Augustina Annan

High prevalence of common respiratory viruses and no evidence of Middle East Respiratory Syndrome Coronavirus in Hajj pilgrims returning to Ghana, 2013

The Middle East respiratory syndrome coronavirus (MERS‐CoV) emerged in 2012 on the Arabian Peninsula and has caused severe respiratory disease with more than 800 laboratory‐confirmed cases. The return of infected pilgrims to their home countries with a putative spread of MERS‐CoV necessitates further surveillance.

Human Coronaviruses Associated with Upper Respiratory Tract Infections in Three Rural Areas of Ghana

Background Acute respiratory tract infections (ARI) are the leading cause of morbidity and mortality in developing countries, especially in Africa. This study sought to determine whether human coronaviruses (HCoVs) are associated with upper respiratory tract infections among older children and adults in Ghana. Methods We conducted a case control study among older children and adults in three rural areas of Ghana using asymptomatic subjects as controls. Nasal/Nasopharyngeal swabs were tested for Middle East respiratory syndrome coronavirus (MERS-CoV), HCoV-22E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1 using Reverse Transcriptase Real-Time Polymerase Chain Reaction. Results Out of 1,213 subjects recruited, 150 (12.4%) were positive for one or more viruses. Of these, single virus detections occurred in 146 subjects (12.0%) and multiple detections occurred in 4 (0.3%). Compared with control subjects, infections with HCoV-229E (OR = 5.15, 95%CI = 2.24–11.78), HCoV-OC43 (OR = 6.16, 95%CI = 1.77–21.65) and combine HCoVs (OR = 2.36, 95%CI = 1.5 = 3.72) were associated with upper respiratory tract infections. HCoVs were found to be seasonally dependent with significant detections in the harmattan season (mainly HCoV-229E) and wet season (mainly HCoV-NL63). A comparison of the obtained sequences resulted in no differences to sequences already published in GenBank. Conclusion HCoVs could play significant role in causing upper respiratory tract infections among adults and older children in rural areas of Ghana.

Insecticide resistance in malaria vectors in Kumasi, Ghana

BackgroundThere have been recent reports of surge in resistance to insecticides in pocketed areas in Ghana necessitating the need for information about local vector populations and their resistance to the insecticides approved by the World Health Organization (WHO). We therefore studied a population of malaria vectors from Kumasi in the Ashanti Region of Ghana and their resistance to currently used insecticides. We conducted susceptibility tests to the four major classes of insecticides by collecting larvae of anopheline mosquitoes from several communities in the region. Surviving adults from these larvae were then subjected to the WHO-approved susceptibility tests and characterization of knockdown resistance and acetylcholinesterase mutant genes.ResultsOut of 619 Anopheles specimens sampled, 537 (87%) were identified as Anopheles gambiae (sensu stricto), which was also the species with the lowest knockdown resistance mutant gene, 61% (P = 0.017). Knockdown resistance mutant gene was as high as 91% in An. coluzzii. Mosquitoes collected showed susceptibility ranging from 98–100% to organophosphates, 38–56% to carbamates and 15–47% and 38–46% to pyrethroids and organochlorides, respectively. The knockdown resistance mutation frequency of Anopheles gambiae (sensu lato) mosquitoes that were exposed to both pyrethroids and organochlorides was 404 (65%). Acetylcholinesterase mutant gene was not found in this population of vectors.ConclusionOur study shows that pyrethroids have the highest level of resistance in the population of mosquito vectors studied probably due to their frequent use, especially in impregnation of insecticide-treated nets and in insecticides used to control pests on irrigated vegetable farms. We recommend studies to monitor trends in the use of all insecticides and of pyrethroids in particular.

Pseudomonas oryzihabitans sepsis in a 1-year-old child with multiple skin rashes: a case report

BackgroundPseudomonas oryzihabitans is a Pseudomonas bacterial organism rarely implicated in human infections. The bacterium has been isolated in a few reported cases of neurosurgical infections and patients with end-stage cirrhosis, sickle cell disease, and community-acquired urinary tract infections. Limited information exists in developing countries, however, because of the lack of advanced microbiological tools for identification and characterization of this bacterium. This case report describes the isolation of a rare Pseudomonas bacterium in a patient presenting with sepsis and skin infection.Case presentationA 1-year-old girl was presented to a hospital in the northeastern part of Ghana with a 1-week history of pustular rashes on her scalp and neck, which occasionally ruptured, along with discharge of yellowish purulent fluid. The child is of Mole-Dagbon ethnicity and hails from the northern part of Ghana. Pseudomonas oryzihabitans was identified in the patient’s blood culture using the 16S ribosomal deoxyribonucleic acid sequencing technique. The rash on the patient’s scalp and skin resolved after continuous treatment with gentamicin while her condition improved clinically.ConclusionsThis finding suggests the potential of this bacterium to cause disease in unsuspected situations and emphasizes the need to have evidence for the use of the appropriate antibiotic in clinical settings, particularly in rural settings in Africa. It also brings to the fore the unreliability of conventional methods for identification of Pseudomonas bacteria in clinical samples and thus supports the use of 16S ribosomal deoxyribonucleic acid in making the diagnosis.

Genotypic characterisation of human papillomavirus infections among persons living with HIV infection; a case–control study in Kumasi, Ghana

The objective of this study is to describe the burden of human papillomavirus (HPV) infection among women living with HIV and non‐infected women in Ghana.

Gonococcal sepsis in a 32-year-old female: a case report

BackgroundNeisseria gonorrhoeae is a Gram-negative bacterium which affects the urethra, throat, rectum and cervix of patients and often associated with sexually transmitted infections. The global epidemiology of the disease is not well characterised especially in resource constraint countries due to poor diagnostic capacity and inefficient reporting systems. Although important, little is known about the propensity of this bacterium to cause sepsis in immunocompetent individuals.Case presentationA 32-year-old female presented with fever and generalised malaise to a rural hospital in Ghana. The patient had previously been diagnosed as having enteric fever from a neighbouring health facility. Blood and urine samples were collected from the patient and cultured using standard microbiological and molecular techniques. Neisseria gonorrhoeae was isolated from the blood which was resistant to penicillin, ciprofloxacin and cotrimoxazole. The patient recovered following ceftriaxone and azithromycin treatment.ConclusionThis case highlights the importance of N. gonorrhoeae in causing sepsis and emphasises the need for blood culture investigation in diagnosis of patients presenting with fever.

Response to the letter to the editor: Barasheed et al., ‘No evidence of MERS-CoV in Ghanaian Hajj pilgrims: cautious interpretation is needed’

Barasheed et al. cite two more studies on surveillance of MERS-CoV in returning Hajj pilgrims, both of which were published after the submission of our manuscript, thus highlighting the interest of MERS-CoV surveillance of Hajj pilgrims that is obviously perceived in the scientific community at the moment [1–4]. Reassuringly, in none of the studies MERS-CoV was detected, which is in line with our findings. However, as a recent study found a lower viral load in samples from the upper respiratory tract compared to those from the lower respiratory tract, Barasheed et al. raise the question of decreased sensitivity for MERS-CoV detection in the surveillance studies that were performed up to now [5]. So far, all surveillance studies of Hajj pilgrims relied on testing of upper respiratory tract samples to exclude the presence of a MERS-CoV infection upon return from the Hajj. Therefore, we want to address the following aspects: the findings from Memish et al. were observed in acutely diseased, hospitalised MERS-CoV cases, and therefore, the relevance from this finding for conducting community-based surveillance studies from both an ethical and a practical point of view is low. Clearly, material from the lower respiratory tract that necessitates invasive procedures such as bronchoscopy cannot be obtained from pilgrims that show no or only mild symptoms. Furthermore, as shedding of virus in the upper airways is also a measure of virus transmissibility, a lack of detection of MERS-CoV RNA in the upper respiratory tract is a valid correlate for a likely absence of a MERS-CoV transmission risk in the cohorts described. Furthermore, Barasheed et al. comment on a lack of the prevalence of influenza-like illness (ILI) in our study. In their table, they provide details on the definitions used in the studies by Barasheed et al. and Benkoutien et al. [2, 4] to assess ILI, both of which include subjective fever and respiratory symptoms such as cough, sore throat and rhinorrhea in their definition without assessing the date of onset. According to the WHO, influenza-like illness is defined as ‘measured fever of ≥ 38 °C and cough with onset within the last 10 days’ [6]. Therefore, none of the studies cited fulfil the WHO-defined criteria for ILI; similar to these two studies, fever was not measured in our study but only self-reported by a standardised questionnaire. As stated by the WHO, ‘using one common case definition globally will allow national health authorities to interpret their data in an international context’, which is of utmost importance when conducting research on mass gathering of international relevance such as the Hajj [6]. We feel that self-reported fever should not be used to assess the prevalence of ILI, and therefore, we did not include the assessment of ILI into our publication. The same limitation arises in our opinion for the assessment of influenza vaccination rates, which cannot reliably be assessed only by self-reporting. As already discussed in our publication, a different pre-existing immunity of African pilgrims (either from natural infection or from vaccination) compared to pilgrims from other countries could account for the differences seen in the virus prevalence. Furthermore, if the differences in prevalence and attack rate mentioned are of relevance, given the different methodologies used in these studies, is of question. Although we agree that the absence of MERS-CoV in nasal or nasopharyngeal samples does not rule out the risk of disease at the Hajj, we disagree on the basic reproductive number (R0) of MERS-CoV as stated by Barasheed et al. The recent estimate of a rather high basic reproductive number of MERS-CoV ranging from 2 to 6.7 [7] is in contrast with findings from our own work and estimates determined by others [8–10]. A serosurvey on MERS-CoV contact cases conducted by our group in Saudi Arabia showed a household transmission rate from cases to close contacts of only 5% [9]. These findings are supported by other studies, which assess an R0 for MERS-CoV below 1 [8, 10]. Furthermore, our observational study conducted during a MERS-CoV outbreak in Jeddah revealed that the peak in case numbers was related to a nosocomial outbreak due to a gross lack of hygiene measures but not to a more virulent MERS-CoV [11]. We very much agree with Barasheed et al. that an ongoing surveillance is important to further understand the epidemiology of respiratory viruses at the Hajj and a potential transmission risk of MERS-CoV, especially in developing countries.