacterial isolates with the most prevalent being coliforms (54.2%). Unlike parasites, bacteria isolates were found among samples from both street vendors and market places. Multiple drug resistance was displayed by Proteus vulgaris. CONCLUSIONS: Buying and eating nuts as well as other fruits taken raw from street vendors and market places could pose a significant public health threat. There is a need for efficient monitoring systems for food borne pathogens in Ghana.

Microbial carriage of cockroaches at a tertiary care hospital in ghana.

Cockroaches are common in the environment of many hospitals in Ghana; however, little is known about their public health risks. To evaluate potential risks, we investigated the external and internal microbial flora of 61 cockroaches from a tertiary hospital in Ghana and evaluated the antibiotic resistance profiles of the common bacterial species. Standard methods were used in all the microbiological investigations and antibiotic susceptibility testing. A rotavirus carriage rate of 19.7% was observed among the cockroaches. Four types of intestinal parasites were carried externally by the cockroaches, and the most prevalent was Hookworm (4.9%). Eight nosocomial bacteria were isolated from the cockroaches, and the most prevalent was Klebsiella pneumoniae, which occurred internally in 29.5% of the cockroaches and 26.2% externally. Multiple drug resistance among common bacteria isolated from the cockroaches ranged from 13.8% (Escherichia coli) to 41.1% (Klebsiella pneumoniae). Cockroaches constitute an important reservoir for pathogenic microorganisms, and may be important vectors of multiple resistant nosocomial pathogens in the studied hospital.

Misclassification of recent HIV-1 seroconversion in sub-Saharan Africa using the sensitive/less sensitive technique.

BACKGROUND: In resource-limited settings where HIV-1 is endemic, there is a need for simple, inexpensive but effective rapid methods for detecting recent infections and estimating incidence for the purposes of surveillance and management. We sort to determine possible reasons for reported misclassifications of recent HIV-1 seroconversion as determined with the S/LS assay in sub-Saharan Africa. FINDINGS: We used the modified Determine HIV-1/2 sensitive/less sensitive method for determining recent HIV-1 seroconversion to determine recent infections among ELISA repeat HIV-1 positive samples from blood donors. Furthermore, HIV-1 seropositivity was confirmed using a line immunoassay and the results used to validate the performance of the modified Determine HIV-1/2 S/LS assay. The results confirmed reported misclassifications of recent HIV-1 seroconversion in sub-Saharan Africa. It was noted that, lack of confirmation of HIV-1 seropositivity in suspected cases of HIV-1 contributed to misclassifications. CONCLUSIONS: It was concluded that, with confirmation of HIV-1 seropositivity, the modified Determine HIV-1/2 S/LS assay will be a rapid and cost effective method for determining HIV-1 recent infections and estimating incidence in resource-limited settings. The need for detailed studies to validate simple methods for determining recent HIV-1 infections is emphasized.