Understanding the pneumocococcus: transmission and evolution

Streptococcus pneumoniae is part of the normal bacterial flora of the narsopharynx, but is also associated with several invasive and non-invasive diseases. Recently, there has been a plethora of research information on the pneumococcus, however, there are few comprehensive review papers discussing the research information. This paper provides a review of the pneumococcus in two vital areas related to its biology including transmission and evolution. Transmission of the pneumococcus is a highly efficient process that usually occurs through respiratory droplets from asymptomatic carriers. Following acquisition, the pneumococcus may only establish in the nasopharynx of the new host, or further progress to sites such as the lungs and cause disease. Pneumococcus transmission risk factors, as well as factors involved in its translocation from the nasophyarnx to diseases sites are still not fully understood. Pneumococcal evolution is dominated by recombination. The recombinational events usually involve genetic exchange with streptococci of the mitis group and some pneumococci are thought to exhibit hyper-recombination

Rannsókn á heilablóðfalli í suður Gana: Faraldsfræði, lífsgæði og samfélagsviðhorf

Bakgrunnur: Heilablóðfall er sjúkdómur sem er mjög mikilvægur lýðheilsu og getur haft í för með sér gríðarlegar efnahags- og félagslegar afleiðingar. Í Gana mælist heilablóðfall meðal efstu þriggja algengustu dánarorsaka og er ein helsta ástæða sjúkrahússinnlagna hjá fullorðnu fólki. Þrátt fyrir hátt og aukið álag á lýðheilsu sökum heilablóðfalls eru fáar nýlegar rannsóknir tengdar málefninu að finna í landinu. Þar af leiðandi er lítil þekking til staðar um ýmsa þætti heilablóðfalls í Gana sem setur virku eftirliti miklar takmarkanir þar í landi. Markmið: Markmið doktorsverkefnisins var að (a) lýsa faraldsfræðilegum einkennum þeirra sem lifðu af heilablóðfall í Suður Gana (b) meta heilsutengd lífsgæði (HRQoL) þeirra sem lifa af heilablóðfall og bera kennsl á tilheyrandi áhrifaþætti (c) meta áhættu samfélagsáunninar bakteríumigu meðal þeirra sem lifa af heilablóðfall (d) meta þekkingu, viðhorf og hegðun með tilliti til heilablóðfalls í suðurhluta Gana. Aðferðir: Verkefnið var unnið í Suður Gana og var skipt upp í þrjá rannsóknir. Í fyrstu rannsókninni var úrtakið 156 heilablóðfallsjúklingar sem stunduðu sjúkraþjálfun við Korle-Bu Teaching Hospital (KBTH) og Tema General Hospital (TGH). Til samanburðar var notast við úrtak 156 áætlaðra heilbrigðra einstaklinga með sambærilegri dreifingu aldurs og kyns. Margreyndur HRQoL spurningalisti, skipt upp í sjö lén, var notaður til að safna upplýsingum frá öllum þátttakenda rannsóknarinnar. Klínískum faraldsfræðigögnum var einnig safnað frá eftirlifendum heilablóðfalls um þætti eins og alvarleika heilablóðfallsins og áhættuþætti. Í annarri rannsókninni var þvagsýnum safnað frá 70 heilablóðfallssjúklingum í sjúkraþjálfun hjá KBTH og 83 áætlaðra heilbrigðra einstaklinga með sambærilegri dreifingu aldurs og kyns. Þvagsýnin voru greind með stöðluðum örverufræðilegum aðferðum til að finna bakteríumigu og greina orsakavaldinn. Í þriðju rannsókninni, var stigskipt úrtökutækni notuð til að velja 63 heimili í öllum 11 hverfum stórborgarsvæðisins í Accra (höfuðborg Gana). Staðlaður spurningalisti var notaður til að safna gögnum um almenna þekkingu á heilablóðföllum frá svarendum sem valdir voru af handahófi frá völdu heimilunum. Víðtækar tölfræðilegar greiningar voru gerðar á öllum söfnuðum gögnum, þar með talið aðhvarfsgreining til að skilgreina áhrifaþætti HRQoL, þvagfærasýkingar og almennrar þekkingar á heilablóðföllum.Stroke is a disease of immense public health importance with serious economic and social consequences. In Ghana, stroke ranks among the top three causes of mortality and is a leading cause of adult medical admission. Despite the high and increasing public health burden of stroke in Ghana, there are hardly any recent epidemiological studies on the disease in the country. Consequently, several aspects of stroke in Ghana are poorly understood and this is a major constraint to effective control of the disease in country. Objectives: The objectives of the doctoral research project were to (a) describe the epidemiological profile of stroke survivors in southern Ghana (b) assess health related quality of life (HRQoL) of the stroke survivors and identify the associated determinants (c) evaluate the risk of community-acquired bacteriuria among the stroke survivors (d) evaluate knowledge, attitudes and practices with respect to stroke in southern Ghana. Methods: The research project was carried out in southern Ghana and was organized into three investigative studies. In the first study, 156 consecutive stroke survivors attending physiotherapy clinics of the Korle-Bu Teaching Hospital (KBTH) and Tema General Hospital (TGH) were sampled. A control group of 156 age and sex matched apparently healthy people were also sampled. A robust HRQoL questionnaire involving seven domains was used to collect data from all the study participants. Clinical epidemiology data was also collected from stroke survivors on parameters such as stroke severity and risk factors. In the second study, urine specimens were collected from 70 consecutive stroke patients attending the physiotherapy clinic of KBTH and 83 age and sex matched apparently healthy controls. The urine specimens were analysed by standard microbiological methods to detect bacteriuria and identify the causative organisms. In the third study, a multi-stage sampling technique was used to select 63 households in each of the 11 sub metropolitan areas of Accra (capital city of Ghana). A structured questionnaire was used to collect stroke awareness data from respondents randomly sampled in the selected households. Extensive statistical analyses were performed on all the data collected, including multiple regression analyses to identify determinants of HRQoL, bacteruria and stroke awareness

Giardia lamblia infections in children in Ghana

Introduction: though giardiasis is an important public health problem in Ghana, several aspects of its epidemiology, particularly the molecular epidemiology has not been investigated adequately. This could be a major hindrance to effective surveillance and control of giardiasis in the country. The study was carried out to determine the prevalence, risk factors and genotypes of Giardia lamblia infecting children at a paediatric hospital in Ghana. Methods: a total of 485 patients including 365 diarrhoea and 120 non-diarrhoea children were enrolled into the study. Stool samples were collected and analysed for parasite presence using microscopy, ELISA and PCR. Positive samples were subsequently characterized into assemblages by PCR-RFLP, and further confirmed with sequencing of the glutamate dehydrogenase (gdh) gene. Epidemiological data on demographic, clinical and behavioral features of the study subjects were also collected. Results: prevalence of G. lamblia infections in diarrhea and non-diarrhea children were 5.8% and 5% respectively (P>0.5). Sequence data confirmed Giardia lamblia assemblage B as the predominant genotype in both diarrhoea and non-diarrhoea cases. There was no significant association of G. lamblia infection with any of the epidemiological variables investigated. Conclusion: our findings suggest that assemblage B could be the predominant genotype causing giardiasis in children. Increased public health education focusing on good sanitary practices, particularly among mothers and children, could decrease the risk of G. lamblia infection.The Pan African Medical Journal 2016;2