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.

Prevalence of human immunodeficiency virus infection among tuberculosis suspect patients in Accra, Ghana.

BACKGROUND: Acquired immunodeficiency syndrome is a major public health concern worldwide, particularly in Ghana, where recent reports indicate an increase of the disease. A close association between infection with human immunodeficiency virus (HIV) and tuberculosis (TB) is well known. A previous study showed a 16.8% seroprevalence of HIV in TB patients on admission at the chest clinic of the Korle-Bu teaching hospital. However this was in severely ill patients on admission and there was a likely selection bias. This study was therefore designed to determine the prevalence of HIV infection among patients suspected of TB attending the laboratory of the chest clinic of the Korle-Bu Teaching hospital, Accra, Ghana. METHODS: Pulmonary TB was diagnosed using clinical, sputum smear microscopy and chest x-ray features. HIV was determined using particle agglutination test (HIV-1 and HIV-2) and synthetic peptide-based immunoassay (Peptilav I and II ELISA). RESULTS: Of the 277 subjects examined, 108 (39%) were diagnosed as TB. The seroprevalence of HIV was 46.2% in all TB suspect patients. It was 47.2% and 45.6% in those with and without tuberculosis, respectively. in both groups, the peak age distribution of subjects positive for HIV antibodies was from 20 to 59 years. CONCLUSION: The results show a great increase in HIV seroprevalence in TB patients in Korle-Bu. The high HIV seroprevalence suggests that subjects suspected of TB should be tested for HIV as well.

Adult tetanus in Accra, why the high mortality? An audit of clinical management of tetanus.

BACKGROUND: Tetanus is a life threatening infection relatively uncommon in the developed countries but occurs frequently in developing countries with case fatality rates of 40-60 %. Recent review of adult tetanus at the Korle-bu Teaching Hospital showed a high case fatality of 50%. In order to determine the factors underlying this high case fatality we conducted a retrospective clinical audit of the clinical management of adult tetanus admitted in 1994 to 2001 to the Korle-bu Teaching Hospital. METHODS: Data extracted from the admission and discharge books of the Fevers' Unit of Korle-bu Teaching Hospital, Accra and patient case notes were examined and analysed. RESULTS: Case fatality rate (CFR) varied from 25 % in 1999 to 72.7% in 2001. There was no gender difference in the case fatality. There was no significant difference in the mean age of those who died and those who survived, however, the CFR rose with age. The presence of neck and a dirty wound were associated with increased CFR. The CFR correlated with the severity of tetanus and increased when an expected treatment action, wound debridement, administration of antibiotics and/or immunoglobulin, was not performed. The administration of anti-tetanus toxin was associated with an increased CFR. CONCLUSION: The high case fatality rate in Accra was due to inappropriate management with most of the patients not treated with immunoglobulin and antibiotics and had inadequate wound care.

Characteristics of adult tetanus in Accra.

BACKGROUND: Tetanus is a life threatening infection with an estimated annual global incidence of about 1 million cases and a mortality of 50%. It is very common in developing countries. The prevalence in Ghana is not known, however, cases continue to be admitted in hospitals in the country. This retrospective study was undertaken to define the characteristics of cases of tetanus in adults admitted to the Korle-bu Teaching Hospital, Accra, Ghana, from 1 January 1994 to 31 December, 2001. METHODS: Information was extracted from the admission and discharge registers of the Isolation Unit of Korle-bu Teaching Hospital, Accra and case notes were examined and analysed. RESULTS: There were 158 (76.6%) males) cases of tetanus with mean age of 32.7 +/- 15.0 years. The peak age was in the 20-29 year group. Admission rate was lowest during the raining season months of June-August. Traumatic injury occurred outdoors (56.9%) and was caused by deep prick (24.3%), or cut (16.2%). The most common site of injury was on the lower (44.6%) limbs. The time interval between injury and admission was 8.3 +/- 22.4 weeks (range 1-156 weeks) and the duration of symptoms was 2.9 +/- 2.7 days (range 1.0-21.0 days). The most common presenting features were locked jaw (82.4%), general spasm (62.2%), presence of a wound (53.7%) and neck stiffness (50.0%). Hospital admission was 11.4 +/- 11.6 (range 0-53) days. The case mortality was 50% (79/158). CONCLUSION: These results confirm that adult tetanus is still very prevalent in Ghana and is occurring in a younger age group compared to that in the developed countries. The case mortality is still very high.

A comparative study of isradipine and nifedipine in the monotherapy of mild to moderate hypertension in the Ghanaian

Clinical experience with the new dihydropyridine calcium antagonist; isradipine; is reported. Isradipine was compared with nifedipine in a multicentre open; parallel group; clinical therapeutic trial involving 70 patients with mild to moderate hypertension. A four week placebo washout period was followed by a 12 week active treatment period during which patients were randomized to receive either 2.5mg isradipine twice daily (n=40) or 10mg nifedipine three times daily (n=30). Isradipine significantly reduced sitting systolic/diastolic blood pressures from 176.7+/-21.0/106.7+/-7.0mmHg to 142.9+/-15/93.1+/-7.7mmHg (p0.001) at the end of 12 weeks. Similarly; nifedipine reduced sitting systolic/diastolic blood pressures from 170.1+/-19.5/106.2+/-7.4mmHg to 139.1+/-9.7/92.1+/-7.8mmHg (p0.001). Normalisation (diastolic 90mmHg) rates were 67 per cent and 60 per cent for isradipine and nifedipine respectively while good response (diastolic fall 10mmHg) rate was over 85 per cent on either drug. Heart rate did not significantly change with either treatment. Three (3) patients taking isradipine experienced headache and 7 patients taking nifedipine had drug related adverse effects (5 had headache; 1 insomnia and 1 first dose hypotension). Therapy was withdrawn in 4 patients taking nifedipine and 1 taking isradipine. It is concluded that isradipine is comparable to nifedipine and is an effective and well tolerated antihypertensive agent in the Ghanaian