Non conversion of sputum smears in new smear positive pulmonary tuberculosis patients in Yaounde, Cameroon

Objectives: To identify clinical, radiological and microbiological factors associated with the non conversion of sputum smears in new smear positive cases of pulmonary tuberculosis after two months of treatment and to evaluate the influence of non-smear conversion on treatment outcomes.Design: A prospective cohort study.Setting: Tuberculosis centre of Hôpital Jamot in Yaoundé- Cameroon from April 2006 to September 2007.Subjects: A total of 413 patients were studied.Main outcome measures: Sputum smear status at two months of treatment, favourable treatment outcome (cured, treatment completed), unfavourable treatment outcome (death, treatment failure, default from treatment) and transferred out.Results: A total of 413 patients were studied; There were 234 (56.8%) males and 178 (43.2%) females with a mean age of 33 years (range 9.80 years). Sputum smears did not convert in 55 (13.4%) patients at the end of two months of treatment. Logistic regression analysis showed that age above or equal to 40 years (OR=2.716, 95% CI:1.412- 5.223, p = 0.003), and a bacillary load of 3+ on pre-treatment sputum smears (OR=1.955; 95%CI: 1.039-3.68, p=0.037) were significantly associated with non conversion of sputum smears at the end of two months of treatment. Persistent positive smears at the end of two months of treatment were significantly associated with unfavourable treatment outcomes (p=0.025) especially default during the course of treatment.Conclusion: In Yaoundé, Cameroon, non conversion of positive sputum smears in new patients with pulmonary tuberculosis at the end of two months of treatment is associated with an unfavourable outcome particularly defaulting later in the course of treatment. Non conversion of sputum smears at two months of treatment is significantly associated with age above or equal to 40 years and the presence of numerous bacilli (3+) on pre-treatment sputum smears. Patients with these factors who do not smear convert after two months of treatment should be given a fully supervised treatment for the entire duration of therapy so as to prevent in particular treatment default

Pulmonary tuberculosis in the central prison of Douala, Cameroon

Objective: To determine the prevalence of and factors associated with pulmonary tuberculosis (PTB) in an urban prison in sub-Saharan Africa.Design: A cross-sectional survey. Setting: The Central Prison of Douala, Cameroon. Results: Two thousand four hundred and seventy four (87.4%) out of 2830 inmates underwent screening. Twenty seven (1.1%) of the inmates were under treatment for smear-positive PTB on commencement of the survey while 60 (2.4%) were diagnosed with smear and/or culture-positive PTB during the active case finding, resulting in a point prevalence of PTB of 3.5%. HIV seroprevalence in inmates without clinical signs of PTB was 111/1067 (10.4%) while it amounted to 6/24 (25%) in PTB patients. In multiple stepwise regression analysis, a low BMl, a prison stay of ≤12 months, and a history of previous incarceration were positively associated with PTB. Conclusion: The study results confirm the high prevalence rates of PTB in prison populations and underscore the need for urgent preventive measures. East African Medical Journal Vol. 83(1) 2006: 25-3

Routine use of antimicrobial drugs during the 2004 cholera epidemic in Douala, Cameroon

Objectives: To evaluate routine use of antimicrobial drugs for treatment and prevention of cholera with special regards to the evolution of the antimicrobial drug resistance patterns of V. cholerae strains. Design: Retrospective population-based descriptive study. Subjects: Four thousand nine hundred and forty one notified cholera cases, their 15,381 patients' guards and their 159,263 household members and close neighbours. Results: A total of 4,941 patients received antibiotic therapy according to the treatment protocols. Prophylactic treatment was administered to 15,381 patients' guards in hospitals and to 159,263 household members and close neighbours during home visits. Over the entire outbreak, the antimicrobial susceptibility patterns of V. cholerae strains isolated remained stable. Conclusions: The routine use of antimicrobial therapy for cholera cases associated with simultaneous and large scale chemoprophylaxis of close contacts does not seem in our experience to compromise the stability of V. cholerae susceptibility profiles to drugs when applied within a comprehensive package of rigorously monitored community interventions. The role of therapy and chemoprophylaxis in limiting the extent of a cholera epidemic is however difficult to ascertain from our experience. Field trials need to be designed to elucidate this aspect. The East African Medical Journal Vol. 83 (11) 2006: pp. 596-60

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

Cardiac involvement in HIV infected people in Yaounde, Cameroon

Objective: To study the cardiac abnormalities in HIV infected patients in relation to the clinical stage of the disease and the immunological status of the patients. Methods: A total 75 consecutive patients tested for HIV on the basis of clinical suspicion of the disease from July to September 1996 at the University Hospital Centre, Yaounde, Cameroon were recruited. The patients were classified into AIDS, HIV positive non-AIDS, and HIV negative according to clinical findings and outcome of ELISA and western blot testing. Every patient underwent a clinical examination, two dimensional and M-mode echocardiography, and blood lymphocyte typing. Results: Dilated cardiomyopathy occurred in 7/30 (23.33%) AIDS patients, 1/24 (4.17%) HIV positive non-AIDS patient, but in none of the HIV negative patients. Other echocardiographic abnormalities included pericardial separation, effusion, thickening, and mitral valve prolapse. Although these abnormalities were more frequent in HIV infected patients, the differences did not reach levels of statistical significance. Dilated cardiomyopathy occurred in six (31.58%) of the patients with a CD4 cell count ≤100/mm(3) and two (6.06%) in those with absolute CD4 counts >100/mm(3) (χ(2) = 4.02, p = 0.03). Conclusions: Cardiovascular abnormalities are frequent in African HIV infected patients but clinically discrete. Low CD4 cell counts are associated with dilated cardiomyopathy. These abnormalities should be expected with greater frequency in cardiological clinical practice as management of opportunistic infections improves in a situation of continued high disease prevalence in Africa

PULMONARY TUBERCULOSIS IN THE CENTRAL PRISON OF DOUALA, CAMEROON

Objective: To determine the prevalence of and factors associated with pulmonary tuberculosis (PTB) in an urban prison in sub-Saharan Africa.Design: A cross-sectional survey.Setting: The Central Prison of Douala, Cameroon.Results: Two thousand four hundred and seventy four (87.4%) out of 2830 inmates underwent screening. Twenty seven (1.1%) of the inmates were under treatment for smear-positive PTB on commencement of the survey while 60 (2.4%) were diagnosed with smear and/or culture-positive PTB during the active case finding, resulting in a point prevalence of PTB of 3.5%. HIV seroprevalence in inmates without clinical signs of PTB was 111/1067 (10.4%) while it amounted to 6/24 (25%) in PTB patients. In multiple stepwise regression analysis, a low BMl, a prison stay of £12 months, and a history of previous incarceration were positively associated with PTB.Conclusion: The study results confirm the high prevalence rates of PTB in prisonpopulations and underscore the need for urgent preventive measures