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The authors report the first two cases of rhinosporidiosis in Cameroon. The patients were females from Cameroon southern-center or littoral areas, damp regions, and presented a conjunctival localization of this mycosis.
Onchocerciasis, also known as "river blindness", presents a plenum of clinical manifestations which vary from one individual to another, and from one area to another. This large spectrum of clinical manifestations of the disease is an indication of the complexity of the pathogenesis of onchocerciasis and suggests that many interacting factors might influence the clinical features of the disease. The present study has focused on the heterogenicity of the host immune response as a plausible explanation for differences in clinical manifestations of the infection. Host genetic factors, namely HLA genes, might play an important role in determining the nature of the immune response mounted against the parasite Onchocerca volvulus, and thus the development of different manifestations of the infection. Genetic diversity of onchocerciasis was assessed in different endemic foci in Cameroon. In order to investigate the possibility that the Major Histocompatibility Complex (MHC) genes might be associated with the different clinical types of onchocerciasis, 146 subjects living in three endemic areas of Cameroon were studied. They were classified in four groups: A (asymptomatic subjects), P (putatively immune subjects) L (patients with localised disease) and G (patients with generalised disease). The four groups differed in the distribution of HLA class II alleles as determined by Direct Heteroduplex Analysis. On the one hand, allele HLA-DQA1*0501 appeared to be associated with protection against severe onchocerciasis; on the other, allele HLA-DQB1*0201 might play an important role in the severe form of the disease.
We determined plasma lipids and apolipoproteins A-I and B in 142 subjects from Ngaoundere, in the north of Cameroon, as a means of evaluating atherosclerotic risks. The mean triglyceride concentration was 0.836 +/- 0.174 g/l; mean total cholesterol concentration was 1.276 +/- 0.251; mean HDL cholesterol concentration was 0.162 +/- 0.222; mean apolipoprotein A-I concentration was 0.577 +/- 0.096 and mean apolipoprotein B concentration was 0.836 +/- 0.174. These values differ from those reported for Caucasian populations but are similar to those reported in other studies in Cameroon. All lipid factors except HDL cholesterol concentration increased significantly with age (p < 0. 05). There were also differences between the sexes, with mean triglyceride, LDL cholesterol, HDL cholesterol and apolipoprotein B concentrations significantly higher (p < 0.01) in men than in women. There was no significant difference between the sexes, however, in total cholesterol and apolipoprotein A-I concentrations. Thus advanced age and being male are risk factors for atherosclerosis in this population.
SETTING: Tuberculosis centre of Hôpital Jamot, Yaounde, Cameroon. OBJECTIVES: To determine the prevalence of acquired resistance (ADR) to the main anti-tuberculosis drugs, and to identify risk factors associated with its occurrence in Yaounde. DESIGN: A total of 111 previously treated adults admitted consecutively to the tuberculosis centre with sputum smear-positive pulmonary tuberculosis between June 1996 and July 1997 were included in the study. Information on potential risk factors for ADR was obtained from each patient, and human immunodeficiency virus (HIV) serostatus was determined. Drug susceptibility testing to the main anti-tuberculosis drugs was performed on cultures of Mycobacterium tuberculosis complex isolated from sputum samples of each patient by the indirect proportion method. All patients whose isolates tested resistant to at least one anti-tuberculosis drug were defined as having ADR. RESULTS: Growth of M. tuberculosis complex was obtained from sputum specimens of 98 (88.3%) of the 111 patients studied; 57 (58.2%) of these were resistant to at least one anti-tuberculosis drug. Resistance to isoniazid was the most common (54.1%), followed by resistance to rifampicin (27.6%), streptomycin (25.5%) and ethambutol (12.2%). Multidrug resistance was observed in 27 (27.6%) of the cases. In a multivariate logistic regression analysis, ADR was significantly associated only with monotherapy use in previous tuberculosis treatment(s) (P = 0.03). CONCLUSION: The rate of ADR of M. tuberculosis is quite high in Yaounde. Acquired resistance to rifampicin alone or in combination with isoniazid is also high. Monotherapy in previous anti-tuberculosis treatment(s) is a significant predictor of ADR in previously treated patients in Yaounde. These results underscore the urgent need for the re-establishment of a tuberculosis control programme, using the DOTS strategy, in Cameroon.
Pediatric ophthalmology is poorly developed in Cameroon. However, efforts are being made to collect data essential for the development of national strategies to combat blindness. We relate our experience, within this framework, at a large public hospital in Cameroon. We carried out a retrospective study covering the period from June 1993 to May 1998, studying the medical files of children under the age of 15 years with ocular traumatism. Data were collected from 144 files. The frequency of ocular/orbital injury was 7.8% and was the third most common condition, after ametropia and kerato-conjunctivitis, in this population. The mean age of the children was 7 years and 3 months and more boys (64%) than girls were affected. Ocular lesions were due to contusion in 83.3% of cases. The principal causes of the trauma were children's games (40.2%), and punishment by parents or teachers (23.7%). The ocular lesions were similar to those described in previous studies. Infection was rare, because the interval from trauma to consultation was very short. The functional prognosis was severe, with 24.3% of patients having final vision less than 1/10. We recommend that children should be informed about the dangers of violent games and that parents and teachers should be made aware of the dangers associated with brutality towards children. Finally, ophthalmologists should ensure that the injured eye is treated rapidly and carefully so as to minimize functional sequelae.
The author updates available data on leishmaniasis and phlebotomine sandflies in Cameroon. After describing the natural environment, we present all the cases of the cutaneous and visceral leishmaniases recorded so far in this country. He refers also to the first biochemical characterisation of Leishmania major MON-26 in Cameroon. The data of a leishmanin skin test survey conducted in the Mokolo cutaneous leishmaniasis focus are presented as well as a repertoire of the phlebotomine sandfly species identified in the country. The implications and shortcomings of these available data are discussed and recommendations are drawn for further research.
A number of cases of Loa encephalopathy have been recorded after ivermectin treatment in the Lekie Division, an area of degraded forest located in central Cameroon. An entomological study was carried out in a village of this region between May 1999 and April 2000 to determine whether the high microfilarial loads of Loa found in the population, which can exceed 10,000 microfilariae per ml of blood, were related to high densities of vector populations. The Chrysops collected at 10 catching stations, using hand nets, by persons standing by a wood fire, were dissected to evaluate their level of infection with Loa. The vectorial densities were three-fold higher in the forest stations than in those located near the habitations (2307 and 725 bites per man per year, respectively). These values are lower than those reported from similar studies in Cameroon, Congo and Gabon. Measurement of Chrysops densities does not seem to be an appropriate tool to evaluate the level of endemicity of loiasis, and to delineate the areas where there is a risk of post-ivermectin Loa encephalopathies.
OBJECTIVE: To evaluate the therapeutic efficacy of sulfadoxine-pyrimethamine, amodiaquine, and the sulfadoxine-pyrimethamine-amodiaquine combination for the treatment of uncomplicated Plasmodium falciparum malaria in young children in Cameroon. METHODS: In a randomized study we evaluated the effectiveness and tolerance of (i) sulfadoxine-pyrimethamine (SP) (25 mg/kg body weight of sulfadoxine and 1.25 mg/kg of pyrimethamine in a single oral dose), (ii) amodiaquine (AQ) (30 mg/kg body weight in three divided daily doses), and (iii) the sulfadoxine-pyrimethamine-amodiaquine combination (SP+AQ) (same doses as in the other two treatment groups, given simultaneously on day 0) in young children in southern Cameroon. The parasitological and clinical responses were studied until day 28 in accordance with the modified 1996 WHO protocol for the evaluation of the therapeutic efficacy of antimalarial drugs. FINDINGS: Of 191 enrolled patients, 6 and 8 were excluded or lost to follow-up before day 14 and between day 14 and day 28, respectively. For the AQ-treated patients, parasitological and clinical evaluation on day 14 showed late treatment failure in 2 of 61 (3.3%) and adequate clinical response with parasitological failure in one (1.6%). There was an adequate clinical response in all patients treated with SP or SP+AQ. Therapeutic failure rates on day 28 were 13.6%, 10.2% and 0% in the SP, AQ, and SP+AQ groups, respectively. Anaemia improved in all three regimens. AQ produced faster fever clearance but was associated with more transient minor side-effects than SP. SP+AQ reduced the risk of recrudescence between day 14 and day 28 but increased the incidence of minor side-effects. CONCLUSION: SP+AQ can be recommended as a temporary means of slowing the spread of multidrug resistance in Plasmodium falciparum in Africa while the introduction of other combinations, including artemisinin derivatives, is awaited.
OBJECTIVES: To evaluate the state of chloroquine resistant malaria in the South West Province of Cameroon. To estimate the prevalence of different species of Plasmodium in the area. DESIGN: A cross sectional study. SETTING: South West Province of Cameroon. SUBJECTS: 326 febrile patients. MAIN OUTCOME MEASURES: Chloroquine resistance studies using the WHO seven-day standard in vivo test. Speciation of malaria by polymerase chain reaction. Prevalence of falciparum malaria by light microscopy of thick blood smears. RESULTS: Prevalence of chloroquine resistance ranged from 4.3 to 13.2%. A total of six cases showed RIII resistance, and three cases showed RII resistance. Plasmodium falciparum was the predominant species, 96.8% of those testing positive for P. falciparum, 6.3% of cases showed mixed infections of P. falciparum and P. malariae. P. ovale accounted for 3% of cases. CONCLUSION: P. falciparum resistance to chloroquine may not be on the increase compared to earlier reports from the South West Province. The results have important implications in treatment of malaria in view of the low cost of chloroquine.
The aim of this month-long cross sectional study was to evaluate the preparedness of health care institutions in Cameroon to provide rational management of emergency patients. During January 2002 a survey was carried out to list all health care institutions offering emergency care services and to determine their other departments and available equipment and staff. A total of 144 institutions with emergency care facilities were found including 12 central reference hospitals and 123 district hospitals equipped to provide primary emergency care. In relation to a population of 15 million inhabitants, the ratio was one reference hospital for 104180 inhabitants and one district hospital for 100,000 inhabitants. None of the services involved in emergency management had facilities for emergency treatment on an outpatient basis. Regarding hospital-based services, an emergency ward was available at the 12 central reference hospitals for a ratio of one ward for 1,250,000 inhabitants. This ratio was 10 times higher than in France in 1994. Almost all major equipment and trained personnel for emergency care medicine were concentrated at the central reference hospitals but these resources were insufficient to organize round-the-clock services except at a single site. The findings of this survey indicate that the distribution of health care facilities in Cameroon was relatively adequate in relation to population density but that equipment and human resources were still insufficient to provide rational management of emergency patients.
The evolution of the population densities of Bulinus truncatus and Bulinus forskalii has been studied during 18 months in a number of sites of the Sudan-Sahelian zone of Cameroon, in relation to certain environmental factors. Only the altitude of the water in the sites has an influence on the density of the snails. The populations of B. truncatus present a greater proportion of young molluscs during the entire year, with the exception of the last months of the dry season. The population dynamics of B. forskalii varies depending on whether the environment is temporarily stagnant, temporarily running or stable. The proportions of B. truncatus and B. forskalii that emit cercariae of schistosomes are 1.2% and 0.8% respectively. Study of the adult worms obtained after infestation of the laboratory mammals show that B. truncatus emits cercariae of Schistosoma haematobium at the end of the dry season and at the beginning of the rainy season. We have not been able to identify precisely the cercariae emitted by B. forskalii, which raises the necessity of further systematic studies being carried out on the schistosomes of Cameroon.
From 1986 to 1991, about 1,000 cases of cancers were diagnosed histologically every year in Cameroon. During this period, investigations showed that only 1 cancer out of 10 is diagnosed histologically. Thus, nearly 10,000 new cases of cancers are expected yearly in Cameroon where a population of 12,000,000 inhabitants is found leading to an incidence of about 100/100,000. Forty-nine percent of patients are female and 51% males. Twelve per cent of patients are less than 20 years old and 60% are between 40 and 70 years. Liver cancer is at the top of the list of cancers, representing 20%, followed by skin cancer (15%), breast cancer (11%) and cancer of the cervix (11%). For men, liver cancer is the most frequent, while cancers of the breast and uterine cervix predominate in women.
Hepatitis C Virus (HCV) is the principal agent of non-A, non-B hepatitis and its spread in the community is not well defined. We evaluated the prevalence of anti-HCV (ortho ELISA System) in 696 children (4-14 years) in Kumba, Cameroon. Children were selected by systematic random sampling in six primary schools. A seroprevalence of 14.5% (101 children) was found which increased steadily with age. No significant differences were observed with respect to sex or to family size. There was a highly significant association both with parents' social class, the lowest class presenting a 2.2-fold risk factor, and with area of residence, suburban children showing a significantly higher prevalence (P less than 0.01). These results suggest that Cameroon is endemic for HCV infection, that children are infected at an early age and that infection increases with age. We can therefore hypothesize that transmission of HCV infection in this population is from child to child. Furthermore, the infection seems to be influenced by social factors but not by demographic ones.
The results of a national HIV seroprevalence survey carried out in 1986/87 showed a 1% HIV seroprevalence in the South of Cameroon, which is higher than in the other regions of the country. We here demonstrate the presence of HTLV-I infections in the South of Cameroon with possible clustering of infection in some villages. Some evidence suggestive of the presence of HTLV-II was obtained. Sera from patients with onchocerciasis did not react on HTLV testing. No HTLV associated haematological or neurological syndromes were observed during this survey. Regarding the human immunodeficiency viruses, the HIV-1 prevalence varied from 0 to 3% in the different populations studied. None of the subjects was HIV-2 positive.
Anopheles funestus is a major vector of malaria in Africa. It belongs to a group of sibling species that can be identified morphologically only at certain stages of their development. A diagnostic polymerase chain reaction (PCR)-based tool made it possible to differentiate five species of the group. The assay seems to be applicable over all their distribution area for four of these species: An. funestus, An. leesoni, An. parensis, and An. vaneedenip. The fifth species, An. rivulorum, is the second most abundant species of the group and can be mistaken at its adult stage for the major vector of malaria An. funestus. Molecular and morphologic observations of specimens identified as An. rivulorum from Cameroon and South Africa showed that they belong to two different taxa. The species identified in Cameroon, and named here An. rivulorum-like, might extend to western Africa and central Africa. The species-specific PCR assay is supplemented by a primer specific to An. rivulorum-like and thus makes it possible to differentiate the five species of the An. funestus group and the newly defined taxon.
The objective of this study was to develop new molecular tools for the identification of members of An. nili group, a malaria vector in Africa. Our strategy was based on the sequence analysis of portions of the rDNA. The ITS2 fragment of An. nili collected in Cameroon was sequenced and compared. The analysis of these sequences has revealed a great variability of ITS2 sequence. Three molecular forms: An. nili typical form, An. nili Oveng form and An. carnevalei were observed within the six morphological types. Specific primers were selected on ITS2 sequence to develop an allele-specific PCR giving 3 size bands. 169 specimens of An. nili collected in Cameroon were successfully tested. This method has been validated on specimens collected in others localities of tropical Africa. The multiplex PCR developed was very sensitive practical and applicable on large scale.
Although 65% of domesticated birds in the Cameroon are kept in traditional chicken farms, very little attention is given to this important sector by the administration as well as by the farmers themselves. This could be detrimental to the modern poultry sector where a lot of investments have been made during recent years. In order to estimate the danger of neglecting traditionally-raised chickens and the health threat they represent for the poultry population of the country, a study was conducted to evaluate the impact of Newcastle disease in traditional farms. A total of 180 chicken blood serum samples from three provinces of the Cameroon were submitted to the haemagglutination inhibition test; 51.66%, 48.33% and 46.66% of birds respectively from the East, West and North provinces reacted positively to the test. The consequences of such a situation are emphasised.
Increasing frequency and severity of cerebral malaria have become a major problem in the area of Yaoundé (Cameroon, Central Africa). Based on recent findings in pharmacokinetic parameters in cerebral malaria, a quinine infusion regimen (8 mg of quinine base/kg of body weight over 1 h followed by 8 mg of base/kg over 7 h, then 8 mg/kg over 8 h 3 times daily for 3 days) was randomly allocated to 10 patients; 10 others received a more classical regimen currently used in Cameroon of 8 mg of base/kg over 8 h, 3 times daily for 3 days. In the loading dose group, there was a significant decrease in the duration of coma (48%), and the parasite clearance times were reduced by 33%. This regimen has been safe and effective: it is recommended in Yaoundé.