An epidemiological study of pleuropulmonary paragonimiasis among pupils in the peri-urban zone of Kumba town, Meme Division, Cameroon

BACKGROUND: Paragonimiasis have previously been reported in two zones of the Southwest Province of Cameroon including the Kupe mountain and Mundani foci. The aim of this study was to investigate the presence and epidemiology of paragonimiasis in the peri-urban zone of Kumba, Meme Division, located about 50 km away from the Kupe mountain focus. METHODS: Pupils of several government primary schools in 5 villages around Kumba underwent both parasitologic and clinical investigations in search of signs and symptoms of paragonimiasis. Mycobacterium tuberculosis was also searched for in the differential diagnosis.Freshwater crabs from neighbouring streams in the five villages were dissected in search of paragonimus metacercariae. RESULTS: Out of a total of 1482 pupils examined in all five villages, 309 individuals (147 males and 162 females) were recruited for this study based on the presence of one or more signs or symptoms of paragonimiasis. Eggs of Paragonimus africanus were found in stools and/or sputum of pupils from all five villages, giving an overall paragonimus prevalence of 2.56%. There was no significant difference in the disease prevalence between the villages (X(2 )= 8.36, P = 0.08). The prevalence of Paragonimus africanus eggs amongst pupils with symptoms of paragonimiasis was 12.3% (38 of 309). Males were infected more than females (17.0% versus 8.0%), but the difference was not significant (X(2 )= 5.76, P = 0.16). All the 38 paragonimus egg positive subjects presented with cough, 23 (60.53%) complained of chest pain while 16 (42.11%) had haemoptysis. Stool examinations also detected some intestinal parasites including Ascaris lumbricoides (29.45%), Trichuris trichiura (6.47%), Necator americanus (2.27%), Strongyloides stercoralis (1.62%), Enterobius vermicularis (0.65%), and Entamoeba histolytica (4.53%). No case of M. tuberculosis was noted. Out of a total of 85 dissected crabs (Sudanonautes africanus), 6.02 % were infected with paragonimus metacercariae. CONCLUSION: In addition to the two previously described paragonimiasis foci of Kupe mountain and Mundani, the identification of autochthonous cases of paragonimiasis in the peri-urban zone of Kumba town, makes the South West Province the most endemic zone of paragonimiasis in Cameroon at present

Skin Diseases Among Sub-Saharan African Prisoners: The Cameroonian Profile

Background: Overcrowding and promiscuity observed in our prisons are a spreading source of several diseases including infections transmitted by interhuman contact. It has been argued that skin diseases are the most frequent reasons for consultations in prisons. In Cameroon, no study has been done to assess the magnitude of this issue. Our study aimed at determining the profile of dermatological pathologies among Cameroonian prison inmates. Methods: This was a cross-sectional study at the Mfou Principal Prison from February to April 2014. Were included all prisoners who consulted the research team at the prison infirmary during the period of recruitment and who accepted to take part in the study. Prisoners were consulted and a structured questionnaire was used for data collection. Diagnosis was based on the anamnestic and clinical findings. Participants with uncertain diagnosis were excluded from the study. Data were entered into Microsoft excel 2010 spreadsheets and analyzed using SPSS version 17.0. Results: A total of 217 prisoners were retained for our study out of the 369 present in the prison during the study period. Among these 217 prisoners, 201 (92.6%) were males, 189 (87.1%) were Christians, 123 (56.7%) did not attend the secondary school, and 137 (63.1%) were single. Age ranged from 14 to 60 years with a mean of 32 ± 4.7 years and, age groups 21-30 and 31-40 being the most represented ones. More than half (57.1%) of our population exhibited skin diseases with scabies being present in 41% of cases. The dominating presentations of skin diseases were: scabies (71.8%), eczema (9.7%), dermatophytosis (specifically tinea corporis: 5.6%), pityriasis versicolor (4.8%), and acne (3.2%). Six point five percent of participants presented with more than one skin disease, and eczema was the most frequent disease associated with scabies in 8 cases (6.4%). Pityriasis versicolor was the most common skin disease among females (25% of women infected). Conclusion: There is a high prevalence of skin diseases among prisoners at the Mfou Principal Prison. of which scabies (71.6%), eczema (9.7%), dermatophytosis (5.6%) and pityriasis versicolor (4.8%) were the prevailing skin diseases encountered .There is thereby an urgent need to implement strong and efficient interventions in order to solve the problems of over population, poor hygiene, precarious quality of life and lack of health care in our prisons

Hepatitis B infection awareness, vaccine perceptions and uptake, and serological profile of a group of health care workers in Yaoundé, Cameroon

Abstract Background Cameroon is one of the countries in Africa with the highest burden of Hepatitis B infection. Health care workers are known to be at risk of occupational exposure to blood and other infectious bodily fluids. The aim of this study was to assess the profile of serological markers of hepatitis B virus (HBV) infection, knowledge and perceptions regarding HBV infection among health care workers in a health area in Yaoundé. Methods A cross-sectional study was conducted in the Mvog-Ada Health Area of the Djoungolo Health District from March 1 to November 31, 2014. All consenting health care workers were included in the study. Serological markers of HBV (HBs Ag, Hbe Ag, anti-HBs Ab, anti-HBe Ab, anti-HBc Ab) were qualitatively tested using Biotech®(OneHBV-5 parameter rapid test website) in each participant and the anti-HBs antibodies were quantified by ELISA (Biorex) among those who were positive with the qualitative test. Chi square test or its equivalents were used to compare qualitative variables and a p-value less than or equal to 0.05 was considered significant. Result A total of 100 participants were retained for the study out of 163 in the health area giving a response rate of 61.34 %; the mean age was 30.5 (SD 6.8) years and 71 % of participants were women. Forty seven percent (47 %) of workers had good level of knowledge of HBV infection. The men were 3.20 times (95 % CI: 1.02–9.19, p = 0.04) more likely to have a good level of knowledge than women. Participants with a university study level were more (95 % CI: 3.17–25, p < 0.0001) likely to have a good level of knowledge than those with a high school study level. Ninety-six percent of participants thought that they were at a greater risk of becoming infected with HBV than the general population, 93 % felt that the vaccine should be compulsory and all (100 %) were willing to recommend it to others. However, only 19 % had received at least one dose of the vaccine. The proportion of HBs Ag was 11 %. The different serological profiles with regard to HBV infection were naive subjects (62 %), chronic carriers (11 %), vaccinated (19 %) and subjects naturally immunized (8 %). Three out of the 19 participants who received at least one dose of the vaccine, only 9 (47.4 %) of whom had titers ≥100 IU/l indicating a good response to vaccination. Among those who received three doses of the vaccine (n = 12, 63 %), 2 (16, 66 %) had poor response to vaccination (HBs Ab titers < 100 IU/l). Conclusion The prevalence of HBs Ag among health care workers in the Mvog-Ada Health Area is high (11 %). These workers are at high risk of HBV infection because of very low vaccine uptake and poor post-exposure practices. Their knowledge of HBV infection is non-optimal

Serological Studies of Neurologic Helminthic Infections in Rural Areas of Southwest Cameroon: Toxocariasis, Cysticercosis and Paragonimiasis

A total of 188 people (168 and 20 with and without symptoms confirmed by clinicians, respectively, 84.6% under 20 years old) were selected on a voluntary basis in Cameroon. Soil transmitted helminthic infections were prevalent among persons surveyed as is common in developing countries, since eggs of Ascaris lumbricoides, Trichuris trichiura and hookworms were found from 56 (33.3%), 72 (42.8%) and 19 (11.3%) persons, respectively. Serological analyses revealed that 61 (36.3%), 25 (14.9%) and 2 (1.2%) persons were positive to the diagnostic antigens specific for toxocariasis, paragonimiasis and cysticercosis, respectively. Among 14 people with epilepsy, 5 persons were seropositive to the antigen of Toxocara and one of them was simultaneously positive to the antigens of Paragonimus. Serological confirmation of cysticercosis in two children is very important, and we suggest that further serologic surveys of cysticercosis be carried out in both children and adults in this area for the promotion of a better quality of life including control and early treatment

Artemisinin derivatives versus quinine in treating severe malaria in children: a systematic review

<p>Abstract</p> <p>Background</p> <p>The efficacy of intravenous quinine, which is the mainstay for treating severe malaria in children, is decreasing in South East Asia and Africa. Artemisinin derivatives are a potential alternative to quinine. However, their efficacy compared to quinine in treating severe malaria in children is not clearly understood. The objective of this review was to assess the efficacy of parenteral artemisinin derivatives versus parenteral quinine in treating severe malaria in children.</p> <p>Methods</p> <p>All randomized controlled studies comparing parenteral artemisinin derivatives with parenteral quinine in treating severe malaria in children were included in the review. Data bases searched were: The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (1966 to February 2008), EMBASE (1980 to February 2008), and LILACS (1982 to February 2008). Dichotomous variables were compared using risk ratios (RR) and the continuous data using weighted mean difference (WMD).</p> <p>Results</p> <p>Twelve trials were included (1,524 subjects). There was no difference in mortality between artemisinin derivatives and quinine (RR = 0.90, 95% CI 0.73 to 1.12). The artemisinin derivatives resolved coma faster than quinine (WMD = -4.61, 95% CI: -7.21 to -2.00, fixed effect model), but when trials with adequate concealment only were considered this differences disappeared. There was no statistically significant difference between the two groups in parasite clearance time, fever clearance time, incidence of neurological sequelae and 28^thday cure rate. One trial reported significantly more local reactions at the injection site with intramuscular quinine compared to artemether. None of the trials was adequately powered to demonstrate equivalence.</p> <p>Conclusion</p> <p>There was no evidence that treatment of children with severe malaria with parenteral artemisinin derivatives was associated with lower mortality or long-term morbidity compared to parenteral quinine. Future studies require adequately powered equivalence trial design to decide whether both drugs are equally effective.</p

Natural products as starting points for future anti-malarial therapies: going back to our roots?

Abstract Background The discovery and development of new anti-malarials are at a crossroads. Fixed dose artemisinin combination therapy is now being used to treat a hundred million children each year, with a cost as low as 30 cents per child, with cure rates of over 95%. However, as with all anti-infective strategies, this triumph brings with it the seeds of its own downfall, the emergence of resistance. It takes ten years to develop a new medicine. New classes of medicines to combat malaria, as a result of infection by Plasmodium falciparum and Plasmodium vivax are urgently needed. Results Natural product scaffolds have been the basis of the majority of current anti-malarial medicines. Molecules such as quinine, lapachol and artemisinin were originally isolated from herbal medicinal products. After improvement with medicinal chemistry and formulation technologies, and combination with other active ingredients, they now make up the current armamentarium of medicines. In recent years advances in screening technologies have allowed testing of millions of compounds from pharmaceutical diversity for anti-malarial activity in cellular assays. These initiatives have resulted in thousands of new sub-micromolar active compounds – starting points for new drug discovery programmes. Against this backdrop, the paucity of potent natural products identified has been disappointing. Now is a good time to reflect on the current approach to screening herbal medicinal products and suggest revisions. Nearly sixty years ago, the Chinese doctor Chen Guofu, suggested natural products should be approached by dao-xing-ni-shi or ‘acting in the reversed order’, starting with observational clinical studies. Natural products based on herbal remedies are in use in the community, and have the potential unique advantage that clinical observational data exist, or can be generated. The first step should be the confirmation and definition of the clinical activity of herbal medicinal products already used by the community. This first step forms a solid basis of observations, before moving to in vivo pharmacological characterization and ultimately identifying the active ingredient. A large part of the population uses herbal medicinal products despite limited numbers of well-controlled clinical studies. Increased awareness by the regulators and public health bodies of the need for safety information on herbal medicinal products also lends support to obtaining more clinical data on such products. Conclusions The relative paucity of new herbal medicinal product scaffolds active against malaria results discovered in recent years suggest it is time to re-evaluate the ‘smash and grab’ approach of randomly testing purified natural products and replace it with a patient-data led approach. This will require a change of perspective form many in the field. It will require an investment in standardisation in several areas, including: the ethnopharmacology and design and reporting of clinical observation studies, systems for characterizing anti-malarial activity of patient plasma samples ex vivo followed by chemical and pharmacological characterisation of extracts from promising sources. Such work falls outside of the core mandate of the product development partnerships, such as MMV, and so will require additional support. This call is timely, given the strong interest from researchers in disease endemic countries to support the research arm of a malaria eradication agenda. Para-national institutions such as the African Network for Drugs and Diagnostics Innovation (ANDi) will play a major role in facilitating the development of their natural products patrimony and possibly clinical best practice to bring forward new therapeutics. As in the past, with quinine, lapinone and artemisinin, once the activity of herbal medicinal products in humans is characterised, it can be used to identify new molecular scaffolds which will form the basis of the next generation of anti-malarial therapies.</p

Situation analysis of parasitological and entomological indices of onchocerciasis transmission in three drainage basins of the rain forest of South West Cameroon after a decade of ivermectin treatment

BACKGROUND: Community-Directed Treatment with Ivermectin (CDTI) is the main strategy adopted by the African Programme for Onchocerciasis control (APOC). Recent reports from onchocerciasis endemic areas of savannah zones have demonstrated the feasibility of disease elimination through CDTI. Such information is lacking in rain forest zones. In this study, we investigated the parasitological and entomological indices of onchocerciasis transmission in three drainage basins in the rain forest area of Cameroon [after over a decade of CDTI]. River basins differed in terms of river number and their flow rates; and were characterized by high pre-control prevalence rates (60-98%). METHODS: Nodule palpation and skin snipping were carried out in the study communities to determine the nodule rates, microfilarial prevalences and intensity. Simulium flies were caught at capture points and dissected to determine the biting, parous, infection and infective rates and the transmission potential. RESULTS: The highest mean microfilaria (mf) prevalence was recorded in the Meme (52.7%), followed by Mungo (41.0%) and Manyu drainage basin (33.0%). The same trend was seen with nodule prevalence between the drainage basins. Twenty-three (23/39) communities (among which 13 in the Meme) still had mf prevalence above 40%. All the communities surveyed had community microfilarial loads (CMFL) below 10 mf/skin snip (ss). The infection was more intense in the Mungo and Meme. The intensity of infection was still high in younger individuals and children less than 10 years of age. Transmission potentials as high as 1211.7 infective larvae/person/month were found in some of the study communities. Entomological indices followed the same trend as the parasitological indices in the three river basins with the Meme having the highest values. CONCLUSION: When compared with pre-control data, results of the present study show that after over a decade of CDTI, the burden of onchocerciasis has reduced. However, transmission is still going on in this study site where loiasis and onchocerciasis are co-endemic and where ecological factors strongly favour the onchocerciasis transmission. The possible reasons for this persistent and differential transmission despite over a decade of control efforts using ivermectin are discussed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13071-015-0817-2) contains supplementary material, which is available to authorized users

Use of a histidine-rich protein 2-based rapid diagnostic test for malaria by health personnel during routine consultation of febrile outpatients in a peripheral health facility in Yaounde, Cameroon

The role of a rapid diagnostic test (RDT) in the case management of Plasmodium falciparum malaria infections has not been determined in Africa. Our study was conducted during November 2007-January 2008 to assess test accuracy of an RDT in the management of febrile Outpatients In a peripheral urban health facility ill found the overall sensitivity to be 71.4% and a specificity of 82.2%; the positive predictive Value and negative predictive value were 73.8% and 80.4%, respectively. False-negative and false-positive cases represented 11.8% and 10.5% of all febrile patients. Malaria alone (31.3%) was the first Cause of fevers 33.5%, of fever Cases Were of unknown origin. Acute respiratory infections were common among children 0-2 years of age (25.5%) and decreased with age. The risk of having a Clinical failure With the presumptive treatment of febrile children was seven times greater than that of the RDT-oriented management (relative risk = 6.8, 95% confidence interval = 0.88-53.4, P = 0.03) because of the delay of appropriate treatment of non-malarial febrile illness. Our results Suggest that the RDT may be of limited utility for children greater than five years of age and adults and that diagnosis based oil microscopic examination of blood smears should be recommended for these patient populations, as Well as in areas of low, transmission