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The human gut microbiome, consisting of bacteria, archaea, fungi, and viruses, influences various physiological processes of the body. The gut microbiome composition is shaped by factors such as diet, geography, and antibiotic use. Malaria has been a global health challenge over the years, especially in low- and middle-income countries. This study investigated how asymptomatic malaria infection altered gut microbial communities in Ghanaian children, offering insights for novel malaria control strategies. Standard aseptic phlebotomy procedures were employed to collect venous blood samples for Plasmodium species detection. The gut microbial community was profiled by sequencing the 16S rRNA V4 region, and sequence data were processed using the DADA2 pipeline in R. Asymptomatic malaria infections were predominantly mixed with P. falciparum and P. malariae. Microbiome analysis revealed that Firmicutes and Bacteroidetes comprised nearly 70% of the total microbial population. Asymptomatic individuals showed a decrease in Firmicutes abundance from 52.5% to 44.0% and an increase in Bacteroidetes from 34.7% to 45.6%. There was also a slight increase in the abundance of Proteobacteria from 3.0% to 4.8%. At the genus level, Prevotella_9 was the most abundant and exhibited the highest variability in the infected groups. The Alloprevotella and Streptococcus genera increased in both infected groups, but Escherichia-Shigella was significantly elevated in only those with mixed infections. Faecalibacterium significantly declined in asymptomatic malaria-infected individuals compared to healthy controls, with variability further reduced in mixed infections. Beta-diversity analysis indicated a significant effect of malaria status on microbial composition (PERMANOVA, p < 0.05), explaining approximately 19.1% of the total variation captured by a 2D Principal Component Analysis (PCA) projection. These findings suggest a potential link between malaria infection and gut microbiota alterations and highlight microbial shifts associated with disease status.

Lymphatic filariasis (LF) is a neglected tropical disease that can be exacerbated by secondary bacterial infections that exhibit AMR. Antimicrobial resistance (AMR) is a pressing global health challenge, particularly in resource-limited settings. A bacterial epidemiological study of LF patients identified Staphylococcus aureus as a prevalent Gram-positive pathogen associated with the disease. The emergence of AMR in S. aureus strains poses a significant threat to patient outcomes and public health. By analysing genetic determinants of resistance, we can inform the development of targeted interventions to mitigate the impact of AMR in LF and related conditions. This study comprehensively characterizes the genetic determinants of AMR in six S. aureus isolates obtained from chronic wounds of LF patients in Southern Ghana. Combining antibiotic susceptibility testing (AST) with whole-genome sequencing (WGS), the AST reveals 100 % (6/6) of isolates were resistant to one or more antibioticresistant (MDR). Resistance phenotypes were largely explained by antibiotic resistance genes in WGS data. All isolates were methicillin-resistant, with 33.3 % showing multidrug resistance; ST1 was the predominant sequence type (50 %). Furthermore, the identified plasmids include rep5a (18.2 %), rep7a (22.7 %), rep7c (13.6 %), rep16 (18.2 %), rep20 (13.6 %), rep21 (4.5 %), rep 22 (4.5 %), and repUS43 (4.5 %). Additionally, genes encoding for fibrin production (fnbA/B, sdrC/E, and vWbp), cell adhesion proteins (can, cap8A/B/F/M, clfA/B, ebp, and icaA/B), type VII secretion system proteins (coa, esaA, essA, esxA, and isdA/G), and toxin-producing enterotoxins (coa, hlgA/B/C, scn, sea/c/d/h, and sel/k/l) were found in the isolates. In conclusion, this emphasizes the urgent need for vigilant surveillance, optimized therapeutic protocols, and strengthened public health interventions such as infection prevention measures to effectively mitigate the impact on public health.

Background and Aims:Lymphatic filariasis (LF) and associated chronic wounds are of public health concern worldwide. Despite the significant burden of lymphatic filariasis (LF) and its associated chronic wounds, the fungal component of the wound microbiome remains poorly understood. Previous research has primarily focused on bacterial pathogens, neglecting the potential role of fungi in wound pathogenesis and progression. A comprehensive understanding of the microbial landscape, especially the overlooked fungal component, is crucial for developing effective prevention and treatment strategies. The study aimed to molecularly characterize the fungal populations present in these wounds via Internal Transcribed Spacer (ITS) sequencing. Methods:This was a cross-sectional study, with a total of 63 individuals sampled from eight (8) LF-hyperendemic communities within the Ahanta West District in Ghana. Skin and wound swabs were collected from each participant between December 2021 and February 2022 and subjected to standard culture-based techniques. Fungal isolates were identified, and their DNA was extracted for subsequent PCR amplification of the ITS region. The sequencing was performed using the Oxford Nanopore platform. Results:Of the 63 patients sampled, fungal colonies were observed in 16 individuals (25.4% prevalence) through culture-based methods. Molecular characterisation identified 24 Twenty-four (24) distinct fungal species at different frequencies from nine different genera: Cladosporium, Aspergillus, Periconia, Penicillium, Candida, Lasiodiplodia, Acrophialophora, Zygosporium, and Trichoderma. Cladosporium spp. was the most prevalent, accounting for 30% of isolates, followed by Aspergillus spp. (28.6%), Periconia spp. (14.3%), Penicillium spp. (12.9%), and Candida spp. (8.6%). A smaller proportion of isolates represented Lasiodiplodia spp., Acrophialophora spp., Zygosporium spp., and Trichoderma spp., each comprising 1.4% of the total isolates. Notably, only 2 out of the 16 patients did not present with mixed fungal populations in their wounds. Conclusions:The presence of fungal pathogens and the potential for polymicrobial infections within the LF-wound environment highlight the need for comprehensive and tailored treatment protocols. Effective wound management is essential to address these complex wounds and mitigate the development of antibiotic resistance, a growing concern in chronic wound care.

Background and Aims:The emergence of antibiotic-resistant strains of urinary tract infections (UTI) pathogens poses a significant challenge to the effective treatment of this condition. This study aimed to conduct a retrospective study to analyze the etiology and antibiotic resistance patterns of common urinary tract pathogens in the Ashanti Region of Ghana. Methods:The study employed a standardized data collection form to extract information on age, sex, urine culture results, antibiotic susceptibility test results, and antibiotic treatment regimens from 2020 to 2023. Results:The primary agent responsible for UTIs was Escherichia coli, identified in 47.8% of cases, followed by Klebsiella pneumoniae at 15.8%, Staphylococcus aureus at 9.2%, and Pseudomonas aeruginosa at 6.5%. Candida species were detected in 12% of cases, while coagulase-negative Staphylococci constituted 3.8%. Proteus and Providencia species were observed in 1.1% and 0.5%, respectively. E. coli exhibited complete resistance (100%) to Nalidixic acid (NAL) and Ofloxacin (OFL), with varying degrees of resistance observed across other antibiotics. Among the 29 isolates of K. pneumoniae, 90.0% showed resistance against Cefotaxime, 81.3% against Ciprofloxacin, and 80% against Trimethoprim/Sulfamethoxazole. Sixty percent of E. coli isolates and 25% of Klebsiella isolates demonstrated multi-drug resistance and ESBL production. Conclusion:The surge in multidrug-resistant (MDR) gram-negative isolates presents a significant healthcare hurdle for UTI patients. A noteworthy portion of prevalent pathogens, resistant to NAL and OFL, falls into the category of ESBL-producing Enterobacterales and Pseudomonas spp. The limited availability of effective treatments for MDR gram-negative isolates underscores the urgent need for innovative therapeutic alternatives.

Background: Orthodox medicines have not been successful in eliminating most bacteria associated with diabetic foot ulcer (DFU) due to multi-drug resistance. This study, therefore, investigated the antimicrobial activities of Chromolaena odorata and Syzygium aromaticum, known for their potent antimicrobial properties, in controlling drug-resistant bacterial isolates among DFU patients. Methods: In this cross-sectional study, the aqueous and ethanol extracts of Syzygium aromaticum, and Chromoleana odorata were prepared by maceration method, and its antibacterial effect on clinical strains of antibiotic-resistant bacteria including Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, Streptococcus sp., Escherichia coli, and Pseudomonas aeruginosa were evaluated with microtiter plate method for determining the MIC (Minimum Inhibitory Concentration). Findings: The MIC of Syzygium aromaticum for Klebsiella pneumoniae was determined to be >5000 µg/ml and 2500 ug/ml for aqueous and alcohol extracts respectively, and 5000 µg/ml and 2500 µg/ml for E. coli. Proteus and Pseudomonas aeruginosa had MIC values of 2500 µg/ml and 1250 µg/ml respectively. In comparison, standard antibiotics like ciprofloxacin and gentamicin have MIC values ranging from 500 to 2000 ug/ml against similar strains, highlighting the potential yet relatively higher concentration requirement of the plant extracts. The MIC of alcohol extract of Chromolaena odorata for Pseudomonas aeruginosa and Proteus mirabilis was 2500 µg/ml, while for E. coli and Klebsiella pneumoniae, it was 5000 µg/ml and >5000 ug/ml respectively. Conclusion: Given the positive effects of the two herbal extracts on resistant bacteria isolates, the plants could be used in different pharmaceutical formulations for the prevention and control of infections associated with DFU however, more studies and trials must be carried out, especially on an herbal extract that possesses antimicrobial properties for developing novel antimicrobial medicines for infection treatment among DFU patients.

Type 2 diabetes mellitus (T2DM) patients are at increased risk of infections, such as malignant otitis externa and rhinocerebral mucormycosis, with the urinary tract being the most affected (for example, emphysematous pyelonephritis commonly caused by Escherichia coli). Hence, this study assessed the prevalence of bacteriuria and antibiogram patterns of bacteria isolates among T2DM patients visiting the Ejisu Government Hospital in the Ashanti Region, Ghana. In this cross-sectional study, 58 patients visiting the hospital for routine healthcare were conveniently recruited after obtaining informed consent. Data on sociodemographic characteristics and medical history were obtained using pretested structured questionnaires. Mid-stream urine was collected for bacteria isolation and identification using standard bacterial culture and biochemical tests. Bacteria cultures >= 105 CFU/mL were considered significant bacteriuria. The antibiotic sensitivity patterns of the bacteria isolates were evaluated using the Kirby-Bauer disc diffusion method. Bacteriuria was recorded among 15.5% (9/58) of the patients, mainly those with no previous history (77.8%) and no symptoms (55.6%) of urinary tract infections (UTIs). E. coli (55.6%) and Klebsiella spp. (44.6%) were primarily isolated from the T2DM patients. All the bacteria isolates (E. coli and Klebsiella spp.) demonstrated the highest resistance to co-trimoxazole and tetracycline (55.6%) and a complete susceptibility to amikacin and levofloxacin (100%). However, 60% of the E. coli isolates and 25% of the Klebsiella isolates were multidrug resistant (MDR; resistant to at least one antibiotic agent in three or more antimicrobial categories). The study shows that T2DM patients have bacteria in their urine which are resistant to most common antibiotics, even among those with no history of UTIs; hence, routine bacterial culture and antibiotic sensitivity testing among T2DM patients is recommended for better patient management to reduce the co-morbidities of UTIs.

Abstract Objective Vaginal douching is practiced by women for various reasons. Studies have shown that this practice can upset the normal vaginal flora, increasing susceptibility to certain sexually transmitted diseases (STIs). This study aimed to assess the health risks associated with this practice among women aged 15–54 years in a densely populated community in Kumasi, the second capital city of Ghana. Methods A cross‐sectional survey was conducted to gather data on the prevalence of vaginal douching among young women and their beliefs, motivations, and knowledge about the practice. A structured questionnaire was used in recruiting participants. One‐hundred and fifteen structured questionnaires were administered to women aged between 15 and 54 after their consent was sought. Results The study established that more than half of the participants (69.6%) engaged in douching with a midpoint of 19.5. The study indicated no significant difference between the age of participants and douching (p < 0.93). However, there was an indication of a significant association between educational status, marital status, and perception in relation to douching (p < 0.003, 0.0015, and 0.00, respectively), which also influenced the frequency of douching and contraction of STIs. Conclusion Most women in the study community recruited, regardless of their educational and marital status, believed that douching is necessary and considered part of feminine hygiene practices. Practicing douching may lead to most health complications including pelvic inflammatory disease and infertility which must be given serious attention by researchers, health personnel, and various women's groups.

BACKGROUND:Tuberculosis remains a major public health threat worldwide, causing significant morbidity and mortality, particularly in low- and middle-income countries. In recent years, efforts to combat tuberculosis have focused on strengthening healthcare systems and increasing access to diagnostics and treatment services. There is scarcity of data on the prevalence of Mycobacterium tuberculosis and rifampicin-resistant tuberculosis in the Volta region of Ghana. Therefore, the aim of this study was to determine the trends of Mycobacterium tuberculosis and rifampicin resistance in a major teaching hospital in Ghana spanning a six-year period. METHODOLOGY:A retrospective cross-sectional hospital study was conducted at Ho Teaching Hospital, Ho, Ghana. Study data included archived results on tuberculosis testing using GeneXpert from 2016-2021. Archived data on tuberculosis testing were collected and entered using Microsoft Excel 2019. IBM SPSS (v26) was used for a statistical analysis of the prevalence of tuberculosis. P-value <0.05 was considered statistically significant. RESULTS:The study included 5128 presumptive tuberculosis cases from 2016 to 2021, of which 552 were positive, revealing an overall prevalence of 10.76%. Males exhibited a significantly higher prevalence of tuberculosis (14.20%) compared to females (7.48%), with a male-to-female ratio of 2:1. The burden of tuberculosis varied significantly between age groups, with those aged 30-45 years and 46-60 years facing twice the risk compared to those under 15 years (p<0.001). Rainy seasons correlated with heightened tuberculosis occurrences (12.12%) compared to dry seasons (8.84%) (p = 0.008). Rifampicin-resistant tuberculosis was prevalent at 3.45%, slightly higher in women, particularly in the 45-59 age group (5.97%). In particular, tuberculosis prevalence exhibited fluctuations, peaking in 2016 (17.1%) and 2020 (11.5%), with a trough in 2019 (4.6%). CONCLUSION:The overall prevalence of laboratory confirmed tuberculosis was 10.76%, and resistance to rifampicin, 3.45%, indicating high infection and possible treatment failure. Considering its infectious nature, this calls for concerted efforts to curb the spread of the infection.

Filarial lymphedema is a chronic pathophysiological condition initiated by parasitism by lymphatic filarial worms. Although the disease is not immediately fatal, it is a significant social and economic issue, particularly in sub-Saharan Africa. Given the ongoing need for effective therapeutic strategies for filarial lymphedema, several countries have turned to natural products and herbal interventions as promising source for developing anti-filarial agents to manage lymphatic filariasis (LF). This review aims to classify various plant molecules implicated in treating LF, with a focus on their anti-filarial properties. This information can be used to further investigate their efficacy in managing filarial lymphedema.

In Africa, Plasmodium falciparum accounts for majority of malaria morbidity and mortality in children under five years. At this age, they also become co-infected with Epstein-Barr virus (EBV). There is scanty of information whether this co-infection is the reason why malaria in children tends to be severe. The aim was to study the association between co-infection of EBV with P. falciparum infection and malaria severity in children under five. A cross sectional study was conducted among eighty children below five years who had been confirmed to have malaria. These children were grouped into those who had severe malaria and those who did not have severe malaria. EBV antibodies (EBNA-1 IgG) and malaria parasitaemia were measured from the blood samples of the children using ELISA and microscopy, respectively. EBV seroprevalence was higher in the severe malaria group, 16 (32.78%) compared to non-severe malaria group, 5 (16.1%); although it did not show any significant difference (Risk ratio: 2.024, 95% CI: 0.8249 to 4.9686, p = 0.1236). Despite the higher seroprevalence of EBV in the severe malaria group, this was not responsible for malaria severity. Children with EBV were however more likely to progress to severe malaria. Key words: Epstein-Barr virus, Plasmodium falciparum, severe malaria, endemicity.

Diabetes mellitus is a metabolic syndrome characterized by high blood glucose levels that is currently a worldwide health concern. The purpose of this study is to use anthropometric indicators to determine the prevalence of obesity and overweight among Type II Diabetic Patients. Over a 20-week period, this cross-sectional study was conducted on Type II Diabetic Patients who were identified through a simple randomized sampling from the Diabetics' Clinic. This study enlisted the participation of a hundred (100) Diabetic Patients. A standardized pre-tested questionnaire was used to collect demographic information from the participants. Anthropometry measurements such as height, weight, waist circumference, and hip circumference were all taken using standardized procedures, and the body mass index (BMI), waist to hip ratio (WHR), Body Adiposity Index (BAI), and waist to height ratio (WHtR) were calculated. In this study, 36% of patients were between the ages of 55 and 64, with 31% of the participants being female. Obesity was prevalent in 46% of the study population according to the BMI classification, 45% according to the WHR classification, 40% according to the WHtR classification, and 32% according to the BAI classification. Using BMI values, 82.6% of females were obese, compared to 17.4% of males, and 58.5% of females were overweight, compared to 41.4% of males. Stretching, swimming, and bicycling were all associated with obesity in Type II Diabetic Patients indicating X2(9) = 19.968, P < 0.018, X2(9) = 15.674, P < 0.016, X2(9) = 12.898, P < 0.045, respectively. There was an establishment of an increased prevalence of obesity and overweight among the cohort of Diabetic patients recruited for this study with the females indicating a higher prevalence than their male counterparts.

Background and AimFilarial infections affect over 150 million people in the tropics. One of the major forms of filarial pathologies is lymphedema; a condition where the immune response is significantly altered, resulting in changes in the normal flora. Staphylococcus hominis, a human skin commensal, can also be pathogenic in immunocompromised individuals. Therefore, there is the possibility that S. hominis could assume a different behavior in filarial lymphedema patients. To this end, we investigated the levels of antibiotic resistance and extent of mecA gene carriage in S. hominis among individuals presenting with filarial lymphedema in rural Ghana. MethodWe recruited 160 individuals with stages I-VII lymphedema, in a cross-sectional study in the Ahanta West District of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were subjected to Matrix-Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry for bacterial identification. Antimicrobial susceptibility testing (AST) was performed using the Kirby-Bauer method. mecA genes were targeted by polymerase chain reaction for strains that were cefoxitin resistant. ResultsIn all, 112 S. hominis were isolated. The AST results showed resistance to chloramphenicol (87.5%), tetracycline (83.3%), penicillin (79.2%), and trimethoprim/sulphamethoxazole (45.8%). Of the 112 strains of S. hominis, 51 (45.5%) were resistant to cefoxitin, and 37 (72.5%) of the cefoxitin-resistant S. hominis haboured the mecA gene. ConclusionThis study indicates a heightened level of methicillin-resistant S. hominis isolated among filarial lymphedema patients. As a result, opportunistic infections of S. hominis among the already burdened filarial lymphedema patients in rural Ghana may have reduced treatment success with antibiotics.

Background: Lymphatic filariasis (LF) is a debilitating neglected tropical disease that remains a major public challenge in endemic countries. In addition to providing mass drugs administration (ivermectin, albendazole and diethylcarbamazine) to reduce parasite burden in endemic communities, there is also a need to mitigate the challenges associated with lymphedema progression. Filarial lymphedema is known to be complicated by secondary bacterial infections; however, this is yet to receive considerable attention in LF-endemic communities in rural Ghana. Thus, the focus of this study was to understand the skin microbiome of individuals presenting with filarial lymphedema over a period. Methods: This longitudinal study employed culture and Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) to characterize the microbiota of filarial lymphedema lesions over 24 months follow-ups and considered how different it is from the skin bacterial composition of non-filarial individuals described previously in literature. Results: The result reveals that filarial lymphedema lesions had four main phyla: Firmicutes (69.7%), Proteobacteria (16.6%), Actinobacteria (13.3%), and Bacteroidetes (0.3%). Firmicutes presented the highest abundance. There were observable differences in the distribution of Firmicutes, Proteobacteria, Bacteroidetes, and Actinobacteria, with the Firmicutes and Proteobacteria phyla enriched while the Bacteroidetes and Actinobacteria were markedly diminished in the filarial lymphedema lesions, relative to healthy skin. Propionibacterium and Corynebacterium, which are usually resident and abundant in healthy skin, were underrepresented in the skin from lymphedema lesions. Most of the taxa found in the skin from lymphedema lesions are not the typical organisms in human skin instead they were potentially pathogenic, with the Streptococcus, Acinetobacter, Klebsiella, Pseudomonas, Bacillus, Corynebacterium, Micrococcus, Enterococcus, Proteus and Staphylococcus genera being topmost isolates. Conclusion: Our data revealed a significant shift of the bacterial population with the introduction of potentially pathogenic bacteria to compete with the healthy skin resident microbiota during LF infection. (C) 2022 The Author(s). Published by Elsevier B.V. on behalf of African Institute of Mathematical Sciences / Next Einstein Initiative.

Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates. Of the sixty (60) participants, fifty-four (n = 54, 90%) were within 31–60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged (in months) seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli. and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively. The findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.

AbstractBackgroundLymphatic Filariasis (LF), a neglected tropical disease, has been speculated to be complicated by secondary bacteria, yet a systematic documentation of these bacterial populations is lacking. Thus, the primary focus of this study was to profile bacteria diversity in the progression of filarial lymphedema among LF individuals with or without wounds.MethodsA cross‐sectional study design recruited 132 LF individuals presenting with lymphedema with or without wounds from eight communities in the Ahanta West District in the Western Region, Ghana. Swabs from the lymphedematous limbs, ulcers, pus, and cutaneous surfaces were cultured using standard culture‐based techniques. The culture isolates were subsequently profiled using Matrix‐assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry.ResultsOf the 132 LF participants recruited, 65% (85) had filarial lymphedema with no wounds. In total, 84% (235) of the bacterial isolates were identified. The remaining 16% (46) could not be identified with the method employed. Additionally, 129(55%) of the strains belonged to the phylum Firmicutes, while 61 (26%) and 45 (19%) represented Proteobacteria and Actinobacteria, respectively. Generally, irrespective of the samples type (i.e., wound sample and non‐wound samples), there was a sharp increase of bacteria diversity from Stages 1 to 3 and a drastic decrease in these numbers by Stage 4, followed by another surge and a gradual decline in the advanced stages of the disease. The Shannon Diversity Index and Equitability for participants with and without wounds were (3.482, 0.94) and (3.023, 0.75), respectively. Further, Staphylococcus haemolyticus and Escherichia coli showed resistance to tetracycline, chloramphenicol, and penicillin.ConclusionThe present study reveals a sharp decline in bacterial load at the late stages of filarial lymphedema patients. In addition, we report an emerging antimicrobial resistance trend of S. haemolyticus and E. coli against commonly used antibiotics such as tetracycline, chloramphenicol, and penicillin in communities endemic for LF in the Ahanta West District, Ghana. This could pose a huge challenge to the management of the disease; particularly as current treatments are not quite effective against the infection.

Background Filarial pathologies such as lymphedema may be associated with complications such as chronic non-healing wounds. Nonetheless, the role of bacterial population colonizing the lymphedematous legs has been posited to worsen the conditions of those living with the infection. These bacteria are usually composed of staphylococcal species partly because they are commensals. Thus, this present study sought to type the methicillin-resistant Staphylococcus aureus (MRSA) prevalence among individuals presenting with filarial lymphedema, particularly as MRSA tends to affect treatments options. Methods We recruited individuals ( n = 321) with stages I–VII of lymphedema in a cross-sectional study in the Ahanta West district of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were later identified using Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry. Results A total of 192 Staphylococci species were isolated, with an overall prevalence of 39.7% (95% CI: 35%–44%; N = 483). S. hominis was the most prevalent species (23.95%), followed by S. haemolyticus (20.83%), S. epidermidis (15.10%), S. aureus (10.41%), and S. saprophyticus (9.32%). The remaining 20.34% were distributed among S. wanneri , S. sciuri , S. pasteuri , S. xylosus , S. simulans , S. cohnii , S. caprae , S. lugdunensis , and S. capitis . MRSA, containing mecA gene, was detected in 21 out of 31 Staphylococci isolates tested, with an overall prevalence of 68% (95% CI: 51%–84%). In addition, a virulent gene, Panton–Valentine leukocidin ( PVL ), which is usually associated with S. aureus , was detected in 20/31 (64.5%) S. aureus in the study. Conclusion These results suggest that MRSA species may pose a challenge to the treatment of filarial lymphedema with antibiotics particularly, as doxycycline is currently being piloted in some endemic areas to treat the infection. Thus, intensive antimicrobial resistance surveillance should be conducted in endemic areas by health authorities to forestall the dilemma of multidrug resistance not only against lymphatic filariasis (LF) infection but other diseases.

Bacterial resistance against antimcrobial agents is a growing international problem in the treatment of nosocomial infections, especially in developing countries. This study therefore sought to determine the antibiotic susceptibility pattern of the isolates in UTIs and to identify the probable antibiotic alternatives in uropathogenic infection to guide antimicrobial therapy at the Brong-Ahafo Regional Hospital-Sunyani. Between January and December 2014, 200 urinary isolates were received from in and out patients at the Microbiology unit of the laboratory. Isolates were tested for antimicrobial susceptibility by the Kirby Bauer disc diffusion method, on Mueller-Hinton Agar (Oxoid GmbH, Wesel, Germany) and the results were presented as resistant or susceptible, according to the recommendations of Clinical and Laboratory Standards Institute (CLSI). One hundred and seventy-two (172, 96.6%) isolates were resistant to tetracycline and 144(90.5%) isolates were resistant to Ampicillin/sulbactam. One hundred and fifty (150, 93.2%) isolates were readily susceptible to Amikacin. Among the third generation cephalosporins, ceftizoxime achieved 50% sensitivity and 20.6% and 16.7% for cefotaxime and ceftazidime respectively against all isolates. The isolates also showed strong resistance to the fluoroquinolones, nalidixic acid (80.8%); ciprofloxacin (74.1%); ofloxacin (65.4%) and levofloxacin (64.6%). Chloramphenicol and gentamicin achieved 23.4% and 24.1% sensitivity respectively. Lower resistance was observed in amikacin and ceftizoxime. The extent of resistance among bacteria isolates in UTIs in non-hospitalized and hospitalized patients is worryingly high in the Brong-Ahafo Regional Hospital. Antimicrobials such as tetracycline, ampicillin/sulbactam, chloramphinicol and gentamicin should no longer be recommended for initial empirical therapies for UTIs especially when E. coli is concerned. Amikacin, ceftizoxime, ofloxacin and levofloxacin may be considered as alternatives.

Introduction.Antimicrobial resistance is a growing international problem resulting from the enzyme β-lactamase production by bacteria, to degrade antibiotics, especially β-lactam antibiotics.In Brong Ahafo Regional Hospital, Sunyani, these antibiotics are heavily depended upon for the treatment of serious infections, but unfortunately high proportions of bacterial isolates in the hospital, have been found to be resistant to the commonly prescribed antibiotics.This study aims to determine the prevalence of ESBL-producing E. coli so as to determine if ESBL are responsible for the high antimicrobial resistance seen at the Brong-Ahafo Regional Hospital, Sunyani.Methods.The study was a cross sectional study, involving 51 E. coli isolates from urine samples of both in-and out-patients between January and December, 2014.Antimicrobial susceptibility profiles of the isolates were determined by the Kirby Bauer disc diffusion method against 12 antibiotics.The isolates were screened for ESBL production, and then confirmed by the combined disc method.The isolates were tested for the presence of ESBL blaCTX-M and blaTEM by conventional PCR.Results.Non-repeat 1,302 midstream urine samples were cultured from which 200 different pathogens were isolated.Of the 200 isolates 51 were E. coli.Isolates obtained from Community isolates were 16(37.2) and isolates from in-patients were 27(62.8).Resistant strains were detected to all the 12 antimicrobials tested.Low proportions were sensitive to cephalosporins (cefotaxime and ceftazidime), both recording 8/51(15.7%),and quinolones (nalidixic acid and ciprofloxacin), 7/51(13.7%)and 8/51(15.7%)respectively.The isolates had varied susceptibility to aminoglycosides, with low sensitivity of 1/32(2.0%) to gentamicin, but a high proportion of 47/51(92.2%)was sensitive to amikacin.High proportion of the isolates [43/51(84.3%)]were ESBL phenotype, and was found to be significantly associated (p<0.001) with antimicrobial resistance among the isolates.The most prevalent ESBL genotype was BlaTEM with 26 (66.7%) and blaCTX-M 28(71.8%),but 9(23.1%)ESBL phenotypes tested negative for both blaTEM and blaCTX-M genes.22 (56.4%) of the isolates had both blaTEM and blaCTX-M genes. Conclusion.High proportions of E. coli isolates from urine in Sunyani produce ESBLs.Both blaTEM and blaCTX-M were prevalent and linked to the high levels of drug resistance found in the locality.Increased antibiotic stewardship and stringent infection control measures along with the testing for ESBL must be instituted in the hospital.