Disease In Ghana Research Articles

Population-based study of diabetic mellitus prevalence and its associated factors in adult Ghanaians in the greater Accra region

The increasing prevalence of Diabetes Mellitus (DM) has become an issue of global concern. Diabetes affects over 100 million people the world over. It has been observed in Ghana that diet-related diseases such as DM and hypertension are on the increase. However, statistical data on the prevalence of the disease in Ghana is scanty. This study therefore investigated the prevalence and the risk-factors of DM in adults in the Greater Accra Region. The study was a cross-sectional one involving people living in purposely selected urban and peri-urban communities in the Greater Accra Region. A total of 288 men and 309 women aged between 36 and 95 years participated in the study. Subjects were screened for DM using urinary and fasting blood glucose determinations. Data on background of subject were collected and anthropometric measurements were taken. Data entry and analysis were done using Microsoft Excel, and SPSS. Statistical significance was tested at 5%. Chi-square test was used to determine the strength of association between DM prevalence and other variables. Prevalence of diabetes among subjects as determined by fasting blood glucose was 3.9%. Physical activity, family history and hypertension among subjects were significantly associated with diabetes prevalence. Positive associations were also observed between diabetes prevalence and age, BMI, and WHR. Other factors were not significantly associated with diabetes prevalence. Diabetes prevalence among subjects was high. This warrants efforts to address risk factors identified in this study.

An epidemiological study of recent outbreaks of Gumboro disease in Ghana

A study to assess the epidemiological factors responsible for the recent outbreaks of infectious bursal disease (IBD) in Accra and Kumasi, between October and December 2002 and January to April 2003, was conducted. Case report records at Veterinary Diagnostic Laboratories were examined for IBD cases. Farm investigations were carried out using a combination of questionnaire and interviews to obtain information on the disease situation on farms, where the outbreaks had occurred. The highest occurrence of the disease was recorded between March and April 2003, with Accra showing the highest number of cases in March, coinciding with the Easter season. Day-old chicks imported into the country succumbed more easily to the disease than those produced locally. There was an association between IBD and the chicken type that was significant (P < 0.05) in cockerels and layers. Chickens vaccinated twice were more likely to be protected from the disease than those not vaccinated or vaccinated only once. The prevalence of the disease was also influenced by the age of the chickens with a rise in susceptibility with age from 3 weeks to 6 weeks old. The results of the study indicate that the factors studied, namely source of day old chicks, bird type, vaccination history, and age of chicks at the time of outbreak influenced outbreaks of IBD and are likely to contribute to the endemicity of infectious bursal disease in the poultry producing areas of Ghana. It is recommended that stringent biosecurity measures be observed on poultry farms to control the disease in the country.

Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial

Rotavirus gastroenteritis causes many deaths in infants in sub-Saharan Africa. Because rotavirus vaccines have proven effective in developed countries but had not been tested in developing countries, we assessed efficacy of a pentavalent rotavirus vaccine against severe disease in Ghana, Kenya, and Mali between April, 2007, and March, 2009. In our multicentre, double-blind, placebo-controlled trial, undertaken in rural areas of Ghana and Kenya and an urban area of Mali, we randomly assigned infants aged 4-12 weeks without symptoms of gastrointestinal disorders in a 1:1 ratio to receive three oral doses of pentavalent rotavirus vaccine 2 mL or placebo at around 6 weeks, 10 weeks, and 14 weeks of age. Infants with HIV infection were not excluded. Randomisation was done by computer-generated randomisation sequence in blocks of six. We obtained data for gastrointestinal symptoms from parents on presentation to health-care facilities and clinical data were obtained prospectively by clinicians. The primary endpoint was severe rotavirus gastroenteritis (Vesikari score >or=11), detected by enzyme immunoassay, arising 14 days or more after the third dose of placebo or vaccine to end of study (March 31, 2009; around 21 months of age). Analysis was per protocol; infants who received scheduled doses of vaccine or placebo without intervening laboratory-confirmed naturally occurring rotavirus disease earlier than 14 days after the third dose and had complete clinical and laboratory results were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT00362648. 5468 infants were randomly assigned to receive pentavalent rotavirus vaccine (n=2733) or placebo (n=2735). 2357 infants assigned to vaccine and 2348 assigned to placebo were included in the per-protocol analysis. 79 cases of severe rotavirus gastroenteritis were reported in 2610.6 person-years in the vaccine group, compared with 129 cases in 2585.9 person-years in the placebo group, resulting in a vaccine efficacy against severe rotavirus gastroenteritis of 39.3% (95% CI 19.1-54.7, p=0.0003 for efficacy >0%). Median follow-up in both groups was 527 days starting 14 days after the third dose of vaccine or placebo was given. 42 (1.5%) of 2723 infants assigned to receive vaccine and 45 (1.7%) of 2724 infants assigned to receive placebo had a serious adverse event within 14 days of any dose. The most frequent serious adverse event was gastroenteritis (vaccine 17 [0.6%]; placebo 17 [0.6%]). Pentavalent rotavirus vaccine is effective against severe rotavirus gastroenteritis in the first 2 years of life in African countries with high mortality in infants younger than 5 years. We support WHO's recommendation for adoption of rotavirus vaccine into national expanded programmes on immunisation in Africa. PATH (GAVI Alliance grant) and Merck.

Over seventy years of a viral disease of cocoa in Ghana: From researchers' perspective

Virus diseases have plagued cocoa (Theobroma cacao) production in West Africa for over seven decades. Principal among them is that caused by the cocoa swollen shoot virus (CSSV), which is endemic in Togo, Ghana and Nigeria, and more recently Cote d’Ivoire. The incidence of the disease in Ghana has led to the launch of the costliest and an over ambitious eradication control programme in the world. This review highlights the various research activities conducted mainly in Ghana that influenced the various control strategies as well as those that have the potential to influence future ones. Isolation of newly planted cocoa has been identified as an efficient method of reducing CSSV prevalence and spread in the field. Identification of mealybugs as vectors, the role of alternative host in the spread of the disease, the need for an urgent review of the eradication procedures, breeding specifically for resistance to CSSV as well as some biochemical and molecular biology studies are some of the points highlighted in this paper. The achievements and limitations made in these fields are duly emphasized. The way forward, however, will be to combine most of these strategies into a single or two integrated approaches to control cocoa swollen shoot virus disease (CSSVD). This will then be in tune with the suggestion that no single measure is adequate to solve the swollen shoot disease problem in Ghana, and the rest of West Africa. Key words: Eradication campaign, mild strain, cross-protection, CSSV, mealybugs, isolation, barriers, non-host crops, molecular biology, biochemistry.

Cocoa swollen shoot virus in Ghana: A review of diagnostic procedures

A quick and more reliable diagnostic method has for a long time been identified as one input that will greatly enhance the control of the cocoa swollen shoot disease in Ghana. Many diagnostic procedures have been developed for detecting the virus that causes the disease; yet, the detection of latent infections is still unpredictable. This paper reviews work done in diagnosing swollen shoot disease to develop a quicker, more reliable, and cost-effective method that could be applicable in programmes for controlling cocoa swollen shoot disease. Enzyme-linked immunosorbent assay (ELISA), virobacterial agglutination tests (VBA), and other biochemical analyses have been discussed as diagnostic tools that could be developed to effectively replace the use of visible symptom expressions as the only method for field detection of the disease.

Social pathology of cleft palate in the african: mathematical precision of pitch gaps in tribal tonal linguistics.

Social pathology of cleft palate in the african: mathematical precision of pitch gaps in tribal tonal linguistics.

Resistance screening trials on coconut varieties to Cape Saint Paul Wilt Disease in Ghana

The Cape Saint Paul Wilt Disease (CSPWD) is a coconut lethal yellowing type disease (LY) and is the single most serious threat to coconut cultivation in Ghana. The recommended disease management strategy is the cultivation of disease-resistant coconut varieties. More than 38 varieties have been screened for their resistance to CSPWD since 1956 and the results are reviewed in this paper. Two varieties, Sri Lanka Green Dwarf (SGD) and Vanuatu Tall (VTT), have shown high resistance to the disease, and their hybrid (SGD × VTT) is under observation to determine its performance. A programme to rehabilitate the CSPWD-devastated areas was started in 1999. Emerging results indicate that the MYD × VTT hybrid being used for the programme, succumbs to the disease under intense disease pressure. A redirection of the rehabilitation programme and the screening of more varieties are recommended.

First Report and Molecular Characterization of DNA A of Three Distinct Begomoviruses Associated with Tomato Leaf Curl Disease in Ghana.

Tomato leaf curl disease is reported to be widespread in Ghana and to cause severe yield losses (4). So far, the causal agent has not been identified. Thirty-three tomato (Solanum lycopersicum L.) samples with symptoms such as curling, yellowing, small leaves, and stunting were collected from the Ashanti Region, the main tomato-production area in Ghana, including three samples from Akumandan in the autumn of 2007 and 30 samples from Kumasi in the spring of 2008. The observed leaf curl disease incidence in the farmer's field in Kumasi was approximately 75%. Viral DNAs were extracted from the 33 samples and tested for the presence of begomoviral DNA-A, DNA-B, and associated satellite DNA by PCR with previously described primers (1,3). The expected 1.4-kb DNA-A begomovirus fragment was obtained from one of the samples from Akumadan and from 25 samples from Kumasi. DNA-B and DNA-beta were not detected by PCR. The 1.4-kb PCR products from all positive samples were cloned and sequenced. Sequence comparison by MegAlign software (DNASTAR, Inc., Madison, WI) showed three distinct virus groups. One isolate from each group was selected and specific primers were designed to complete the DNA-A sequence. The DNA-As of GH5-3 (group 1), GOTB2-2 (group 2), and GHK2 (group 3) isolates consisted of 2,803 (GenBank Accession No. EU350585), 2,794 (GenBank Accession No. EU847739), and 2,792 nt (GenBank Accession No. EU847740) respectively. All contain the geminiviral conserved nonanucleotide sequence TAATATTAC in the intergenic region and the six predicted open reading frames (ORFs V1, V2, C1, C2, C3, and C4). BLASTn analysis was conducted with geminivirus sequences available in the GenBank database at National Center for Biotechnology Information (Bethesda, MD). Further sequence comparisons were performed by Clustal V algorithm of MegAlign software with the representative isolates of begomovirus species reported by Fauquet et al (2) and the sequences that showed high scores in BLASTn search. The DNA-A sequence of isolate GHK2 from Kumasi showed highest sequence identity (96.5%) with Tomato yellow leaf curl Mali virus (TYLCMLV; GenBank Accesssion No. AY502934). The DNA-A sequence of GH5-3 and GOTB2-2 isolates had 87.5% sequence identity with each other. Both had highest sequence identities of 76.7 and 77.6%, respectively, with Tomato leaf curl Antsiranana virus, Madagascar (GenBank Accession No. AM701764). They constitute two distinct begomovirus species based on DNA-A sequence comparisons and the International Committee on Taxonomy of Viruses proposed species demarcation of 89% sequence identity. The names Tomato leaf curl Ghana virus for isolate GH5-3 and Tomato leaf curl Kumasi virus for isolate BOTB2-2 are proposed, respectively. To our knowledge, this is the first report of molecular characterization of begomoviruses associated with tomato leaf curl disease in Ghana and of the presence of three distinct tomato begomoviruses. This presence should be considered for recommending or developing stable begomovirus resistant tomato cultivars for Ghana.

Is there Avocado sunblotch Viroid in Ghana

The prevalence of Avocado sunblotch Viroid (ASBVd) among Ghanaian accessions was investigated. One hundred and eighty five (185) symptomatic and symptomless avocado trees were tested by DIGdot blot hybridization for the presence of ASBVd. One (0.01%) accession tested positive, 158 (85.8%) tested negative, while the results of the remaining 26 (14.1%) were inconclusive (herein referred to as “possible carriers”). Only one true symptomless carrier of the viroid was identified. The viroid showed no geographical or topographical preferences. The positive and ”possible carriers” were evenly distributed around the country. The incidence of the disease in Ghana was found to be very low and hence steps must be taken to eradicate it and maintain a clean industry.

Fruit of the emergence of an enterovirus: acute haemorrhagic conjunctivitis

First seen in Ghana and Indonesia in the early 70's, acute haemorrhagic conjunctivitis or "Apollo 11" disease is an eye infection caused by Enterovirus type 70 (EV70). The disease appeared to be a highly contagious conjunctivitis which spread rapidly all over the world. EV70 has been considered as an emerging virus and was classified as a new Enterovirus. No human or animal virus genetically similar to EV70 was known before the sudden outcome of the disease in Ghana, West Africa. EV70 appeared as a pretty demonstrative example of virus emergence and virus spreading. Studies of virus genetic mutations emphasized the variations of RNA virus within a short time period. The current review presents the EV70 infection and the genetic profile of the virus from its emergence to nowadays.

Performance of HerpeSelect and Kalon Assays in Detection of Antibodies to Herpes Simplex Virus Type 2

The performances of commercial enzyme-linked immunosorbent assays (ELISAs) in detecting herpes simplex virus type 2 (HSV-2) antibodies have been inconsistent for African and human immunodeficiency virus (HIV)-positive populations. We compared the performances of the HerpeSelect and Kalon glycoprotein G2 ELISAs for patients with genital ulcer disease in Ghana and the Central African Republic. Sera from 434 women were tested with the HerpeSelect assay, and a subsample (n = 199) was tested by the Kalon assay. Ulcer swabs and cervicovaginal lavage samples were tested for HSV-2 DNA by PCR. HSV-2-seronegative women with detectable genital HSV-2 DNA were retested for HSV-2 antibodies 14 and 28 days later by the two ELISAs. A total of 346 (80%) women were positive by HerpeSelect at baseline, and 225 (54%) had detectable genital (lesional or cervicovaginal) HSV-2 DNA. Sixty-six (19%) HerpeSelect-positive samples had low-positive index values (1.1 to 3.5), and 58% of these samples had detectable genital HSV-2 DNA. Global agreement between the two serological assays was 86%. Concordance was high (99%) for sera that were negative by HerpeSelect or had high index values (>3.5). Defining infection detected by HSV-2 DNA PCR and/or Kalon assay as true infection, 71% of sera with low-positive index values were associated with true HSV-2 infection. Twenty-five women were identified as having nonprimary first-episode genital HSV-2 infection. Rates of HSV-2 seroconversion at day 14 were 77% (10/13 patients) by HerpeSelect assay and 23% (3/13 patients) by Kalon assay, with four additional seroconversions detected by Kalon assay at day 28. HIV serostatus did not influence assay performance. Low index values obtained with the HerpeSelect assay may correspond to true HSV-2 infection, in particular to nonprimary first episodes of genital HSV-2 infection, and need to be interpreted in the context of clinical history.

Detection of lethal yellowing phytoplasma in embryos from coconut palms infected with Cape St Paul wilt disease in Ghana

This study investigated the potential of seed transmission of Cape St. Paul wilt disease (CSPWD) in coconuts. PCR amplification was used to assess the distribution of phytoplasmas in parts of West African Tall (WAT) palms infected with CSPWD. Employing phytoplasma universal primer pair P1/P7 in standard PCR, or followed with a nested PCR using CSPWD–specific primer pair G813f/AwkaSR, phytoplasma infection was detected in the trunks, peduncles, spikelets, male and female flowers of four infected WAT coconut palms. Through nested PCR, phytoplasma was also detected in four of 19 embryo DNA samples extracted individually from fruits harvested from three of the four infected palms and was confirmed as CSPWD by cloning and sequencing. Subsequently, CSPWD phytoplasma was again detected in five of 33 embryos from nine infected palms, and in one of eight fruits from two symptomless palms. Fruits from infected palms recorded higher percentage germinations in two field nurseries (average of 71·0%) compared to fruits from healthy palms (average of 57·6%), and matured fruits that had dropped from infected palms showed the same levels of germination as those harvested directly from the palms. This indicates that infected fruits retain the ability to germinate whether harvested or dropped. No phytoplasmas were detected in any of the resulting seedlings and plantlets obtained through embryo in‐vitro culture. Therefore, although phytoplasma DNA can be detected in embryos, there is as yet no evidence that the pathogen is seed transmitted through to the seedling to cause disease in progeny palms.

Epidemiology of invasive pneumococcal disease in Kumasi, Ghana

There are few data on the epidemiology of invasive pneumococcal disease in Africa. We undertook a prospective study of these infections in Kumasi, Ghana, collecting clinical data on all patients with laboratory-confirmed pneumococcal meningitis, pneumonia or systemic sepsis associated with bacteraemia. A total of 140 cases were identified in the period from January 2002 to April 2005. The disease was most prevalent among patients <5 years of age and immediately following the peak of the harmattan wind. The majority of patients were treated with a combination of antibiotics, in part reflecting concerns regarding antibiotic resistance. Mortality was high (47%), with no evidence of an improved prognosis compared with earlier studies in the region. Although most isolates of pneumococci were resistant to tetracyclines and co-trimoxazole, there was no high-level resistance to penicillin and only 12% of isolates showed intermediate level resistance. Serotype 1 was the most common serotype (36%), whilst intermediate-level penicillin resistance was associated with serotype 14. Theoretical coverage by existing 7-, 9-, 11- and 23-valent vaccines was 26%, 63%, 64% and 76%, respectively. Vaccination may improve control of pneumococcal disease in Ghana, although modified vaccine formulations are required for local use.

External quality assurance for the laboratory diagnosis of Buruli ulcer disease in Ghana

To assure the quality of the laboratory diagnosis of Buruli ulcer disease; microscopy and PCR were subjected to external quality assurance (EQA). Slides were read by test laboratory staff, followed by blinded re-reading by the controller. Parallel testing of PCR specimens was carried out at the local and external reference laboratory. Slides and PCR specimens with discordant results were subjected to a second reading/testing by the controller to determine the final result. For training purposes, slides and PCR specimens with discrepant results were subsequently re-read/re-tested under supervision at the test laboratory. Microscopy. First reading: concordance rate 82.9%, discordance rate 17.1%, percentage false negatives 27.1% (sensitivity 72.9%), percentage false positives 10.1% (specificity 89.9%). Second reading: concordance rate 97.9%, discordance rate 2.1%, percentage false negatives 4.2% (sensitivity 95.8%), percentage false positives 0.6% (specificity 99.4%). PCR. First testing: concordance rate 87.9%, discordance rate 12.1%, percentage false negatives 8.2% (sensitivity 91.8%), percentage false positives 19.1% (specificity 80.9%). Second testing: concordance rate 96.2%, discordance rate 3.8%, percentage false negatives 4.7% (sensitivity 95.3%), percentage false-positives 2.1% (specificity 97.9%). EQA identified deficiencies in the laboratory performance. Corrective action consisted in on-site training and reduced the number of false-negative and false-positive microscopy and PCR results.

Gallstones in Ghanaian children with sickle cell disease

This prospective, cross-sectional study was done to define the prevalence and age of onset of gallstones in Ghanaina children with Sickle Cell Disease (SCD) in steady state, using ultrasonography. The study was conducted at the Paediatric SCD clinic, Korle Bu Teaching Hospital, Accra, Ghana. Three hundred and fifteen (315) children comprising 162 males and 153 females aged 2 to 13 years with a confirmed diagnosis of SCD of haemoglobin SS, (HbSS), Haemoglobin SC, (HbSC) or Haemoglobin S-betathalassemia (SbetaThal) genotype whose parents/guardians gave informed conset, were recruited consecutively. The main outcome measure was the detection of gallstones in the gall bladder or common bile duct by ultrasonography. Thirteen children, 12 males and 1 female had gallstone, giving an overall prevalence of 4%. The youngest was aged 6. Four children had sludge only. Peak age of prevalence was 12 years. All patients under 12 years with gallstone were males (92.3%). The very high male: female ratio in these sickle cell disease children is at variance with the normal male: female ratio of 1:4.6. Although twenty percent of all the patients were genotype SC, only one SC patient had gallstones, giving a prevalence rate of 0.3%, and a prevalence ratio of stone in SS: SC of 12:1. Twenty patients had no spleen detectable clinically or on ultrasoound examination and none of them had gallstones. Gallstones occur at an early age in children with sickle cell disease in Ghana.

270 Newborn Screening for Sickle Cell Disease in Ghana

Screening of newborns for SCD allows early initiation of prophylactic therapy, parental education, and comprehensive management, resulting in reduced mortality. Since April 1993, a demonstration project to develop and implement a program of newborn screening for SCD has been conducted in Kumasi (Ghana) by the Comprehensive Sickle Cell Center, the Children's Hospital of Philadelphia (CHOP), in collaboration with the Ministry of Health and other institutions in Ghana. Methodology: Babies are screened at birth or at well-baby visits within days or a few weeks after birth. Mothers are asked to come for results within 4 weeks and failing that, an extensive tracking system is used to deliver results to the homes of families with babies with possible-SCD (P-SCD). Tracking relies solely on information obtained from mothers at the time of screening. The goal is to enroll P-SCD babies into the sickle cell clinic by eight weeks of age. Pregnant women, parents with children and the general public are regularly educated about the screening program. Children with SCD receive comprehensive care through the Sickle Cell Clinic at Komfo Anokye Teaching Hospital. Results: From February 13, 1995 (when newborn testing was started) to December 31, 2004, a total of 177,283 babies were screened through 8 public health institutions and 11 private clinics in Kumasi and one maternity centre in Tikrom, a nearby, rural community. A total of 3,346 (1.9%) babies were identified as having P-SCD with the following Hb phenotypes by isoelectric focusing: 1,847 (1.04%) FS; 1,478 (0.83%) FSC; 6 (0.003%) FSA; and 15 (0.008%) Other. Screening and Tracking Results: Feb. 1995 – Dec. 2004 Conclusions: Screening and follow-up of newborns for sickle cell disease is feasible in a developing country in Africa. Extra effort in tracking is necessary to ensure that babies with disease are found early and referred for medical management.

On-farm evaluation of the coconut hybrid, Malayan Yellow Dwarf x Vanuatu Tall for tolerance to the lethal yellowing disease of coconut in Ghana

The performance of the coconut hybrid, Malayan Yellow Dwarf x Vanuatu Tall (MYD x VTT) was assessed in Ghana for a period of 6-8 years. The hybrid has previously been identified as being tolerant to the devastating lethal yellowing disease known in Ghana as Cape Saint Paul Wilt Disease (CSPWD). CSPWD is the most important coconut disease in Ghana. It has destroyed approximately 11,000 ha of coconut in Ghana, causing economic hardship to thousands of people. Mortality due to CSPWD during the trial period was only 1.0%. The hybrid showed remarkable tolerance to CSPWD during the 8-year trial period. Mortality, inflorescence emergence and nut load depended largely on the level of farmers’ commitment to basic management practices. In well maintained farms, the hybrid performed two to three times better compared to farms where maintenance was poor.

Evaluation of crop management options for replanting of coconut plantations devastated by lethal yellowing disease in Ghana

Evaluation of four coconut management options was carried out from May 1999 to May 2004 in the coconut belt of the Western and Central Regions of Ghana for replanting of coconut plantations devastated by the Cape St Paul Wilt Disease of Ghana. Coconut hybrid identified for the replanting was MYD x VTT. On fertile soils just intercropping of inter-rows with food crops proved appropriate for managing the coconut hybrid successfully. On low fertile soils however, fertilization was required in addition to intercropping for proper management of the hybrid. Where intercrops were fertilized the coconut palms benefited from the residual effect. While Pueraria phaseoloides did not have any visible impact, Cassia siamea was antagonistic to growth and development of the young coconut hybrid. Fertilized intercropping was more profitable especially on low fertile soils.

Cytokine Responses to Stimulation of Whole Blood from Patients with Buruli Ulcer Disease in Ghana

Buruli ulcer disease (BUD), caused by Mycobacterium ulcerans, follows an indolent course of initial progression to ulceration accompanied by extensive tissue damage. It has been suggested that healing disease stages are accompanied by a protective immune response. We hypothesized that interleukin-4 (IL-4)- or IL-10-induced downregulation of Th-1 responses plays a key role in the progression of early BUD and that healing is accompanied by an augmented Th-1 response. Gamma interferon (IFN-gamma), IL-4, and IL-10 responses were measured after in vitro stimulation with phytohemagglutinin (PHA) and tuberculin purified protein derivative (PPD) of whole blood from 39 (23 early- and 16 late-stage) BUD patients and 39 healthy control subjects in Ghana. Additionally, 30 patients with active or treated tuberculosis (TB) serving as PPD-responsive positive controls were studied. Early-stage BUD patients produced significantly lower levels of IFN and IFN-gamma/IL-4 ratios compared to late-stage BUD patients after PHA stimulation. Compared to that of controls, IFN-gamma production after tuberculin stimulation was significantly higher in late-stage but not in early-stage BUD patients (P=0.009). IL-10 and IL-4 levels did not differ between BUD patients and controls, although active TB patients had significantly higher IL-10 production levels than did treated TB patients. Multivariate analysis showed no confounding factors. In conclusion, Th-1 down regulation in early BUD appears to reverse in later stages of BUD, although an association with IL-10 or IL-4 production does not emerge from our data. Here we show differences in Th-1-type cytokine production between early- and late-stage BUD that might reflect an improved immune defense over time.

Histopathologic Features ofMycobacterium ulceransInfection

Because of the emergence of Buruli ulcer disease, the World Health Organization launched a Global Buruli Ulcer Initiative in 1998. This indolent skin infection is caused by Mycobacterium ulcerans. During a study of risk factors for the disease in Ghana, adequate excisional skin-biopsy specimens were obtained from 124 clinically suspicious lesions. Buruli ulcer disease was diagnosed in 78 lesions since acid-fast bacilli (AFB) were found by histopathologic examination. Lesions with other diagnoses included filariasis (3 cases), zygomycosis (2 cases), ulcerative squamous cell carcinomas (2 cases), keratin cyst (1 case), and lymph node (1 case). Thirty-seven specimens that did not show AFB were considered suspected Buruli ulcer disease cases. Necrosis of subcutaneous tissues and dermal collagen were found more frequently in AFB-positive specimens compared with specimens from suspected case-patients (p<0.001). Defining histologic criteria for a diagnosis of Buruli ulcer disease is of clinical and public health importance since it would allow earlier treatment, leading to less deforming sequelae.