ArticleBMC microbiology2026
Gut dysbiosis in people with epilepsy: a dual-site cross-sectional study of enterobacteriaceae patterns and clinical correlates in peri-urban and urban Ghana.
Article in BMC microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo compare recoverable Enterobacteriaceae patterns in adults with epilepsy and controls across peri-urban and urban Ghana, and to explore associations with comorbidity and antiseizure medication (ASM) regimen.
methodsThis dual-site cross-sectional study enrolled 120 adults (70 people with epilepsy [PWE], 50 controls) from Tarkwa Municipal Hospital (peri-urban) and KNUST Hospital, Kumasi (urban). Stool samples were subjected to enrichment in Brilliant Green Bile Broth followed by selective/differential culture for Enterobacteriaceae. Recoverable CFU/g-equivalents were defined as colony-forming units recovered after enrichment and selective culture, back-calculated to the gram of stool input, and interpreted as a standardized recoverability measure (not absolute stool bacterial load). Isolates were identified by MALDI-TOF MS (Bruker) using manufacturer score thresholds (≥ 2.0 species-level; 1.70–1.99 genus-level). Richness was defined as the number of distinct MALDI-TOF–confirmed Enterobacteriaceae taxa recovered per participant.
resultsIn the peri-urban cohort, PWE had lower setting-dependent recoverable burden than controls (11.20 ± 2.44 vs. 20.95 ± 3.95 [recoverable CFU/g-equivalents, post-enrichment]; p < 0.0001). In the urban cohort, PWE had higher setting-dependent recoverable burden than controls (17.48 ± 4.00 vs. 11.29 ± 1.86 [recoverable CFU/g-equivalents, post-enrichment]; p = 0.002). Site-dependent differences were observed for Citrobacter freundii, Proteus mirabilis, and Enterobacter hormaechei. Comorbidities were more frequent in urban PWE (50%) than peri-urban PWE (15%); among peri-urban PWE, E. hormaechei recoverable abundance was higher in comorbid versus non-comorbid participants (p = 0.03). In urban PWE, ASM polytherapy was associated with higher psychosis-related symptom scores than ASM monotherapy (p < 0.0001).
conclusionRecoverable Enterobacteriaceae-associated patterns in epilepsy differed by setting under enrichment and selective culture conditions, supporting context-specific dysbiosis hypotheses in Ghana and motivating larger longitudinal, sequencing-based studies with environmental and standardized clinical phenotyping.
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