Antimicrobial resistance (AMR) is a major threat to global health. Understanding the emergence, evolution, and transmission of individual antibiotic resistance genes (ARGs) is essential to develop sustainable strategies combatting this threat. Here, we use metagenomic sequencing to analyse ARGs in 757 sewage samples from 243 cities in 101 countries, collected from 2016 to 2019. We find regional patterns in resistomes, and these differ between subsets corresponding to drug classes and are partly driven by taxonomic variation. The genetic environments of 49 common ARGs are highly diverse, with most common ARGs carried by multiple distinct genomic contexts globally and sometimes on plasmids. Analysis of flanking sequence revealed ARG-specific patterns of dispersal limitation and global transmission. Our data furthermore suggest certain geographies are more prone to transmission events and should receive additional attention.

Objective: To determine the prevalence of chronic typhoidal salmonellae amongst food vendors in Kumasi Ghana. Design: A prospective study. Setting: Sitting and itinerant food vendors in Kumasi. Methods: Screening of 258 (230 females of 28 males) healthy food vendors for Salmonella typhi, and S. paratyphi A, B, and C, using stool culture, the widal test, and standard microbiological identification methods. Main outcome measures: Prevalence of chronic typhoidal Salmonellae carriers among food vendors in Kumasi. Results: Typhoidal Salmonellae were isolated from six people, giving a carriage rate of 2.3%. Three of the Salmonellae isolated were S. typhi, and they had significant Widal agglutinin titres of ≥l/160 and ≥1/320 for 0 and H antigens, respectively. The other three were non-typhoidal Salmonellae. The three had S. typhi and the other three had titres of 1/80 or less for both 0 and H antigens, respectively. We have discussed the implications of this high carriage rate, and we have suggested the inclusion of screening for Salmonellae of the regular health screening exercise undertaken by food handlers to detect and monitor chronic carriers in the food industry, to help control salmonella diseases in the community. Conclusion: From our study, food handlers consitute a significant risk in the spread of enteric fever in Kumasi. We therefore, suggest the inclusion of screening for Salmonellae in the regular obligatory six-monthly examination required of food handlers and to monitor those found to be infected.

Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections. Incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia, and disseminated histoplasmosis cases in AIDS was estimated at 6275, 12,610 and 724, respectively. Oral and esophageal candidiasis collectively affect 27,100 Ghanaians and 42,653 adult asthmatics are estimated to have fungal asthma. We estimate a prevalence of 12,620 cases of chronic pulmonary aspergillosis (CPA and an incidence of 1254 cases of invasive aspergillosis (IA). Estimated cases of candidemia and candida peritonitis cases were 1446 and 217, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) and tinea capitis was 442,621 and 598,840, respectively. Mucormycosis and fungal keratitis each may affect 58 and 810 Ghanaians. These data highlight the urgent need for intensified awareness to improve diagnosis and management.

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