Diabetes Mellitus and HIV Infection among Newly Diagnosed Pulmonary Tuberculosis Patients in the North West Region of Cameroon: A Cross-Sectional Study.

Objective: To determine the prevalence rate of HIV and diabetes among tuberculosis (TB) patients and also the comorbidity rate. Design: Cross-sectional study. Setting. This study was carried out at the Tuberculosis Reference Laboratory, Regional Hospital Bamenda, North West Region of Cameroon, from January 2017 to December 2019. Participants. 1115 cases of pulmonary tuberculosis aged ≥14 years (mean 42.5 ± 15.28 years). Methods: Sputum samples collected were acid-fast stained and examined macroscopically as well as inoculated for culture. A chest X-ray was performed for further confirmation of TB diagnosis. After the TB diagnosis was done, fasting blood glucose, 2 h-PG test, HbA1c, and biochemical enzymatic tests were performed for the diagnosis of diabetes. Rapid strip test and enzyme-linked immunosorbent assay were used to diagnose HIV infection. Interventions. No intervention was done during the period of study. Outcome Measures. The prevalence of TB/HIV and TB/HIV/DM, signs and symptoms, imaging results, and bacteriology status among TB/HIV, TB/HIV/DM coinfected, and comorbidity cases. Results: Of 1115 participants, 38.57% had TB/HIV, and 5.83% had TB/HIV/DM. Among TB/HIV/DM cases, 20.39% had a cough for more than 2 weeks [p < 0.0001; OR (95%CI): 4.866 (3.170-7.404)], and 35.71% had a fever for at least 2 weeks [p < 0.0001; OR (95%CI): 7.824 (5.336-11.36)]. The majority of TB/HIV/DM patients (77.42%) had chest pain for at least 2 weeks [p < 0.0001; OR (95%CI): 114.3 (59.78-207.1)]. 7.41%, 14.18%, and 9.09% of TB/HIV/DM, respectively, had chest abnormality, positive smear, and positive culture (p = 0.018). Significant differences were observed between signs and symptoms, imaging results, bacteriology, treatment history for TB cases and those with HIV and/or DM, and those without HIV and/or DM coinfection and comorbidity. Conclusion: This study reports a high prevalence of DM comorbidity and HIV coinfection among active TB patients in the North West Region of Cameroon as well as TB/HIV/DM comorbidity.

Group B Streptococcus colonisation, prevalence, associated risk factors and antimicrobial susceptibility pattern among pregnant women attending antenatal care at Dschang District Hospital, West Region of Cameroon: A hospital-based cross-sectional study.

BACKGROUND: Group B Streptococcus (GBS), also known as Streptococcus agalactiae, is a Gram-positive bacterium known for its ability to colonise the vaginal and rectal areas of the mother and is a leading cause of neonatal mortality and morbidity. This study aimed at determining the prevalence, associated risk factors and antimicrobial susceptibility of GBS colonisation among pregnant women attending antenatal care (ANC) at Dschang District Hospital. METHODS: This hospital-based cross-sectional study used a multistage sampling method to recruit a total of 621 consented pregnant women who attended ANC in Dchang District Hospital. The 621 Participants at 23.5 ± 6.4 weeks gestation each completed a questionnaire and vaginal swabs were collected for GBS analysis. RESULTS: Among the 621 pregnant women that were included in this study, the colonisation rate of GBS was found to be 8.69%. Induced abortion (odds ratio [CI] = 3.09, 95% [1.56-6.21]), Spontaneous abortions (OR = 2.82, 95% CI 1.14-7.29), Stillbirth (OR [CI] = 7.75, 95% [2.61-21.71]), Fever (OR [CI] = 0.37, 95% [0.19-0.71]) and anaemia (OR [CI] = 0.22, 95% [0.12-0.43]) were found to be factors associated with GBS colonisation. CONCLUSION: Our findings suggest that we found that, induce abortion, spontaneous abortions and stillbirths were highly associated rates of GBS colonisation, while fever and anaemia were associated with lower rates of GBS colonisation. Further longitudinal research is needed to establish the causal relationship and its biological mechanisms.

First detection of Leishmania donovani in sand flies from Cameroon and its epidemiological implications.

OBJECTIVES: A sound knowledge of the vector-host-parasite transmission dynamics is a prerequisite for adequate control measures of vector-borne diseases. To achieve this, an entomological investigation was conducted in the cutaneous leishmaniasis (CL) endemic focus of Mokolo District, northern Cameroon to identify the insect vector(s) of the disease. METHODS: Phlebotomine sand flies were collected in and around Mokolo using New Standard CDC Miniature Light Traps. Individual sand flies were used for morphological species identification, and the remainder of the body for DNA analysis. Sand flies were demonstrated to harbour Leishmania spp. parasites using ITS1 PCR. Mitochondrial vertebrate-specific Cytochrome b -PCR was used to identify blood meals ingested by female sand flies. PCR amplicons were sequenced for Leishmania and blood sources discrimination. RESULTS: This study revealed the presence of Leishmania donovani complex DNA (n = 1) in Phlebotomus duboscqi and of lizard-borne Leishmania tarentolae-like DNA (n = 3) in Sergentomyia spp. in 79 sand fly specimens from Mokolo district. CONCLUSIONS: The causative agent of CL could not be detected in potential vectors. Instead, we found evidence for visceral leishmaniasis (VL) parasites in Phlebotomus duboscqi as well as enzootic reptile parasites in the Mokolo area. We recommend that an epidemiological survey be carried out in the area to evaluate the prevalence and eventually describe the clinical manifestations of VL in the human population. Political instability in neighbouring countries and the resulting refugee migration are likely explanations for the emergence of VL in Mokolo.

Impaired T-cell-dependent protection against Leishmania major infection in HIV-positive patients is associated with worsened disease outcome.

Cutaneous leishmaniasis (CL) patients coinfected with HIV are known to show a more severe, prolonged course of disease; the immunological basis is not known. We now assessed clinical features, sera and skin biopsies of HIV(+) and HIV(-) patients with CL to identify drivers of increased susceptibility to Leishmania. CL lesion numbers, surface, and healing duration were significantly increased in HIV(+) as compared to HIV(-) patients (2.5, 14 and >4-fold, respectively). Patients with HIV infection exhibited lower serum Leishmania-specific IgG levels and decreased IL-6 and IL-8. Most importantly, dramatically decreased numbers of CD4(+) T cells (approximately eightfold), but not CD8(+) cells, together with fewer CXCR3(+) Th1 cells, fewer Foxp3(+) effector/regulatory T cells, and reduced levels of IFN-γ expression were found in lesional skin. Our findings suggest that compromised CD4(+) T-cell responses may be responsible for worsened disease outcome leading to defects in parasite elimination in the absence of sufficient numbers of IFN-γ-producing Th1 cells.

Ecological site distribution of sand fly species of Mokolo, an endemic focus of cutaneous leishmaniasis in northern Cameroon.

Leishmaniasis is a vector borne disease present in two major clinical forms (cutaneous and visceral) in the northern part of Cameroon. The disease is classified as a neglected tropical disease by the World Health Organization and thus, requires more attention. The aim of this study was to correlate the previously established composition and abundance of sand fly fauna with the putative vector status and the ecological behavior in the Mokolo cutaneous leishmaniasis focus to propose fighting strategies integrating vectors control. Over a 12-month period light traps were used for sand flies' collection in urban, peri-urban and sylvatic environment found in Mokolo, an endemic focus of leishmanisis in northern Cameroon, microscope and taxonomic keys were used for their identification. Nineteen (19) species were identified belonging to the genera Sergentomyia, and Phlebotomus. The influence of human population density on sand fly's species density and composition was assessed trough the evaluation of ecological distribution of sand flies in Mokolo. It came out that, Se. coronula and Se. thomsoni mandarai are strictly wild species and Ph. duboscqi, a domestic species. The other species are generalists.The number of Se. antennata and Se. adami decreases with the increase of the density of human population while Se. distincta, Se. vorax and Ph. duboscqi increase with the density of human population in the study site. Based on its previous reports in the Leishmania transmission in West Africa, Ph. duboscqi should still be considered as the main suspected vector in Mokolo. Ph. duboscqi, Se. distincta, Se. affinis ssp. vorax and Se. schwetzi are highly represented around human dwellings.

Leishmaniasis in Cameroon and neighboring countries: An overview of current status and control challenges.

Leishmaniasis causes the ninth largest disease burden among infectious diseases but remains a very neglected tropical disease. Although the disease is endemic in Cameroon and some neighboring countries, data on its epidemiology are very scanty. The present review summarizes the available information on leishmaniasis in the central region of Africa. According to available records, Cameroon, Chad and Nigeria have been identified as endemic foci of both cutaneous (CL) and visceral leishmaniasis (VL). In addition, the phlebotomine vectors of leishmaniasis have been reported in these three countries and also in Congo and the Central African Republic. Although Gabon, Central African Republic, Equatorial Guinea and Congo are all situated next to the above leishmaniasis-endemic countries and are characterized by similar landscapes and vegetation, they lack published reports of autochthonous cases of leishmaniasis. Considering that many cases of the disease might remain unreported, it might not be an overstatement to recommend that research should be carried out in Gabon, Equatorial Guinea, Central African Republic and Congo to identify cases of leishmaniasis (CL and/or VL), the parasite and vector species, and the mammalian reservoir host. This review updates data on leishmaniasis and its insect vector in the geographical region of Central Africa. Such updates are basic requirement for the development of successful control programmes in individual countries and the whole region. In order to address the shortcomings identified in the present review, the authors recommend training of more scientists in leishmaniasis epidemiology in the region that should be accompanied by necessary funding. This training must be multidisciplinary and include development of laboratory and field skills for studies of the parasite, the vector, the reservoir, the vegetation and the soil in potential endemic foci. In addition, prospective studies involving geographers and other experts should develop a disease risk map of the Central Africa region.

Aqueous Extract from Cinnamomum zeylanicum (Lauraceae) Stem Bark Ameliorates Gentamicin-Induced Nephrotoxicity in Rats by Modulating Oxidative Stress and Inflammatory Markers.

Nephropathies and especially nephrotoxicity have become one of the serious causes of life-threatening conditions because of intensive exposure to xenobiotic whether by environmental pollution or by drug abuse. The present study was undertaken to assess the protective effects of Cinnamomum zeylanicum stem bark aqueous extract (AECZ) on gentamicin-induced nephrotoxicity. AECZ was prepared by maceration in water and tested orally at the doses of 200 and 400 mg/kg/day to prevent gentamicin-induced nephropathies in male Wistar rats. Gentamicin (100 mg/kg/day) was administered for 14 consecutive days by intraperitoneal route, concomitantly with AECZ or silymarin (50 mg/kg/day) used as reference drug. Animal body weight was monitored during the treatment. After the last treatment on the 14th day, animals were sacrificed. Blood was collected for the evaluation of hematological and renal function biomarkers. The homogenate of one kidney was used to assess oxidative stress markers and proinflammatory cytokines, while the other one was fixed in formaldehyde for histopathological studies. Gentamicin decreased body weight, serum total proteins, and calcium level but increased kidneys' relative weight, serum creatinine, urea, and uric acid. Moreover, the levels of reduced glutathione, catalase, and superoxide dismutase activities were decreased, while an increase in malondialdehyde, proinflammatory cytokines (TNF-α, IL-1ß, and IL-6), and nitrites was observed in the negative control group as compared to normal control. Histological analysis of the kidney revealed the presence of tubular necrosis, glomerular degeneration, and macrophage infiltration in the gentamicin-treated group. All these impairment parameters were prevented by AECZ and silymarin treatments. AECZ has a protective effect against gentamicin-induced nephrotoxicity. The antioxidant and anti-inflammatory potentials of this extract may highly contribute to its nephroprotective activity.

Inventory and taxonomy of phlebotomine sand flies of the Mokolo leishmaniasis focus, northern Cameroon, with description of new Sergentomyia taxa (Diptera: Psychodidae).

Leishmaniasis is endemic in northern Cameroon. However, the sand fly vectors have not been incriminated. A sand fly species inventory was generated by integrating a number of techniques. Miniature light traps were used for collecting sand flies in a variety of ecotopes found across the area, and a morphological and molecular identification approach for taxonomic confirmation was undertaken. In a pilot survey conducted in September 2012, we captured 687 sand flies, 259 of which were morphologically identified to species level. They represent 14 species of the genera Sergentomyia and Grassomyia. No Phlebotomus spp. were found. A second series of collections was carried out during 2013 in five different environmental setups: two urban, two peri-urban/rural and one sylvatic; 14,036 sand flies (6665 males and 7371 females) were collected. A total of 5926 females and 98 males were morphologically identified to species level, representing 19 species of the genera Sergentomyia, Grassomyia and Phlebotomus, including Ph. duboscqi, a known vector of cutaneous leishmaniasis in the region. Two new taxa were found and are described: Sergentomyia (Sintonius) thomsoni mandarai ssp. nov. and Se. coronula sp. nov. Our study is the first to report the following species in Cameroon: Se. (Sin.) thomsoni (as ssp. nov. mandarai), Se. (Ser.) cincta, Se. (Sin.) affinis ssp. vorax, Se. (Sin.) adami, Se. (Sin.) herollandi, and Se. (Sin.) christophersi. In addition, some morphologically atypical Sergentomyia specimens (combination of Ser. x Sin. traits) were recorded. A checklist of 32 species reports from Cameroon is presented.

Antidiarrhoeal and antimicrobial activities of Emilia coccinea (Sims) G. Don extracts.

Emilia coccinea (Sims) G. Don is reported to possess a number of medicinal properties including antidiarrhoeal and antimicrobial activities. The antidiarrhoeal effects of both methanol and aqueous extracts of the leaves of Emilia coccinea were studied in rats against castor oil-induced diarrhoea at the doses of 200, 400 and 600 mg/kg body weight. The methanol extract, and to a lesser extent the aqueous extract, significantly prolonged the time for diarrhoeal induction; it reduced the frequency of diarrhoea episodes and decreased the propulsion of charcoal meal through the gastrointestinal tract in a dose dependent manner. The aqueous extract did not have any antimicrobial activity at the tested concentration (5 mg/ml), but the methanol extract was most active on Escherichia coli. These results may support the fact that this plant is used traditionally to cure diarrhoea.

Clinical features and epidemiology of cutaneous leishmaniasis and Leishmania major/HIV co-infection in Cameroon: results of a large cross-sectional study.

Cutaneous leishmaniasis (CL) is endemic in Central Africa, including Cameroon. However, data on its prevalence and co-infection with HIV are scarce. Here we present the results of a large cross-sectional study reporting the prevalence, clinical features and species identification of CL and HIV co-infection in northern Cameroon. A total of 32 466 subjects were clinically screened for CL during a door-to-door survey, followed by parasitological diagnosis in the field laboratory. Amongst the subjects surveyed, 146 (0.4%) were diagnosed with active CL. Seven (4.8%) of these 146 CL patients tested positive for HIV-1 and/or HIV-2. The number of lesions per CL patient ranged from 1 to 20. Three of the five subjects with >10 active lesions were co-infected with HIV. In both CL and HIV co-infected subjects, three successful parasite isolates were identified as Leishmania major by PCR. This first report of L. major/HIV co-infection in Cameroon and Central Africa confirms the endemicity of CL in the region and highlights a worsened CL pathology in HIV co-infected individuals. These findings provide important data necessary for the development and implementation of successful control programmes against CL and HIV in this geographical area.