Background: Several studies have linked coronavirus disease 2019 (COVID-19) risk to age and ABO blood groups. Variations in plasma angiotensin-converting enzyme 2 (ACE2) levels and blood counts have been reported, suggesting an association between disease severity and low lymphocyte levels. Aim: this study aimed to understand how these factors relate to COVID-19 in Ghanaian patients, considering geographical and demographic differences. Methods: Participants were recruited from six hospitals in Kumasi, Ghana, between June 2020 and July 2021. Nasopharyngeal swabs were taken to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and blood samples were collected for complete blood count testing, ABO/Rhesus typing, and assessment of plasma ACE2 levels. Demographic and COVID-19 severity data were gathered, and IBM SPSS version 25.0 was used for analysis. Results: Overall, 515 patients were enrolled, out of which 55.9% (n = 288/515) were males and 50.3% (n = 259/515) tested positive for SARS-CoV-2. The median age was 37 years (IQR = 26–53). Age was significantly associated with SARS-CoV-2 infection (p = 0.002). The severe COVID-19 group was the oldest (70 years, IQR = 35–80) and presented with anaemia (haemoglobin, g/dL: 9.55, IQR = 7.85–11.93), leukocytosis (WBC × 10³/μL: 15.87, IQR = 6.68–19.80), neutrophilia (NEUT × 10⁶/μL: 14.69, IQR = 5.70–18.96) and lymphocytopenia (LYMPH × 10⁶/μL: 0.47, IQR = 0.22–0.66). No association was found between SARS-CoV-2 positivity and ABO (p = 0.711) or Rh (p = 0.805) blood groups; no association was also found between plasma ACE2 levels and SARS-CoV-2 status (p = 0.079). However, among COVID-19 participants, plasma ACE2 levels were significantly reduced in the moderate illness group (40.68 ng/mL, IQR = 34.09–48.10) compared with the asymptomatic group (50.61 ng/mL, IQR = 43.90–58.61, p = 0.015). Conclusions: While there may be no real association between the ABO blood group, as well as plasma ACE2 levels, and SARS-CoV-2 infection in Ghanaian patients, older individuals are at a higher risk of severe disease. Anaemia, and leukocytosis with lymphocytopenia may be indicators of poor disease progression.

Background/Objectives: The COVID-19 pandemic has significantly impacted global health. However, Africa has reported relatively low numbers of cases and fatalities. Although the pandemic has largely receded, the reasons for its milder course on the African continent have not yet been fully clarified. This study explored the hypothesis that helminth co-infections may have contributed to these observations. Methods: A retrospective cohort study was conducted using 104 plasma samples collected during the third wave of the pandemic in the Ashanti Region of Ghana. Luminex assays were used to measure SARS-CoV-2-specific IgA and IgG, neutralizing antibodies, systemic cytokines and helminth-specific IgG. Results: The results indicated that the highest cumulative seroprevalence of helminths (61.5%) was observed in asymptomatic COVID-19 patients. In comparison, mild and moderate patients had helminth seropositivity rates of 43.8% and 34.5%, respectively, which were 1.4 and 1.8 times lower than those of the asymptomatic group, respectively. Notably, the two severe COVID-19 cases investigated were seronegative for all three of the helminths tested. Strikingly, co-exposure resulted in lower SARS-CoV-2-specific IgA/IgG expression and reduced neutralization potential. However, co-seropositive individuals for helminths and SARS-CoV-2 exhibited a higher expression of Th2 cytokines and IL-10 over Th1 cytokines compared to SARS-CoV-2-positive individuals alone. Conclusion: These data suggest that co-exposure to helminths could mitigate the severity of COVID-19 outcomes by reducing the Th1 and Th17 responses; this highlights the potential protective role of helminthiasis against severe COVID-19. These findings provide valuable insights for the development of public health policies in helminth-endemic regions and underscore the importance of considering helminth co-infections in managing viral infections. It also offers a plausible explanation for the milder disease severity observed in helminth-endemic regions while raising critical considerations regarding vaccine efficacy, as helminth-induced immune modulation may influence the magnitude and quality of vaccine-induced immune responses.

Background and Aims: Hemolysis is a fundamental feature of sickle cell disease (SCD) contributing to the vaso‐occlusive crisis of patients. The objectives of the study were to assess the link between hemolysis proteins and hematological parameters, and to validate cystatin C (CYS C) as a potent renal marker in diagnoising SCD.Method: Here, a cross‐sectional study carried out at the pediatric SCD clinic of the Komfo Anokye Teaching Hospital comprised 90 SCD children (HbSC, HbSF, and HbSS). ANOVA, t‐test, and Spearman's rank correlation analysis were done. Elevated proteins levels were compared to standard values; alpha‐1 microglobulin (A1M) (1.8−65 µg/L), CYS C (0.1−4.5 µmol/L), and haemopexin (HPX) (500−1500 µg/mL).Results: The mean (standard deviation) age of participants was 9.830 (±0.3217) years, and 46% of them were males. From simple descriptive analysis, we observed that all but one patient had their HPX level below the reference range (<500 µg/mL). Here, A1M levels were shown to be within the appropriate reference range for all the patients except few patients. CYS C levels were also all within the required reference values. A Spearman's rank correlation test between full blood count and HPX generally suggested a weak but positive correlation; RBC (coef. = 0.2448; p = 0.0248), HGB (coef. = 0.2310; p = 0.030), hematocrit (coef. = 0.2509; p = 0.020), and platelet (coef. = 0.1545; p = 0.160). Mean corpuscular volume (coef. = ‐0.5645; p = 0.610) had a stronger but negative correlation with HPX. This study depicts a positive and stronger association between CYS C and HPX levels (coef. = 0.9996; p < 0.0001), validating the use of CYS C as a useful marker of renal function in persons with SCDs.Conclusion: In the present study, we show that A1M levels were normal for most of the patients, hence CYS C levels are not alarming in this study. Further, there exists a correlation between hemolysis scavenger proteins and hematological parameters.

Background: Individuals with COVID-19 experience thrombotic events probably due to the associated hypofibrinolysis resulting from the upregulation of plasminogen activator inhibitor-1 (PAI-1) antigen. This study evaluated plasma PAI-1 antigen levels and haematological parameters before treatment and after recovery from severe COVID-19 in Ghana. Materials and methods: This cross-sectional study was conducted at Sunyani Regional Hospital, and recruited 51 patients who had RT-PCR-confirmed SARS-CoV-2. Participants’ sociodemographic data and clinical characteristics were taken from the hospital records. Venous blood was taken before COVID-19 treatment commenced for FBC, PAI-1 and ferritin assays. FBC was assessed using an automated haematology analyzer, whilst plasma PAI-1 Ag and serum ferritin levels were assessed with sandwich ELISA. All the tests were repeated immediately after participants recovered from COVID-19. Results: Of the 51 participants recruited into the study, 78.4% (40) had non-severe COVID-19 whiles 21.6% (11) experienced a severe form of the disease. Severe COVID-19 participants had significantly lower haemoglobin (g/dL): 8.1 (7.3–8.4) vs 11.8 (11.0–12.5), p<0.001; RBC x 10¹²/L: 2.9 (2.6–3.1) vs 3.4 (3.1–4.3), p = 0.001; HCT%: 24.8 ± 2.6 vs 35.3 ± 6.7, p<0.001 and platelet x 10⁹/L: 86.4 (62.2–91.8) vs 165.5 (115.1–210.3), p<0.001, compared with the non-severe COVID-19 group. But WBC x 10⁹/L: 11.6 (9.9–14.2) vs 5.4 (3.7–6.6), p<0.001 and ferritin (ng/mL): 473.1 (428.3–496.0) vs 336.2 (249.9–386.5), p<0.001, were relatively higher in the participants with severe COVID-19 than the non-severe COVID-19 counterparts. Also, the severely ill SARS-CoV-2-infected participants had relatively higher plasma PAI-1 Ag levels (ng/mL): 131.1 (128.7–131.9) vs 101.3 (92.0–116.8), p<0.001, than those with the non-severe form of the disease. Participants had lower haemoglobin (g/dL): 11.4 (8.8–12.3 vs 12.4 (11.5–13.6), p<0.001; RBC x 10¹²/L: 3.3 (2.9–4.0) vs 4.3 (3.4–4.6), p = 0.001; absolute granulocyte count x 10⁹/L: 2.3 ± 1.0 vs 4.6 ± 1.8, p<0.001, and platelet x 10⁹/L: 135.0 (107.0–193.0) vs 229.0 (166.0–270.0), p<0.001 values at admission before treatment commenced, compared to when they recovered from the disease. Additionally, the median PAI-1 Ag (ng/mL): 89.6 (74.9–100.8) vs 103.1 (93.2–128.7), p<0.001 and ferritin (ng/mL): 242.2 (197.1–302.1) vs 362.3 (273.1–399.9), p<0.001 levels were reduced after a successful recovery from COVID-19 compared to the values at admission. Conclusion: Plasma PAI-1 Ag level was higher among severe COVID-19 participants. The COVID-19-associated inflammation could affect red blood cell parameters and platelets. Successful recovery from COVID-19, with reduced inflammatory response as observed in the decline of serum ferritin levels restores the haematological parameters. Plasma levels of PAI-1 should be assessed during the management of severe COVID-19 in Ghana. This will enhance the early detection of probable thrombotic events and prompts Physicians to provide interventions to prevent thrombotic complications associated with COVID-19.

Background Salmonella are a group of facultative anaerobic bacteria that belong to the family of Enterobacteriaceae. The common serovars are Salmonella enterica subsp. enterica serovar Typhi which causes typhoid fever and the non-typhoidal Salmonellae (NTS) which are associated with gastroenteritis. Data on the epidemiology and genomic characteristics of Salmonellae in sub-Saharan African countries are limited. This study describes the epidemiology and genomic characterization of Salmonellae in Ghana. Methods A prospective incidental hospital-based surveillance study among patients presenting with febrile illness from May, 2016 to April, 2023 was conducted in the Asante Akyem District of Ghana and Komfo Anokye Teaching Hospital. Blood cultures were processed for identification of Salmonella using standard bacteriological techniques. A subset of Salmonella isolates were confirmed using real-time-PCR amplification targets for S.Typhi and invasive NTS. The concentration of DNA were quantified using nanodrop and shipped to Eurofins Genomics for illumina based sequencing. Raw reads were assembled and analysed using Pathogenwatch web tool. Results The study enrolled 6,557 participants between the ages of 1 and 95 years of which 51.7% were males. The prevalence of Salmonella Typhi and NTS were 0.14% (95%CI: 0.096 – 1.5) and 0.33% (95%CI: 0.21% - 0.5%) respectively. Male gender (adj OR; 95%CI = 1.6; 0.93–2.75) and age group below 15 years (Adj OR; 95%CI=3.94; 1.67–9.3) had higher odds of infection with Salmonella Typhi. A subset of 42 Salmonella Typhi isolates sequenced, identified the predominant genotype as 2.3.2 (54.1%) followed by 3.1.1 (42.9%). Of 17 iNTS isolates sequenced, Typhimurium (10; 62.5%), Enteritidis (5; 31.3%), Poona (1; 6.2%) and Saintpaul (1; 6.2%) were identified. Common resistance markers identified were chloramphenicol resistance (catA1; 10/50), sulphonamides resistance (sul1; 10/50), beta-lactam (9/10) and trimethoprim (dfrA; 10/50). Conclusion The increasing rate of resistance and endemicity of infections emphasize the need for the introduction of vaccines to reduce disease burden.

Typhoid intestinal perforation (TIP) is a late complication of Salmonella enterica serovar Typhi infection, and blood cultures, if available, are often negative at this stage, making etiologic confirmation challenging. In areas without access to blood culture diagnostics, TIP incidence can serve as a proxy for enteric fever burden. Antibodies against hemolysin E (HlyE) and S . Typhi lipopolysaccharide (LPS) are promising serologic markers for typhoid, but their diagnostic utility for TIP remains unclear. In this study, we assessed the diagnostic accuracy of anti-HlyE and anti-LPS IgG and IgA antibodies measured by kinetic enzyme immunoassay in children undergoing emergency laparotomy for acute abdomen in Niger. Dried blood spots (DBS) were collected pre-operatively (baseline) and within 30 days post-hospital discharge (convalescence). Patients classified intraoperatively as TIP ( n = 341) or as confirmed non-typhoid-related alternative etiology (i.e., controls, n = 48) were included in this serologic analysis. The primary analyses were conducted in a longitudinal sub-cohort of 122 TIP cases and 33 controls in whom all four anti-HlyE and anti-LPS IgA and IgG responses were measured at baseline and at convalescence. Anti-HlyE IgA and anti-LPS IgA were additionally measured at baseline in the full analytic cohort. In the primary analysis, all antigen-antibody isotype combinations distinguished TIP cases from controls with high accuracy: anti-HlyE IgA (AUC 0.94), anti-HlyE IgG (AUC 0.94), anti-LPS IgA (AUC 0.96), and anti-LPS IgG (AUC 0.96). Anti-HlyE IgA and anti-LPS IgA performed similarly in the full cohort (AUC 0.93 and 0.93, respectively), supporting the representativeness of the sub-cohort. Anti-LPS IgG showed the best overall performance (99% sensitivity, 94% specificity), exceeding that of all other individual markers, and combining markers did not improve diagnostic accuracy. Diagnostic performance at convalescence was similar to or lower than that observed at presentation. Overall, anti-HlyE and anti-LPS antibodies showed high diagnostic accuracy for TIP at presentation, extending the potential utility of these serologic markers for supporting the diagnosis of typhoid-associated intestinal perforation and improving surveillance of severe typhoid disease when patients present with late-stage complications. Our findings show that serologic testing could improve case detection and burden estimation of enteric fever and its complications in resource-limited settings.