First report of Kingella kingae infection in a paediatric population in Accra, Ghana

Introduction

Kingella kingae is recognized as a frequent source of childhood bacteremia and the commonest agent of skeletal system infections in children 6 months - 4 years old. Several factors, including difficulty in detecting this fastidious organism in routine laboratory assays, result in underdiagnosis of the infections. Species-specific nucleic acid amplification assays, however, significantly improve the detection of K. kingae in blood samples. The aim of this study was to detect K. kingae infection in young children in Accra, Ghana.

Methods

a cross-sectional based study was carried out in three hospitals in Accra. Children with febrile illness and directed by a clinician for blood culture were recruited. Blood samples collected were analysed by culture and polymerase chain reaction (PCR), using universal prokaryotic and K. kingae rtxA primers.

Results

blood samples from 232 children (mean age 20.10 ± 12.57 months) were analysed. Bacteremia (72.4%) was the highest clinical diagnosis particularly in the 12-24 months age group. Only 7 (3.1%) samples showed bacterial growth and were negative for Kingella. PCR with universal prokaryotic primers succeeded in 223 (96.1%) out of 232 samples. PCR with K. kingae rtxA toxin primers was positive for 12 (5.4%) samples, all diagnosed as bacteremia, out of the 223 samples. Eleven (91.7%) out of the 12 K. kingae PCR positives were culture-negative.

Conclusion

Kingella kingae was detected only by PCR specific for the K. kingae rtxA toxin. Kingella kingae may be a potential cause of bacteremia and hence febrile illness in young children living in Accra, Ghana.

Emergence of HIV-1 drug resistance mutations in mothers on treatment with a history of prophylaxis in Ghana

BACKGROUND

Antiretrovirals have been available in Ghana since 2003 for HIV-1 positive pregnant women for prevention of mother-to-child transmission (PMTCT). Suboptimal responses to treatment observed post-PMTCT interventions necessitated the need to investigate the profile of viral mutations generated. This study investigated HIV-1 drug resistance profiles in mothers in selected centres in Ghana on treatment with a history of prophylaxis.

METHODS

Genotypic Drug Resistance Testing for HIV-1 was carried out. Subtyping was done by phylogenetic analysis and Stanford HIV Database programme was used for drug resistance analysis and interpretation. To compare the significance between the different groups and the emergence of drug resistance mutations, p values were used.

RESULTS

Participants who had prophylaxis before treatment, those who had treatment without prophylaxis and those yet to initiate PMTCT showed 32% (8), 5% (3) and 15% (4) HIV-1 drug resistance associated mutations respectively. The differences were significant with p value < 0.05. Resistance Associated Mutations (RAMs) were seen in 14 participants (35%) to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). The most common NRTI mutation found was M184 V; K103 N and A98G were the most common NNRTI mutations seen. Thymidine Analogue Mutations (TAMs) such as M41 L, K70R and T215Y were found in all the groups; the most common of the TAMs found were M41 L and T215Y. Majority of the subtypes were CRF02_AG (82%).

CONCLUSION

In Ghana initiation of uninterrupted treatment upon diagnosis, coupled with drug resistance testing, would produce a better treatment outcome for HIV-1 positive pregnant women.

Occurrence of transmitted HIV-1 drug resistance among Drug-naïve pregnant women in selected HIV-care centres in Ghana

BACKGROUND

Access to antiretroviral therapy in Ghana has been scaled up across the country over the last decade. This study sought to determine the occurrence of transmitted HIV-1 drug resistance in pregnant HIV-1 positive women yet to initiate antiretroviral therapy at selected HIV Care Centres in Ghana.

METHODS

Plasma specimens from twenty-six (26) HIV seropositive pregnant women who were less than 28weeks pregnant with their first pregnancy and ART naïve were collected from selected HIV care centres in three (3) regions in Ghana. Genotypic testing was done for the reverse transcriptase gene and the sequences generated were analyzed for HIV-1 drug resistance mutations using the Stanford University HIV Drug Resistance Database.

RESULTS

Resistance mutations associated with the reverse transcriptase gene were detected in 4 (15.4%) of the participants. At least one major drug resistance mutation in the reverse transcriptase gene was found in 3 (11.5%) of the women.

CONCLUSION

The detection of transmitted HIV-1 drug resistance in this drug-naïve group in two regional HIV care sites is an indication of the need for renewed action in monitoring the emergence of transmitted HIV-1 drug resistance in Ghana.

FUNDING

None declared.

Ocular complications in HIV positive patients on antiretroviral therapy in Ghana

Background

Patients infected with human immunodeficiency virus (HIV) usually develop some form of ocular complication in the different segments of the eye due to immune deficiency. In Ghana, data regarding ocular complications among HIV/AIDS patients is scarce. This study investigated the occurrence of ocular complications in HIV infected patients undergoing antiretroviral therapy at the Agogo Presbyterian Hospital in the Ashanti Region of Ghana.

Methods

Blood samples were taken from 100 confirmed HIV infected patients. The CD4 + T cell count and WHO clinical staging were determined. The patients were taken through thorough ophthalmic assessments to determine any ocular complications.

Results

Forty-eight patients (48 %) had at least one HIV-related ocular complication. These complications occurred more frequently among those with CD4 counts below 200 cells/μL. Of the participants with HIV-related ocular complications, 11 (23 %) had retinal microvasculopathy, 10 (21 %) showed allergic conjunctivitis, 7 (15 %) had HIV retinopathy and 7 (15 %) had conjunctival carcinoma. All the participants in the study were on first-line antiretroviral therapy; 68 % were females and 72 % were in the Stage 3 of the WHO Clinical Staging of HIV infection.

Conclusion

The prevalence of ocular complications in HIV positive persons under treatment in Ghana is high. Lower CD4 + T cell counts coupled with age were predisposing factors to HIV-related ocular complications.

A case-control study of prevalence of anemia among patients with type 2 diabetes

BACKGROUND

Anemia is defined as a reduction in the hemoglobin concentration of blood, which consequently reduces the oxygen-carrying capacity of red blood cells such that they are unable to meet the body's physiological needs. Several reports have indicated that anemia mostly occurs in patients with diabetes with renal insufficiency while limited studies have reported the incidence of anemia in people with diabetes prior to evidence of renal impairment. Other studies have also identified anemia as a risk factor for the need for renal replacement therapy in diabetes. Understanding the pathogenesis of anemia associated with diabetes may lead to the development of interventions to optimize outcomes in these patients. The aim of this study was therefore to determine the prevalence of anemia among patients with type 2 diabetes.

METHODS

A total of 100 (50 with type 2 diabetes and 50 controls) participants were recruited for our study. Participants' blood samples were analyzed for fasting blood glucose, full blood count and renal function tests among others. The prevalence of anemia was then determined statistically.

RESULTS

A high incidence of anemia was observed in the cases. Of the patients with diabetes, 84.8% had a hemoglobin concentration that was significantly less (males 11.16±1.83 and females 10.41±1.49) than the controls (males 14.25±1.78 and females 12.53±1.14). Renal insufficiency determined by serum creatinine level of >1.5 mg/dL, estimated glomerular filtration rate <60 ml/minute/1.73 m2, and erythropoietin levels was also observed to be high in the cases (54.0%; with mean creatinine concentration of 3.43±1.73 and erythropoietin 6.35±1.28 mIU/mL). A significantly increased fasting blood glucose, urea, sodium, potassium, and calcium ions were observed in the cases (7.99±1.30, 5.19±1.99, 140.90±6.98, 4.86±0.53 and 1.47±0.31 respectively) as compared to the controls (4.66±0.54, 3.56±2.11, 135.51±6.84, 4.40±0.58 and 1.28±0.26 respectively). Finally, a significant association between hemoglobin concentration and fasting blood glucose was also observed in the cases.

CONCLUSIONS

The findings suggest that a high incidence of anemia is likely to occur in patients with poorly controlled diabetes and in patients with diabetes and renal insufficiency.

Level of male infertility in the Ghanaian city of Tema

Infertility among couples is a sensitive issue in Ghana; females are mostly blamed. Most male infertility cases are generally due to low sperm counts (oligozoospermia), poor sperm quality - characterised by poor sperm motility (asthenozoospermia) - or a combination of both (oligoasthenozoospermia). This is a retrospective study from January 1995 to December 2005 which determined the level and type of male infertility in and around the city of Tema. Seminal fluid analysis reports of male clients who visited the Adom Medical Laboratory in Tema were extracted from laboratory data and analysed. Our study involved 2795 males in the age range of 24-36 years. In 1995, 75% of the total samples analysed had sperm concentrations ranging from 21 to 350 million sperms/ml and showed a decreasing trend to 41% in 2005. Samples with sperm concentrations below 20 million sperms/ml in 1995 increased from 20.5% to 57.6% in 2005; those with active motility > 45% decreased from 27 (30.7%) in 1995 to zero (0%) in 2005, whilst samples with > 50% non-motile sperms increased from 47 (53.4%) in 1995 to 449 (87.7%) in 2005. Male infertility in the samples analysed was due to a combination of oligozoospermia and asthenozoospermia.

Epidemiology and prevention of nosocomial pneumonia associated with Panton-Valentine Leukocidin (PVL) producing Staphylococcus aureus in Departmental Hospital Centre of Zou Collines in Benin

BACKGROUND

An eight (8) months prospective study was carried out to control an outbreak of nosocomial pneumonia due to a Panton-Valentine Leukocidin (PVL) producing Staphylococcus aureus, in the paediatrics' unit at the Zou/Collines Departmental Hospital (CHDZ/C), (Benin).

METHODS

Between 1(st) September 2004 and 30(th) May 2005 an investigation was conducted that involved the screening of all patients suspected to have nosocomial pneumonia, hospital environment sampling and the follow-up of cases until the end of hospital admission period. Isolates were identified, tested for antimicrobial susceptibility and analysed for PVL production. The study period was divided into Period I, corresponding to the outbreak period and Period II, after the complete renovation of the Unit along with hand washing promotion.

RESULTS

A total of 453 patients were admitted during the period of the study; (235 during Period I and 218 during Period II) in the malnourished children sector. Twenty eight (28) cases of pneumonia due to S. aureus were discovered and PVL-producing S. aureus constituted 61% (17/28) of identified cases. The mortality rate among the PVL- producing strains was 15/17 (88%) while it was 1/11 (9%) among non PVL-producing strains. Enhanced hygiene measures helped to terminate the outbreak.

CONCLUSIONS

This study showed that PVL was strongly linked to nosocomial pneumonia. PVL-producing S aureus can be controlled in the hospital by a combination of the promotion of preventive measures, decontamination of the environment and the early use of the correct antibiotic at the appropriate dose and for an adequate duration.