Sero-diagnosis of tuberculosis with A60 antigen enzyme-linked immunosorbent assay: failure in HIV-infected individuals in Ghana

In order to assess the diagnostic usefulness of the A60 (ANDA Biological; Strassbourg; France) sero-diagnostic enzyme-linked immunosorbent assay (ELISA) kit for tuberculosis in Africa; sera of 53 pulmonary smear-positive tuberculosis (TB) patients; 30 apparently healthy control subjects and 6 AIDS suspects were sampled in Agogo Hospital in the forest area of Ghana. These sera were analyzed for antibodies to HIV-1 and HIV-2; and IgG-antibodies to the A60 BCG-antigen; while the non-HIV individuals were tested for total IgG levels. One healthy control subject; all of 6 AIDS suspects and 7 of the TB patients has HIV infections. In the non-HIV TB group; the sensitivity and specifity of the A60 ELISA was 78 per cent and 86 per cent; respectively; which was much poorer than expected from published reports about the A60 test. The A60 test failed; completely however; to discriminate between TB and non-TB in the HIV-positive group. In the non-HIV groups; total IgG levels were significantly higher in TB patients than in controls. It seems that the usefulness of the A60 ELISA test to diagnose tuberculosis is very limited in this high-incidence area; and that it seems to be of no value in patients infected with HIV

High initial drug resistance in pulmonary tuberculosis in Ghana

Between July 1985 and March 1987; initial sensitivity to anti-tuberculosis drugs was studied in patients presenting at the Chest Clinic of Agogo Hospital in the forest area of Ghana. Culture and sensitivity test results were obtained in 99 out of 123 consecutive patients with pulmonary tuberculosis who claim not to have received previous treatment. Isoniazid resistance was alarmingly high in the isolates of M tuberculosis: 21 out of 57 (37 per cent); and thiacetazone resistance was very high in the M africanum isolates: 20 out of 42 (47 per cent). Overall resistance was high: 27 per cent to isoniazid; 23 per cent to streptomycin; 29 per cent to thiacetazone; 16 per cent to both streptomycin and isoniazid; and 5 per cent to all of these three drugs. Only 45 per cent of the isolates were sensitive to all three drugs. Primary drug resistance to rifampicin; pyrazinamide or ethalmbutol was not observed