Detection of herpesviruses and enteroviruses in patients with suspected infectious meningoencephalitis in three referral hospitals in Yaounde, Cameroon.

In Cameroon, routine diagnosis of central nervous system (CNS) infections is based on the detection of bacteria, fungi, parasites, and mycobacteria in cerebrospinal fluids. Therefore, there is no data on viral etiologies of meningoencephalitis (ME) in the country. We aim to identify viral etiologies (herpesviruses and enteroviruses) of ME in Cameroon, to provide useful information to physicians that will help improving management of ME. From February to May 2018, adult patients with clinical signs of ME in three referral hospitals in Yaounde were included. Detection of herpesviruses and enteroviruses was performed using reverse transcriptase polymerase chain reaction. P value of 5% was chosen as the threshold for statistical significance in statistical analyses. Eighty-one patients were included and 15 (18.51%) were positive for herpesviruses. No enterovirus was detected. The most prevalent virus was Epstein-Barr virus (8.6%) and most of herpesviruses were detected from human immunodefeciency virus (HIV)-positive patients (86.7%). The overall mortality rate was high, 60.5% (49/81) and analysis of risk factors showed that HIV-positive status and altered state of consciousness were associated with higher risk of death (odds ratio [OR], 5.41; confidence interval [CI]: 1.91-16.88; P = .002 and OR, 3.24; CI: 1.11-0.13; P = .036 respectively). We showed that herpesviruses are present in patients with ME symptoms in Yaounde and can be sometimes in coinfection with others common pathogens of CNS infections. There is therefore a need for increased clinician awareness and education regarding the diagnostic and management of CNS infections in Cameroon to limit unnecessary use of antibiotics.

Prevalence and vaccination coverage of Hepatitis B among healthcare workers in Cameroon: A national seroprevalence survey.

Hepatitis B virus (HBV) infection is hyperendemic in Cameroon, and healthcare workers (HCWs) are at high risk of infection. We aimed to assess prevalence, risk factors and vaccine coverage of HBV infection among HCWs in Cameroon. We conducted a cross-sectional study in 16 hospitals across all regions of Cameroon. HCWs were tested for HBV using rapid diagnostic tests (RDT). We collected data on socio-demographics and HBV vaccination status. We estimated prevalence of HBV and used Poisson regression models with robust standard errors to model the prevalence ratios of HBV positivity between covariates. We enrolled 1824 of 1836 eligible HCWs (97.5%). The mean age was 34 (SD: 10) years, 65.3% (n = 1787) were women, and 11.4% (n = 1747) had three or more doses of the HBV vaccine. Overall, we found a HBV prevalence of 8.7% (95% CI: 5.2%-14.3%). Patient transporters had the highest crude prevalence (14.3%; 95%CI: 5.4%-32.9%), whereas medical doctors had the lowest (3.2%; 95%CI: 0.8%-12.1%). The Far North Region had the highest prevalence of HBV (24.0%; 95%CI: 18.3%-30.8%). HBV prevalence decreased with increasing doses of the HBV vaccine (10.3% for no doses vs 3.5% for three or more doses; P < 0.001). In conclusion, approximately 1 in 12 HCWs in Cameroon have evidence of HBV infection, yet fewer than 1 in 6 have been fully vaccinated. Our results illustrate the urgent need to scale up systematic HBV screening and targeted vaccination of HCWs in the region.

A practical approach to low protein diets for patients with chronic kidney disease in Cameroon.

Cameroon is a low-middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of therapies such as low protein diets (LPDs) that slow its progression. Moreover, the prescription of LPDs is challenging in Cameroon because dieticians are scarce, there are no renal dieticians, and people often have to fund their own healthcare. The few nephrologists that provide care for CKD patients have limited expertise in LPD design. Therefore, only moderate LPDs of 0.6 g protein per kg bodyweight per day, or relatively mild LPDs of 0.7-0.8 g protein per kg bodyweight per day are prescribed. The moderate LPD is prescribed to patients with stage 3 or 4 CKD with non-nephrotic proteinuria, no evidence of malnutrition and no interrcurrent acute illnesses. The mild LPD is prescribed to patients with stage 3 or 4 CKD with nephrotic proteinuria, non-symptomatic stage 5 CKD patients or stage 5 CKD patients on non-dialysis treatment. In the absence of local sources of amino and keto acid supplements, traditional mixed LPDs are used. For patients with limited and sporadic access to animal proteins, the prescribed LPDs do not restrict vegetable proteins, but limit intake of animal proteins (when available) to 70 % of total daily protein intake. For those with better access to animal proteins, the prescribed LPDs limit intake of animal proteins to 50-70 % of total daily protein intake, depending on their meal plan. Images of 100 g portions of meat, fish and readily available composite meals serve as visual guides of quantities for patients. Nutritional status is assessed before LPD prescription and during follow up using a subjective global assessment and serum albumin. In conclusion, LPDs are underutilised and challenging to prescribe in Cameroon because of weakness in the health system, the rarity of dieticians, a wide diversity of dietary habits, the limited nutritional expertise of nephrologists and the unavailability of amino and keto acid supplements.

Shigella dysenteriae type 1-induced diarrhea in rats.

With the aim of setting up an animal model of Shigella dysenteriae-induced diarrhea, Wistar rats received per os increasing densities of S. dysenteriae type 1 (Sd1). Inoculum of 12 x 10(8) Sd1 provoked dysenteric diarrhea within 24 h. Feces of healthy rats were molded, brown to black and rough. Rats developing diarrhea presented blood at the anal orifice; stools were soft or liquid containing mucus, or molded, smooth and mucus-coated. At times, stools appeared longer, dark and shiny due to the presence of mucus and blood, or molded, lumpy and brittle. Diarrheal induction was associated with abdominal ailment, progressive increase in stool weight and frequency, and increase in bacterial population. Sixty-seven percent of the total number of deaths had occurred by day 6 after diarrheal induction. These results indicate that Sd1 induced in rats a model of shigellosis which might be helpful for physiopathological and pharmacological studies of this type of infectious diarrhea.

Operational research and HIV policy and guidelines: lessons from a study of patients lost to follow-up from a public antiretroviral treatment program in Cameroon.

Can operations and implementation research guide today's unprecedented efforts to scale-up HIV/AIDS prevention, treatment, care, and support in resource-limited settings? Our study of patients with HIV/AIDS who were first seen at the Central Hospital (Yaoundé, Cameroon) to begin antiretroviral therapy demonstrates the value of using operations research to explore programs, policies, and guidelines used in health care. We studied one group of patients, those lost to follow-up. Our findings confirmed the value of early treatment, systems to follow individuals, free treatment, and resources that enable operations research. We encourage health-care workers and program managers to perform operational research in their own context, and we emphasize the importance of allocating adequate human, financial, and logistic resources for this activity. Finally, we stress that the health-care workers, program managers, and researchers must work together to better inform policy and guidelines.

Reduced dose of stavudine and lipoatrophy in HIV-infected patients in Cameroon.

BACKGROUND: This study assessed the effect of stavudine (d4T) 30 mg dosage on lipoatrophy in HIV-infected patients on antiretroviral treatment. METHODS: A total of 243 patients from Cameroon receiving d4T or zidovudine (AZT) in combination with lamivudine and efavirenz or nevirapine for >6 months were clinically assessed for moderate to severe ('strict' definition) and mild to severe ('large' definition) lipoatrophy. Prevalence of lipoatrophy was compared between 69 patients who had received exclusively d4T 30 mg (d4T(30)), 64 patients who had received both d4T 30 and 40 mg dosages since treatment initiation (d4T(30/40)) and 110 patients on AZT-related therapy. RESULTS: Prevalence of lipoatrophy varied from 7% to 24%, according to the definition. After adjustment for gender, age, treatment duration and CD4(+) T-cell count, the risk of lipoatrophy in the d4T(30) group was lower than in the d4T(30/40) group (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.8 with the large definition and OR 0.2, 95% CI 0.0-0.8 with the strict definition) and was comparable to that of the AZT group (OR 1.0, 95% CI 0.2-4.6 and OR 1.0, 95% CI 0.4-2.2 with the large and strict definitions, respectively). The risk was significantly higher in the d4T(30/40) group compared with the AZT group (OR 2.9, 95% CI 1.3-6.4 with the large definition and OR 5.5, 95% CI 1.3-23.5 with the strict definition). CONCLUSIONS: The use of d4T at a lower dosage might increase safety with regard to its effect on lipoatrophy.

Activities of aqueous extracts of Mallotus oppositifolium on Shigella dysenteriae A1-induced diarrhoea in rats.

1. Mallotus oppositifolium is reported to possess medicinal properties and is traditionally used in Cameroon for the treatment of diarrhoea. In the present study, we have evaluated the acute toxicity, in vitro antibacterial and in vivo antidiarrhoeal effects of an aqueous extract of these plant leaves. 2. Shigella dysenteriae A(1) (Sd1)-induced diarrhoeal rats were obtained by oral administration of increasing densities of the Sd1 strain isolated from bloody diarrhoea occurring in East Cameroon. When diarrhoea appeared, rats were treated for 5 consecutive days with 120, 240 or 360 mg/kg extract or norfloxacin (5.7 mg/kg). The weight and frequencies of faeces, as well as the number of Sd1, were assessed during the treatment period and the death rate was recorded. 3. The M. oppositifolium extract was not toxic. In vitro, the minimal inhibitory and minimal bactericidal concentrations of the extracts were 1,172 and 9,375 microg/mL, respectively. In vivo, 12 x 10(8) Sd1 provoked diarrhoea within 24 h, which was characterized by soft or liquid stools, that were moulded, smooth and mucus or blood coated. Diarrhoea went along with an increase in faeces weight and frequency (P < 0.001 by the 3rd day), as well as an increase in the bacterial population to a maximum on the 2nd day after infection (P < 0.05). The death rate was 67% by day 6. 4. Whereas norfloxacin significantly (P < 0.01) reduced Sd1 growth, M. oppositifolium extracts (240 and 360 mg/kg) restored bacterial growth to its initial density and no deaths were recorded. There was a significant (P < 0.05) reduction in stools weight and frequency with 240 mg/kg extract. 5. The results suggest that M. oppositifolium leaves could be a therapeutic alternative for bacterial aetiological diarrhoea in Central Africa, where multidrug supply and access to modern health centres are public health problems.