Antifungal susceptibility profiles and risk factors of vaginal candidiasis amongst female university students in southwest region, Cameroon

Vaginal candidiasis (VC) is second to bacterial vaginitis, as the most common opportunistic mucosal infection that affects large numbers of otherwise healthy women of childbearing age. The incidence of VC is significantly modified by dressing patterns and aberrant health-care practices. Contemporary young women often shift their preference from skirt to trousers and leggingswhich also coincides with a rise in auto-medication and over-the-counter drugs phenomena in our communities. These could result in increased occurrence of vaginal candidiasis infection and antifungal drug resistance. This was a cross-sectional study conducted between March 2011 and August 2011 among150 female students(aged 17-29 years) of the University of Buea. Socio-demographics information, risk factors and clinical symptoms were gotten through a standard questionnaire. Vaginal swabs were collected from each participant and cultured on Sabouraud'sdextrose agar supplemented with chloramphenicol (SDA-CAF). Identification and antifungal susceptibility testing was performed following standard microbiological procedures. Of the 150 participants who submitted vaginal swabs, yeasts was isolated in 98 (65.3%). Of the 98 yeasts isolates, 73.5% were Candida species, mainly C. albicans (65.3%). Overhalf (64.7%) ofstudyparticipantshadapreferencefortrousers,however, this attitude was not significantly associated (p = 0.559) with candidiasis.Previous episodes of vaginal infection and treatment for candidiasis were significantly associated with VC (p = 0.004). Antifungal susceptibility results showed a high resistance to fluconazole (82.0%), nystatin (80.0%) and ketoconazole (72.0%), while clotrimazole (50.0%) was the most activeantifungal drug. There was a high prevalence of VC in this study population with previous vaginal infectionbeing important risk factor for reoccurrence. Clotrimazole was the drug of choice in the treatment of VC in this population.Key words: vaginal candidiasis, risk factors, antifungal susceptibility profilesFrench AbstractLa candidose vaginale (CV) est la deuxième infection opportuniste de la muqueuse la plus fréquente (après la vaginite bactérienne) qui affecte un grand nombre de femmes en âge de procréer. L'incidence de la CV est affectée de façon significative par certaines habitudes vestimentaires et pratiques de soins de santé « aberrante »s. Chez les jeunes femmes contemporaines, les pantalons et leggings sont de plus en plus préférés aux jupes, ce qui coïncide aussi avec une augmentation du phénomène d'automédication dans nos communautés. Ces deux facteurs pourraient entraîner une augmentation de la prévalence de l'infection à Candida vaginale et la résistance aux antifongiques. La présente étude transversale a été menée entre Mars et Août 2011 portait sur 150 étudiantes âgées de 17 à 29 ans, à l'Université de Buea (Cameroun). Elle avait pour objectifs majeurs d’évaluer les profils de sensibilité aux antifongiques ainsi que les facteurs de risque de candidose vaginale chez les étudiantes universitaires. Les données sociodémographiques, informations sur les facteurs de risque et les symptômes cliniques ont été explores à l’aide d’un questionnaire semi-structuré. Des spécimens vaginaux ont été prélevés dans chaque participante et soumis à une culture sur le dextrose gélose de Sabouraud supplémenté par le chloramphénicol (SDA-CAF). Les tests d'identification et de sensibilité antifongique ont été réalisés suivant des procédures microbiologiques standard. Parmi les 150 participants qui ont soumis des prélèvements vaginaux, des levures ont été isolées de 98 personnes (65,3%). Sur les 98 levures isolées, 73,5% étaient des espèces de Candida, principalement C. albicans(65,3%). Plus de la moitié des participants (64.7%) ont exprimé des préférences pour les pantalons et autres styles vestimentaires émergents. Cependant, de telles attitudes n’ont pas paru statistiquement associées à l’occurrence des candidoses au sein de la population ciblée (p = 0.559). Des précédents épisodes d'infection vaginale et le traitement de la candidose reportés par les participantes étaient significativement associés à CV (p = 0,004). Les résultats de sensibilité antifongiques ont montré une grande résistance au Fluconazole (82,0%), Nystatine (80,0%) et Kétoconazole (72,0%), tandis que le Clotrimazole (50,0%) était le médicament antifongique le plus actif. Il y avait une forte prévalence de CV dans cette population d'étude avec infection vaginale précédente étant facteur de risque important pour la répétition. Le Clotrimazole s’est avéré comme étant le médicament de choix dans le traitement des CV dans cette population, malgré la forte résistance.Mots clés: Candidose Vaginale, facteurs de risque, les profils de sensibilité aux antifongique

The seasonality of tuberculosis, sunlight, vitamin D, and household crowding.

BACKGROUND: Unlike other respiratory infections, tuberculosis diagnoses increase in summer. We performed an ecological analysis of this paradoxical seasonality in a Peruvian shantytown over 4 years. METHODS: Tuberculosis symptom-onset and diagnosis dates were recorded for 852 patients. Their tuberculosis-exposed cohabitants were tested for tuberculosis infection with the tuberculin skin test (n = 1389) and QuantiFERON assay (n = 576) and vitamin D concentrations (n = 195) quantified from randomly selected cohabitants. Crowding was calculated for all tuberculosis-affected households and daily sunlight records obtained. RESULTS: Fifty-seven percent of vitamin D measurements revealed deficiency (<50 nmol/L). Risk of deficiency was increased 2.0-fold by female sex (P < .001) and 1.4-fold by winter (P < .05). During the weeks following peak crowding and trough sunlight, there was a midwinter peak in vitamin D deficiency (P < .02). Peak vitamin D deficiency was followed 6 weeks later by a late-winter peak in tuberculin skin test positivity and 12 weeks after that by an early-summer peak in QuantiFERON positivity (both P < .04). Twelve weeks after peak QuantiFERON positivity, there was a midsummer peak in tuberculosis symptom onset (P < .05) followed after 3 weeks by a late-summer peak in tuberculosis diagnoses (P < .001). CONCLUSIONS: The intervals from midwinter peak crowding and trough sunlight to sequential peaks in vitamin D deficiency, tuberculosis infection, symptom onset, and diagnosis may explain the enigmatic late-summer peak in tuberculosis

Mycobacterium tuberculosisis the causative agent of tuberculosis in the southern ecological zones of Cameroon, as shown by genetic analysis

BACKGROUND: Tuberculosis (TB) is a major cause of mortality and suffering worldwide, with over 95% of TB deaths occurring in low- and middle-income countries. In recent years, molecular typing methods have been widely used in epidemiological studies to aid the control of TB, but this usage has not been the case with many African countries, including Cameroon. The aims of the present investigation were to identify and evaluate the diversity of the Mycobacterium tuberculosis complex (MTBC) isolates circulating in two ecological zones of Cameroon, seven years after the last studies in the West Region, and after the re-organization of the National TB Control Program (NTBCP). These were expected to shed light also on the transmission of TB in the country. The study was conducted from February to July 2009. During this period, 169 patients with symptomatic disease and with sputum cultures that were positive for MTBC were randomly selected for the study from amongst 964 suspected patients in the savannah mosaic zone (West and North West regions) and the tropical rainforest zone (Central region). After culture and diagnosis, DNA was extracted from each of the MTBC isolates and transported to the BecA-ILRI Hub in Nairobi, Kenya for molecular analysis. METHODS: Genetic characterization was done by mycobacterial interspersed repetitive unit–variable number tandem repeat typing (MIRU-VNTR) and Spoligotyping. RESULTS: Molecular analysis showed that all TB cases reported in this study were caused by infections with Mycobacterium tuberculosis (98.8%) and Mycobacterium africanum (M. africanum) (1.2%) respectively. We did not detect any M. bovis. Comparative analyses using spoligotyping revealed that the majority of isolates belong to major clades of M. tuberculosis: Haarlem (7.6%), Latin American-Mediterranean (34.4%) and T clade (26.7%); the remaining isolates (31.3%) where distributed among the minor clades. The predominant group of isolates (34.4%) corresponded to spoligotype 61, previously described as the “Cameroon family. Further analysis based on MIRU-VNTR profiles had greater resolving power than spoligotyping and defined additional genotypes in the same spoligotype cluster. CONCLUSION: The molecular characterization of MTBC strains from humans in two ecological regions of Cameroon has shown that M. tuberculosis sensu stricto is the predominant agent of TB cases in the zones. Three decades ago, TB was reported to be caused by M. africanum in 56.0% of cases. The present findings are consistent with a major shift in the prevalence of M. tuberculosis in Cameroon

Mycobacterium tuberculosis complex drug resistance pattern and identification of species causing tuberculosis in the West and Centre regions of Cameroon

<p>Abstract</p> <p>Background</p> <p>Data on the levels of resistance of <it>Mycobacterium tuberculosis </it>complex (MTBC) strains to first line anti-tuberculosis drugs in Cameroon, and on the species of MTBC circulating in the country are obsolete. The picture about 10 years after the last studies, and 6 years after the re-organisation of the National Tuberculosis (TB) Control Programme (NTBCP) is not known.</p> <p>Methods</p> <p>The study was conducted from February to July 2009 in the West and Centre regions of Cameroon. A total of 756 suspected patients were studied. MTBC species were detected by the standard Ziehl-Neelsen staining method. Bacterial susceptibility to the first line drugs [isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (SM)] were performed on cultures using the indirect proportion method. MTBC species were identified by standard biochemical and culture methods.</p> <p>Results</p> <p>Of the 756 suspected patients, 154 (20.37%) were positive by smear microscopy. Of these, 20.77% were HIV patients. The growth of <it>Mycobacterium </it>was observed with the sputa from 149 (96.75%) subjects. All the isolates were identified as either <it>M. tuberculosis </it>or <it>M. africanum</it>. Among these, 16 (10.73%) were resistant to at least one drug (13.3% for the West region and 8.1% for the Centre). The initial resistance rates were 7.35% for the Centre region and 11.29% for the West region, while the acquired resistance rates were 16.66% (1/6) for the Centre region and 23.07% (3/13) for the West. Within the two regions, the highest total resistance to one drug was obtained with INH and SM (2.68% each). Multidrug-resistance (MDR) was observed only in the West region at a rate of 6.67%. No resistance was recorded for EMB.</p> <p>Conclusions</p> <p><it>M. tuberculosis </it>and <it>M. africanum </it>remain the MTBC species causing pulmonary TB in the West and Centre regions of Cameroon. Following the re-organisation of the NTBCP, resistance to all first line anti-TB drugs has declined significantly (<it>p </it>< 0.05 for West; and <it>p </it>< 0.01 for Centre) in comparison to previous studies. However, the general rates of anti-TB drug resistance remain high in the country, underscoring the need for greater enforcement of control strategies.</p

Seasonal variation and prevalence of tuberculosis among health seekers in the south western Cameroon

Objectives: To determine the prevalence of tuberculosis (TB) in Fako health District, to assess the effects of seasonal variation on the incidence of TB in the study area and to use sentinel analysis to predict areas of greatest infection.Design: A prospective cross sectional study based on laboratory investigations.Setting: Fako health District, South Western Carneroon.Results: The prevalence of TB was 23.3%.Tuberculosis was significantly more prevalent in males (12.6%) as compared with females (10.7%) (P = 0.034). TB prevalence was significantly different between age groups, with the highest number of cases recorded in the age group 21-30 (P = 0.002).When the health areas were compared, TB prevalence varied significantly (P = 0.001), with Limbe Town recording the highest number of TB cases. We recorded more TB cases in the wet season compared with the dry season and the difference was statistically significant (P = 0.000). Therewas a significant drop in the prevalence of TB over the study period (P = 0.000).Conclusion: This study is the first to report on the effects of season on the prevalence of TB in Cameroon. These findings will therefore provide additional useful base line data for setting upTB control strategies in Cameroon

Research Article Prevalence of Bovine Tuberculosis in Abattoirs of the Littoral and Western Highland Regions of Cameroon: A Cause for Public Health Concern

Copyright © 2010 J. Awah Ndukum et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bovine tuberculosis (BTB) is widespread but poorly controlled in Africa and M. bovis is posing threats to human health. The risk of cattle handlers to M. bovis prevalence and public health significance of BTB in Cameroon were assessed. Slaughter inspection records from major cities revealed that BTB detection rates in cattle from 0.18 % to 4.25 % and BTB lesions were most common. Analyses of tissues and sera confirmed BTB in 31 % (Ziehl-Neelsen), 51 % (culture), and 60 % (antibody detection) of test cattle. Among cattle handlers, 81.9 % were aware of BTB, 67.9 % knew that BTB is zoonotic, and 53.8 % knew one mode of transmission but over 27 % consumed raw meat and/or drank unpasteurized milk. Respondents who had encountered tuberculosis cases were more informed about zoonotic BTB (P &lt;.05). Tuberculosis is prevalent in cattle destined for human consumption in Cameroon with serious public health implications. Targeted monitoring of infected animal populations and concerted veterinary/medical efforts are essential for control. 1

Prevalence of Bovine Tuberculosis in Abattoirs of the Littoral and Western Highland Regions of Cameroon: A Cause for Public Health Concern

Bovine tuberculosis (BTB) is widespread but poorly controlled in Africa and M. bovis is posing threats to human health. The risk of cattle handlers to M. bovis prevalence and public health significance of BTB in Cameroon were assessed. Slaughter inspection records from major cities revealed that BTB detection rates in cattle from 0.18% to 4.25% and BTB lesions were most common. Analyses of tissues and sera confirmed BTB in 31% (Ziehl-Neelsen), 51% (culture), and 60% (antibody detection) of test cattle. Among cattle handlers, 81.9% were aware of BTB, 67.9% knew that BTB is zoonotic, and 53.8% knew one mode of transmission but over 27% consumed raw meat and/or drank unpasteurized milk. Respondents who had encountered tuberculosis cases were more informed about zoonotic BTB (P<.05). Tuberculosis is prevalent in cattle destined for human consumption in Cameroon with serious public health implications. Targeted monitoring of infected animal populations and concerted veterinary/medical efforts are essential for control

Bacteriologically confirmed extra pulmonary tuberculosis and treatment outcome of patients consulted and treated under program conditions in the littoral region of Cameroon

Abstract Background Extra-pulmonary tuberculosis (EPTB) is defined as any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than the lungs. It is frequently a diagnostic and therapeutic challenge with paucity of data available. The aim of this study was to assess the prevalence of bacteriologically confirmed EPTB; to determine the most affected organs and to evaluate the therapeutic outcome of EPTB patients treated under program conditions in the littoral region of Cameroon. Methods A descriptive cross-sectional laboratory-based epidemiological survey was conducted from January 2016 to December 2017 and 109 specimens from 15 of the 39 diagnosis and treatment centers in the littoral region were obtained. Two diagnostic methods (Gene Xpert MTB and culture (LJ and MGIT) were used for EPTB diagnosis. Determine HIV1/2 and SD Biolinewere used for HIV diagnosis. Confirmed EPTB cases were treated following the national tuberculosis guide. Results The prevalence of bacteriologically confirmed EPTB was 41.3% (45). All 45 cases were sensitive to rifampicin. Males were predominately more infected [26 (57.8%)] likewise the age group 31–45 years with 15 (33.3%) cases. The overall prevalence for HIV was 33.6% (36). HIV infection was present in 28.9% (13) of patients with EPTB. The most affected sites with EPTB were: Lymph nodes (66.5%), pleural cavity (15.6%), abdominal organs (11.1%), neuromeningeal (2.2%), joints (2.2%) and heart (2.2%). Overall, 84.4% of the study participants had a therapeutic success with males responding better 57.9% (p = 0.442). Therapeutic success was better (71.7%) in HIV negative EPTB patients (p = 0.787). Conclusion The prevalence of bacteriologically confirmed EPTB patients treated under program conditions in the littoral region of Cameroon is high with a therapeutic success of 84.4% and the lymph nodes is the most affected site