Pattern of venous thromboembolic diseases in a resources-limited setting in Cameroon

Introduction: Admission for a medical illness is associated with an increased risk of venous thrombo-embolism; however reports addressing at this issue are rare in Cameroon. We sought to assess the pattern of thrombo-embolism among in-medical patients of a semi-urban hospital. Methods: We prospectively included 79 hospitalized medical patients of the Military Hospital of Bamenda (north-west region-Cameroon). From July 2010 and December 2013, we collected baseline demographic data, risk factors of venous thromboembolism, clinical presentation, diagnostic process and treatment. Results: In the 1445 patients admitted for medical illnesses, a total of 79 venous thrombo-embolic diseases were detected (55 deep vein thrombosis, 14 pulmonary embolism, 9 post-phlebitic syndrome and 1 cerulae alba dolens). The leading risk factors were prolonged immobilization (100%), age > 40 years (78.9%), obesity (43%), long distance travel (30.4%) and HIV-AIDS (21.5%). Thirty one (40.5%) had ≤ 2 cumulative risk factors, and 8 (10.1%) more than 4. All the patients in the group had a significant risk of deep vein thrombosis: 5 (6.3%), 34 (43%) and 40 (50.6%) with moderate, high and very high risk respectively. Increasing number of deep vein thrombosis was associated with increasing level of the risk and the clinical probability scores. Lower limb location of deep vein thrombosis was the most frequent with 75 (94.9%) cases. Almost all the patients received appropriate therapy with heparin and oral anticoagulant during their hospital stay. The mean length of hospital stay was 17.5 +/-15 (range 4- 62) days; disability and death occurred in 15 (19%) and 17 (21.5%) respectively. Conclusion: Venous thromboembolism is also a common concern in a semi-urban practice of our country. Long distance travel, one of the leading risk factors merits to be more specifically studied.Pan African Medical Journal 2016; 2

Pediatric multi-drug resistant-tuberculosis and HIV co-infection in a resource—limited setting: a case report

Abstract Background Tuberculosis remains a major cause of morbidity and mortality worldwide, especially in developing countries. The diagnosis and treatment of multi-drug resistant tuberculosis (MDR-TB) in children remain a major limitation in this setting, largely due to difficulties in isolating Mycobacterium tuberculosis from pediatric specimens, management with toxic second line drugs, and practically the inexistence of contact tracing. In 2016, the World Health Organization (WHO) recommended a standardized 9-month regimen for adults and children in zones which are highly endemic for the human immunodeficiency virus (HIV). Herein, we present a case of pediatric MDR-TB/HIV co-infection highlighting the difficulties in treatment and the importance of contact tracing. Case presentation A 6-year old male infant from the West Region of Cameroon infected with HIV who presented at a local health center with a 10 days history of productive cough associated with nocturnal fever and abdominal pains non responsive to broad spectrum antibiotics. A sputum sample analysis requested was smear positive for acid-fast bacilli, and he was initiated on quadritherapy for drug sensitive pulmonary tuberculosis. Since he was a household contact of the mother who was being managed in a referral hospital for MDR-TB at 1 month of treatment, and given his critical clinical situation, a gastric aspirate was repeated and sent for Xpert MTB/RIF to the Tuberculosis Reference Laboratory which was positive for a Rifampicin resistant strain of M. tuberculosis. The short 9 months regimen against MDR-TB was then initiated. During the course of his management, he developed minor side effects of the drugs which were managed symptomatically. Conclusion Even though pediatric MDR-TB is difficult to confirm, it can be treated with favorable clinical outcomes using the short regimen recommended by the WHO. Experts involved in the control of tuberculosis over the national territory should consider adopting routine contact tracing for all cases of tuberculosis particularly amongst children