Objective: To determine the prevalence of chronic typhoidal salmonellae amongst food vendors in Kumasi Ghana. Design: A prospective study. Setting: Sitting and itinerant food vendors in Kumasi. Methods: Screening of 258 (230 females of 28 males) healthy food vendors for Salmonella typhi, and S. paratyphi A, B, and C, using stool culture, the widal test, and standard microbiological identification methods. Main outcome measures: Prevalence of chronic typhoidal Salmonellae carriers among food vendors in Kumasi. Results: Typhoidal Salmonellae were isolated from six people, giving a carriage rate of 2.3%. Three of the Salmonellae isolated were S. typhi, and they had significant Widal agglutinin titres of ≥l/160 and ≥1/320 for 0 and H antigens, respectively. The other three were non-typhoidal Salmonellae. The three had S. typhi and the other three had titres of 1/80 or less for both 0 and H antigens, respectively. We have discussed the implications of this high carriage rate, and we have suggested the inclusion of screening for Salmonellae of the regular health screening exercise undertaken by food handlers to detect and monitor chronic carriers in the food industry, to help control salmonella diseases in the community. Conclusion: From our study, food handlers consitute a significant risk in the spread of enteric fever in Kumasi. We therefore, suggest the inclusion of screening for Salmonellae in the regular obligatory six-monthly examination required of food handlers and to monitor those found to be infected.

Antimicrobial resistance (AMR) is a major threat to global health. Understanding the emergence, evolution, and transmission of individual antibiotic resistance genes (ARGs) is essential to develop sustainable strategies combatting this threat. Here, we use metagenomic sequencing to analyse ARGs in 757 sewage samples from 243 cities in 101 countries, collected from 2016 to 2019. We find regional patterns in resistomes, and these differ between subsets corresponding to drug classes and are partly driven by taxonomic variation. The genetic environments of 49 common ARGs are highly diverse, with most common ARGs carried by multiple distinct genomic contexts globally and sometimes on plasmids. Analysis of flanking sequence revealed ARG-specific patterns of dispersal limitation and global transmission. Our data furthermore suggest certain geographies are more prone to transmission events and should receive additional attention.

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Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections. Incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia, and disseminated histoplasmosis cases in AIDS was estimated at 6275, 12,610 and 724, respectively. Oral and esophageal candidiasis collectively affect 27,100 Ghanaians and 42,653 adult asthmatics are estimated to have fungal asthma. We estimate a prevalence of 12,620 cases of chronic pulmonary aspergillosis (CPA and an incidence of 1254 cases of invasive aspergillosis (IA). Estimated cases of candidemia and candida peritonitis cases were 1446 and 217, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) and tinea capitis was 442,621 and 598,840, respectively. Mucormycosis and fungal keratitis each may affect 58 and 810 Ghanaians. These data highlight the urgent need for intensified awareness to improve diagnosis and management.

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ObjectiveThe purpose of this study was to investigate the virulent factors of Vibrio cholerae which caused an unprecedented large cholera outbreak in Ghana in 2014 and progressed into 2015, affected 28,975 people with 243 deaths.ResultsThe V. cholerae isolates were identified to be the classical V. cholerae 01 biotype El Tor, serotype Ogawa, responsible for the large cholera outbreak in Ghana. These El Tor strains bear CtxAB and Tcp virulent genes, making the strains highly virulent. The strains also bear SXT transmissible element coding their resistance to antibiotics, causing high proportions of the strains to be multidrug resistant, with resistant proportions of 95, 90 and 75% to trimethoprim/sulfamethoxazole, ampicillin and ceftriaxone respectively. PFGE patterns indicated that the isolates clustered together with the same pattern and showed clusters similar to strains circulating in DR Congo, Cameroun, Ivory Coast and Togo. The strains carried virulence genes which facilitated the disease causation and spread. This is the first time these virulent genes were determined on the Ghanaian Vibrio strains.

Extended spectrum β-lactamases (ESBLs) are frequently reported in Ghana, but AmpC bacteria reports are scanty. This study determines the prevalence of AmpC Pseudomonas aeruginosa and Proteus mirabilis clinical isolates at the Komfo Anokye Teaching Hospital (KATH), Kumasi, where ESBL and AmpC are not routinely tested. Non-duplicate 245 isolates comprising 187 (76.3%) P. aeruginosa and 58 (23.7%) P. mirabilis were tested for AmpC and ESBL production using the modified three-dimensional test method and the double disc synergy test (DDST) methods, respectively. The proportion of the 245 isolates producing AmpC β-lactamase was 93 (38.0%) and 79 (32.2%) produced ESBL. AmpC producers confirmed 49 (52.7%) as inducible and 44 (47.3%) non-inducible AmpC producers. P. aeruginosa and P. mirabilis that produced AmpC were 84 (44.9%) and 9 (15.5%), respectively. ESBL production was 41 (21.9%) in P. aeruginosa and 38 (65.6%) in P. mirabilis. Co-producers of AmpC together with ESBL were 7.3%. Both enzyme were detectable in 13 (7.0%) of P. aeruginosa and 5 (8.6%) of P. mirabilis. AmpC and ESBL are detectable in high proportions among P. aeruginosa and P. mirabilis isolates at KATH and the Kumasi community. This emphasizes the need to start testing for both enzymes to guide therapeutics.

Cryptosporidium species infects a wide number of animals including livestock all over the world. The current study was done to determine the prevalence and risk factors of Cryptosporidium infection among cattle in the Central Region of Ghana. Two hundred and eighty-seven (287) faecal samples were randomly collected from animals on eight cattle farms in four districts across two agroecological zones. A commercial enzyme-linked immunosorbent assay kit (CoproELISA, Savyon® Diagnostics Ltd., Israel) for Cryptosporidium was used in the detection of Cryptosporidium antigens in faecal samples. Characteristics of the animals such as age, sex, and location, as well as consistency of faecal samples, were collected. Pearson’s chi-square or Fisher’s exact test was used to determine the association between explanatory variables and Cryptosporidium infection while a logistic regression model was also used to determine the risk of infection. The overall prevalence of Cryptosporidium infection was 23.7% (95% CI, 18.7-28.6). Prevalence was significantly higher ( p = 0.049 ) among cattle aged 12-month old and above compared to those under 12 months of age. Among the four districts in the study area, Cape Coast metropolis recorded a significantly higher prevalence (60.5%; CI, 49.3-71.8), ( p < 0.001 ) compared to the other three. Furthermore, a significant association was observed between the consistency of faecal samples and Cryptosporidium infection ( p = 0.042 ). The prevalence of Cryptosporidium infection was also significantly higher among cattle from the coastal savanna zone (26.9%; 95% CI, 21.0-32.8) compared to those from the semideciduous forest area ( p = 0.017 ). Cattle in the forest zone had a lower risk of being infected with the parasite compared to those from the coastal savanna zone (OR 0.408; 95% CI, 0.182-0.915). In conclusion, Cryptosporidium was prevalent among cattle in the Central Region of Ghana. A higher prevalence of Cryptosporidium infection occurred in older animals and among animals in the coastal agroecological zone. The area of location and age of animals were identified as risk factors for Cryptosporidium infection in the Central Region of Ghana.