Identification of rare HIV-1 Group N, HBV AE, and HTLV-3 strains in rural South Cameroon.

Surveillance of emerging viral variants is critical to ensuring that blood screening and diagnostic tests detect all infections regardless of strain or geographic location. In this study, we conducted serological and molecular surveillance to monitor the prevalence and diversity of HIV, HBV, and HTLV in South Cameroon. The prevalence of HIV was 8.53%, HBV was 10.45%, and HTLV was 1.04% amongst study participants. Molecular characterization of 555 HIV-1 specimens identified incredible diversity, including 7 subtypes, 12 CRFs, 6 unclassified, 24 Group O and 2 Group N infections. Amongst 401 HBV sequences were found a rare HBV AE recombinant and two emerging sub-genotype A strains. In addition to HTLV-1 and HTLV-2 strains, sequencing confirmed the fifth known HTLV-3 infection to date. Continued HIV/HBV/HTLV surveillance and vigilance for newly emerging strains in South Cameroon will be essential to ensure diagnostic tests and research stay a step ahead of these rapidly evolving viruses.

MUSCULOSKELETAL PRESENTATION OF MULTIPLE MYELOMA AT GENERAL HOSPITAL DOUALA, CAMEROON.

UNLABELLED: Background: very little is known about musculoskeletal features of multiple myeloma (MM) in Africa. OBJECTIVES: To describe the musculoskeletal features of multiple myeloma at presentation in a tertiary health care centre in sub-Saharan Africa. DESIGN: A Cross sectional observational study. SETTING: The Douala General Hospital, Cameroon from 2007 to 2013. SUBJECTS: A patient was said to have MM according the current international consensus criteria for diagnosis and staging of MM. Patients with monoclonal gammopathy of undetermined significance, solitary plamocytoma and other haematologic malignancies were excluded. RESULTS: A total of 62 patients were diagnosed with multiple myeloma, 63% were female. Mean age was 57 ± 12,1 (19-81) years. Musculoskeletal presentation included spine bone pains (75.6%); vertebral fracture with spinal cord compression in 46.8 %. Other clinical features at presentation included anaemia (70.93%), and nephropathy (17.74%). The average percentage of bone marrow plasmacytosis at diagnosis was 33% and Immunoglobulin G was found in 86% of patients. Sixty three per cent of patients were diagnosed at stage III of the disease. CONCLUSION: Presence of bone pain and anaemia should alert the clinician to investigate along the lines of multiple myeloma. Majority of the patients have osteolytic lesions and pathologic fractures at the time of diagnosis.

Blood donor haemovigilance in Yaoundé, Cameroon.

BACKGROUND: Blood availability is an issue of concern in countries of sub-Saharan Africa where both the demand and discard rates of blood are high. Although some degree of attention is paid when transfusion reactions occur in recipients, no information is available on donor reactions in this setting. OBJECTIVES: This study was carried out in order to obtain some data on adverse reactions (ARs) to blood donations. It would make it possible to monitor and improve the safety of the donation procedure, which constitutes a strategy towards increasing donor supply by encouraging first-time donors to return in the absence of any negative outcomes of donation. METHODS: A hospital blood bank-based descriptive and prospective study was carried out to document ARs among 1034 blood donors from September 2010 to January 2011. A pre-structured data collection tool was used to record the signs and symptoms observed. RESULTS: The ARs occurred at a rate of 2.8%. The most frequent reaction was hypotension which constituted 26.62% of all ARs. Haematomas represented 18.42% while weakness and dizziness were each noted in 13.16% of donors. There was no severe vasovagal reaction. Associated factors to vasovagal reactions were first-time donor status (P = 0.004), female sex (P = 0.01) and low body weight (P = 0.02). CONCLUSION: Our results suggest that blood donation is a relatively safe procedure in our context. The frequency is higher than studies from developed countries. The association of AR with first-time blood donation needs to be verified in a larger study. However, it could suggest another benefit of regular blood donation.

Impact of HIV-1infection on survival in patients with haematological malignancies in Yaoundeé, Cameroon.

The impact of HIV-1 infection on the survival of patients with haematological cancers in Yaoundeé, Cameroon, was examined. The prevalence of HIV-1 was 26.2% among 172 patients, predominantly lymphoid malignancies. At the time of analysis, 75% of patients had died giving an incidence rate of 0.05 deaths per year and a median of survival of 15 (6-27) months. However, the hazard ratio for HIV-infected patients to die was not statistically different from that of uninfected patients (1.3, 95% confidence interval: 0.9-2.0).

[Blood safety: malaria and blood donation in Africa]. / Sécurité transfusionnelle: paludisme et don de sang en Afrique.

Malaria is a principal cause of mortality in Africa and represents a major blood-borne disease. The studies made on the continent show that transfusion-associated malaria is highly prevalent in blood donors groups and that some risk factors and clinical manifestations are frequently observed. The disease is mostly asymptomatic and the signs are mild, which reduces significantly an efficient selection of the blood donors during the predonation interview and a secure supply of blood products. Furthermore, the lack of appropriate screening assays of the malaria in blood banks on the continent limit the diagnosis of the disease and hamper the blood safety. However, the prevention of transfusion-associated malaria is a frequently asked question. The destruction of the parasite in the blood bag and the recipient anti-malarial prophylaxis are the described possibilities, added to local programs against the vectors of the disease.

Serological findings amongst first-time blood donors in Yaoundé, Cameroon: is safe donation a reality or a myth?

Blood safety remains an issue of major concern in transfusion medicine in developing countries where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are lacking. This is aggravated by the predominance of family and replacement, rather than regular benevolent, nonremunerated donors. Thus, in order to identify and encourage healthy, regular and benevolent nonremunerated donors, consenting first-time blood donors in the Yaoundé University Teaching Hospital were screened for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBSAg), hepatitis C virus (HCV), human T-cell lymphotropic virus-I (HTLV-I) and syphilis using standard methods. Of 252 first-time donors recruited, 66 (26.2%) were positive for at least one of the infections screened. There were 7.9% positive for HIV, 10.7% for HBSAg, 4.8% for HCV and 9.1 and 1.6%, respectively, for syphilis and HTLV-I. About 30% of the 66 infected persons had co-infections. HIV-positive donors had a significantly increased risk of being positive for antibodies to syphilis (OR = 7.27; 95% CI = 2.23-23.51; P = 0.0007), not observed for HBV, HCV and HTLV-I. These results suggest that blood transfusion is still very unsafe in this community and that it is imperative that emphasis be laid on donor education. Furthermore, donors with a history of sexually transmitted infections should be totally excluded from all donations.

HIV-1 infection in adults with haematological malignancies in Yaoundé, Cameroon.

To determine the association between haematological malignancies and the HIV-1 in Yaoundé, Cameroon, adult patients (> 16 years) followed up in the Haematology Clinics of two major hospitals were screened for the HIV between 1994 and 1999. There were nine haematological malignancies diagnosed among the 172 patients including Non Hodgkin's lymphomas (31.9%); chronic lymhocytic leukaemia (21.5%); chronic myelogeneous leukaemia (18.0%); acute myelogeneous leukaemia (9.9%); acute lymphoblastic leukaemia (7.6%) and multiple myeloma (7.0%). Burkitt's lymphoma, Hodgkin's disease and myelodysplastic syndrome were less frequently diagnosed. Forty-five of all cases (26.2%) had antibodies to the HIV-1 virus, predominantly in patients with Non-Hodgkin's lymphomas (p < 0,001, OR = 5.8, adjusted for age; CI = 2.7 - 12.4). About 19.4% and 11.8% of cases with chronic and acute myelogenous leukaemia respectively were HIV-1 positive. Although B-lineage-derived malignancies are more often associated with the HIV infection, other malignant proliferations of the haematopoietic system may not be coincidental.

Transfusion outcome in a resource-limited setting of Cameroon: a five-year evaluation.

OBJECTIVE: With a goal to establish strategies for improving blood safety in resource-limited conditions, the outcome of blood transfusion in a hospital setting of Cameroon was examined. METHODS: A 5-year descriptive and prospective study was conducted in which information on donor blood and recipients was obtained by direct patient observation and by examining patient notes in the various services of the hospital and records from the blood bank. RESULTS: Of 40,134 donations, 35,318 (88%) were from relatives or friends of recipients. Only 80% of all donated blood was considered safe for distribution. An average of about 20% of donated blood was rejected each year for positive human immunodeficiency virus (HIV) or hepatitis B antigen results. Other infections were not screened for. More than 50% of transfusions within the hospital were associated with an unfavorable outcome, predominantly febrile reactions and urticaria (40.1% and 19.4%, respectively). Acute intravascular hemolysis, circulatory overload, and deaths occurred in 0.01%, 0.04%, and 0.14% of cases, respectively. A case of post-transfusion HIV infection was also detected. CONCLUSIONS: Blood transfusion is still unsafe in many resource-limited communities of developing countries. However, it is possible to reduce some of these complications without sophisticated technology. Efforts to recruit more benevolent and autologous donors in the communities are essential.