Pulmonary tuberculosis in Kumasi, Ghana: presentation, drug resistance, molecular epidemiology and outcome of treatment.
To assist implementation of tuberculosis (TB) control measures, knowledge of the disease characteristics in a community is essential. This study in Kumasi, Ghana, correlates the clinical presentation, microbiology, molecular epidemiology and clinical outcome of thirty consecutively diagnosed patients with new smear-positive pulmonary TB. Several important factors that potentially promote disease transmission in the community were identified: patients had prolonged duration of productive cough prior to diagnosis (mean=4.1 months; SD=2.1); the disease was typically advanced at presentation and Ziehl-Neelson sputum smears indicated a high bacterial load (80% graded > AFB++); home accommodation was overcrowded with a mean of 3.3 other persons sleeping in the same room as the patients at night. IS6110 restriction fragment length polymorphism (RFLP) fingerprinting of 25 isolated (23 Mycobacterium tuberculosis and 2 Mycobacterium africanum) from epidemiologically unrelated cases identified 3 identical strains and 3 clusters containing 2, 4 and 8 isolates of > or =80% similarity, suggesting high rates of disease transmission. A high prevalence of primary resistance to isoniazid was found (6 out 26; 23%) but resistance to rifampicin, pyrazinamide, ethambutol, streptomycin and ciprofloxacin was not detected. Smear coversion at 2 months and final outcome of treatment with short courses chemotherapy were independent of isoniazid resistance, but the rate of treatment default was unacceptably high (37%). High rates of disease transmission, primary isoniazid resistance and treatment default all indicate poor TB control. The use of rifampicin-containing short-course chemotherapy in this community must be accompanied by adequate resources and infrastructure to ensure very stringent treatment supervision to improve case-holding and reduce the risk of multi-drug resistance.
Lawn
S D
SD
Department of Medicine, School of Medical Sciences, University of Science & Technology, Kumasi, Ghana.
Frimpong
E H
EH
Al-Ghusein
H
H
Acheampong
J W
JW
Uttley
A H
AH
Butcher
P D
PD
Griffin
G E
GE
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D010349:Patient Compliance / Q000523:psychology; D012150:Polymorphism, Restriction Fragment Length; D011859:Radiography; D013183:Sputum / Q000382:microbiology; D016019:Survival Analysis; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000523:psychology; D014504:Urban Health / Q000706:statistics & numerical data*
D000995:Antitubercular Agents