Pulmonary tuberculosis in Kumasi, Ghana: presentation, drug resistance, molecular epidemiology and outcome of treatment

• Published in: West African journal of medicine Vol. 20; no. 2; p. 92
• Main Authors: Lawn, S D, Frimpong, E H, Al-Ghusein, H, Acheampong, J W, Uttley, A H, Butcher, P D, Griffin, G E
• Format: Journal Article
• Language: English
• Published: Nigeria 01-04-2001
• Subjects: Adult; Antitubercular Agents - therapeutic use; Drug Resistance; Drug Therapy, Combination; Female; Ghana - epidemiology; Humans; Male; Molecular Epidemiology; Patient Compliance - psychology; Polymorphism, Restriction Fragment Length; Radiography; Sputum - microbiology; Survival Analysis; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - microbiology; Tuberculosis, Pulmonary - psychology; Urban Health - statistics & numerical data
• ISSN: 0189-160X

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.