[Mycological profile of onychomycosis in Yaoundé, Cameroon]. / Profil mycologique des onychomycoses vues en consultation de dermatologie à Yaoundé, Cameroun.

BACKGROUND: The lack of data concerning the mycological spectrum of onychomycosis in Cameroon prompted us to conduct the present study, which aimed to determine the mycological profile of onychomycosis diagnosed during dermatologic consultations in Yaoundé, Cameroon. METHODS: This was a cross-sectional study held from October 2014 to March 2015 in six hospitals of Yaoundé. Patients suspected of onychomycosis were consecutively recruited during dermatologic consultations; anamnestic and clinical data were recorded and one or several nail fragments sampled for mycological examination (direct examination or culture). RESULTS: A total of 3457 patients were examined during the study period, 117 of whom were suspected of onychomycosis; 133 samplings were performed. The distolateral subungual form was the dominating one: 72/110; 65.5%. The diagnosis was confirmed with 110 of the 133 samples (82.7%), these collected among 96 patients, hence a prevalence of 2.8% (96/3457). We isolated 99 germs, among which two-co-infestations. Dermatophytes (52/99; 52.5%), especially Trichophyton rubrum (23/52; 44.2%) and Trichophyton verrucosum (11/52; 21.2%) were the main pathogens causing onychomycois of the toes whereas yeasts (43/99; 43.4%), Candida albicans (31/43; 72.1%) in majority, were the prevailing germs incriminated in onychomycosis of the fingers. There were few cases of molds infestation (4/99; 4%). CONCLUSION: Onychomycosis are common in dermatology consultations in Yaoundé. Candida albicans, Trichophyton rubrum and Trichophyton verrucosum are the main pathogens in cause.

First findings on the seroepidemiology of human paragonimosis at the anti-tuberculosis centre of Divo, Repubuc of Ivory Coast (West Africa).

An epidemiological study was carried out in 2004-2005 at the anti-tuberculosis centre of Divo (Ivory Coast) to collect sera from patients who consulted for tuberculosis suspicion and to estimate the seroprevalence of human paragonimosis in the context of a systematic screening. No Paragonimus egg was found in the stools and/or sputa of the 167 persons investigated. In contrast, 41 sera were ascertained with antibodies against Paragonimus africanus using ELISA testing. As the optical density (OD) values related to seropositive findings were found under 0.6 (the minimal OD to detect an active paragonimosis), the above antibody titres might originate from patients in chronic or in convalescent stages, or might result of cross reactions with trematodes. Concomitantly, dissection of local crabs (Callinectes marginatus) demonstrated the presence of Paragonimus metacercariae in six out of 34 examined. The parasite burdens in crabs ranged from two to 35 cysts with a mean diameter of 302 microm. In Ivory Coast, the locality of Divo must be considered an at-risk zone in reason of the presence of anti-Paragonimus antibodies in several human sera and the presence of infected crabs at the local market.

[Paragonimiasis in Cameroon: clinicoradiologic features and treatment outcome]. / La paragonimose au Cameroun: tableaux radio-cliniques et évolution sous traitement.

A prospective study of paragonimiasis was undertaken from September 1992 to July 1997 in the Mount Kupe zone of the Southwest Province of Cameroon. In a group of 2700 subjects, 312 presenting one or more signs of paragonimiasis underwent testing to detect Paragonimus africanus eggs in sputum and stools. Eggs were found in 30 subjects (9.61%). These patients underwent chest x-rays to assess radiological lesions due to paragonimiasis before and after treatment with Praziquantel. Symptoms included cough in all patients, hemoptysis in 13 (43.33%) and chest pain in 18 (60%). Only one patients presented altered general status. No patients presented fever. Before treatment chest x-rays demonstrated perinodular shadow in 22 patients (73.33%), pulmonary infiltrative opacity in 12 (40.00%), pulmonary nodules and cavitation in 3 (10.00%), pleuropulmonary calcification in 3 (10.00%), and cicatricial lesions in 2 (6.66%). Radiological findings were normal in 8 patients (26.66%). Following treatment parasitological and clinical cure was achieved at 1 and 2 months in all cases but X-ray abnormalities persisted for six months in 56.6% of cases. The most notable changes included disappearance of perihilar shadow in 8 out of 22 patients (36.36%) and worsening of radiological findings in 3 (13.66%). In 19 patients, treatment had no effect on X-ray findings in comparison with baseline. Absence of pleural effusion and high incidence of perihilar shadow may be specific features of paragonimiasis in Central Africa where the incidence of concomitant parasitic, fungal and microbial diseases is high.

[Prevalence of Bancroftian filariasis in seven villages of the Bonassama Health District in the Wouri Estuary, littoral province of Cameroon]. / Enquête sur la filariose lymphatique dans sept villages du district de santé de Bonassama dans l'estuaire du Wouri, Province du Littoral, Cameroun.

Lymphatic filariasis is one of the 6 diseases targeted for global eradication by the World Health Organization. In 2000 Cameroon was selected for inclusion in the eradication program. As a prerequisite for the program, epidemiological mapping was undertaken to determine the prevalence of Wuchereria bancrofti in 7 villages located in the mangrove area of the Wouri estuary littoral province of Cameroon. Informed consent was obtained from each participant or from parents of minors. Night blood specimens were collected for thick and thin blood films, stained using the Giemsa solution, and microscopically examined to identify microfilariae of W. bancrofti. The study population included 924 subjects (336 males and 558 females). Their age ranged from 1 to 79 years (mean, 26.9 years). W. bancrofti was identified in 4 of the 7 villages with prevalence rates ranging from 0.7% to 3.25% (mean, 0.97%). All positive subjects were over 30 years old. Despite night blood specimen collection, other blood microfilariae were detected including Loa loa in 54 cases (prevalence, 5.84%) and Dipetalonema perstans in 10 (prevalence, 1.1%). Only a small number of subjects presented clinical manifestations of lymphatic filariasis (e.g., pruritus). Elephantiasis of the lower limb was identified in only one subject but there was hearsay evidence of other cases involving subjects embarrassed to come forward.

Search for Enterocytozoon bieneusi infection in wild monkeys in Cameroon.

Faecal samples collected from 42 wild monkeys in Cameroon were examined for microsporidia by light microscopy (using Weber trichrome and Uvitex 2B stains) and by PCR (using Enterocytozoon bieneusi specific primers). None of the 42 samples was positive, suggesting that wild monkeys do not represent a major reservoir for microsporidia in Central Africa.

Effects of a 3-day regimen of albendazole (800 mg daily) on Loa loa microfilaraemia.

The encephalopathy that sometimes develops after ivermectin treatment in patients with high Loa microfilaraemias is probably related to a massive effect of the drug on the Loa microfilariae. A trial was therefore conducted to evaluate whether a course of albendazole would bring about a slower decrease in the Loa microfilaraemia, and thus could be used as a mass 'clearing' treatment, before the distribution of ivermectin in areas where onchocerciasis and loiasis are co-endemic. The Loa microfilarial loads were followed monthly for 9 months in two groups of subjects, one treated with albendazole (400 mg twice a day for 3 days), and the other with vitamin (B(1), B(6) and B(12)) tablets. There were no significant between-group differences in the microfilarial loads at any of the examination rounds. During the follow-up period, there was also no significant change in the overall loads among those treated with albendazole, although the counts in those with high initial microfilaraemias (>8000 microfilariae/ml) tended to decrease progressively during the first 3 months. Further trials should now be performed, to evaluate the effects on Loa loa of two courses of albendazole given 2-3 months apart.

Clinical trial of beta-arteether versus quinine for the treatment of cerebral malaria in children in Yaounde, Cameroon.

One hundred and two children aged 0-10 years with cerebral malaria (Blantyre coma score of 2 or less) were randomly treated either with intramuscular arteether (3.2 mg/kg on Day 0, followed by 1.6 mg/kg on Days 1 to 4) or intravenous (i.v.) quinine dihydrochloride (20 mg of the salt/kg, followed by 10 mg of the salt/kg every 8 hr up to Day 6). Treatment with oral quinine sulfate (10 mg/kg every 8 hr) was substituted for i.v. quinine when the patient was able to take oral medicine. All patients were followed up in the hospital for 7 days; thereafter, they were treated as outpatients on Days 14, 21, and 28. Mortality rate, the main efficacy parameter, was 11.8% lower in the arteether treatment group than in the quinine group (15.7% versus 27.4%); however, the difference was not significant (P = 0.25). Means for fever clearance time, coma resolution time, and parasite clearance time were similar in the 2 treatment groups (42.2 +/- 34.9 hr; 34.8 +/- 18.8 hr, and 46.3 +/- 28.5 hr, respectively for arteether, versus 45.0 +/- 26.7 hr; 30.3 +/- 18.9 hr, and 40.7 +/- 18.9 hr, respectively, for quinine). At 28 days, the cure rates were 73.2% and 64.9% for the arteether and quinine treatment groups, respectively. Arteether is safe and therapeutically at least as effective as quinine for the treatment of cerebral malaria in children in Cameroon. Because of its ease of administration, arteether appears to be suited for use in the rural zones where monitoring facilities do not exist.

Deltamethrin impregnated bednets for the control of urban malaria in Kumba Town, South-West Province of Cameroon.

This study was conducted from January to December 1992 in Kumba, a town situated in the rain forest region of the South-West Province of Cameroon, and consisted of a longitudinal survey including parasitological and clinical studies. Forty households were chosen for the study and randomly divided into two groups, each with approximately 240 inhabitants aged < or = 15 years. One group received deltamethrin impregnated bednets and the other group had no nets (control). For the months of April, June and August (rainy season), deltamethrin impregnated bednets did not reduce malaria prevalence significantly, but the overall malaria prevalence for all months of the study was significantly reduced (chi 2 MH = 9.17, P = 0.002). Enlarged spleen rates (chi 2 MH = 6.73, P = 0.009) and spleen sizes (P = 0.0002) were also significantly reduced by the nets. However, the reduction in the geometric mean parasite density (GMPD) was not significant. Even though some of these reductions were statistically significant, they were relatively low in a global context compared with previous work done mainly in rural areas. In an urban environment, parents and children usually stay up late, and probably receive many mosquito bites before going to sleep.

PIP: In 1992, in Cameroon, 40 households in two neighborhoods of Kumba, located in the rain forest region of the South-West Province, were randomly allocated to either the group that received deltamethrin impregnated bednets or the group who received no bednets. Each group had about 240 persons aged 15 years or under. The neighborhoods were Kossala (high malaria prevalence) and Mbonge Road (low prevalence). Parasitological, entomological, and clinical studies were conducted longitudinally so researchers could determine whether deltamethrin impregnated bednets would cause a reduction in malaria morbidity and parasitic indices. The geometric mean parasite density (GMPD) decreased with age, especially for 11-15 year olds, suggesting acquired immunity. The deltamethrin group was more likely than the control group to have lower malaria prevalence (29% vs. 41%; p = 0.002), spleen rates (18.5% vs. 30.4%; p = 0.009), and spleen sizes (p = 0.0002). GMPD was also lower, but not significantly so (764 vs. 1081/mcl). During the rainy season (April, June, and August), malaria prevalence was not statistically significant between the test and control groups. In Kossala, children aged 6-10 years had a higher malaria prevalence rate than other age groups. The deltamethrin impregnated bednets afforded better protection in Mbong Road than in Kossala, suggesting that they are most effective in areas of low malaria endemicity. The significant reductions in human/vector contact were relatively low when compared with earlier studies mainly conducted in rural areas. Parents and children in urban areas such as Kumba tend to stay up late (e.g., watching TV) and probably receive many mosquito bites while awake. Impregnated window curtains may improve protection in malaria endemic urban areas.

Multi-drug resistant falciparum malaria in Cameroon in 1987-1988. I. Stable figures of prevalence of chloroquine- and quinine-resistant isolates in the original foci.

The status of drug-resistant Plasmodium falciparum in Cameroon was determined in 1987-1988 in 221 children who were selected for chloroquine and quinine in vitro microtests. Resistance to quinine was found in 17% of 72 isolates from the southern part of the country, and in 7% of 87 isolates from the northern part of the country. The effective concentrations of 50% and 90% (EC50 and EC90) differed little from those observed in 1986. In southern Cameroon, 38 (51%) of 74 individuals harbored chloroquine-resistant isolates. The EC50 ranged from 8 to 553 nmol and the mean +/- SD EC50 was 154 +/- 148 nmol. In contrast, in the northern area, all but one of the 120 subjects studied had EC50 values below the cutoff limit of 80 nmol (mean = 20 nmol). In vivo 7-day assays performed with chloroquine at a dose of 25 mg/kg in 389 individuals from the southwestern part of the country clearly confirmed RII-RIII levels of resistance in 18-52% of the cases, depending on the location studied. In the northern area, in vivo 7-day assays at a chloroquine dose of 10 mg/kg showed 36 of 39 subjects studied to have drug-sensitive parasites. Based on these results, it appears that after a rapid emergence of resistance that occurred in southern Cameroon, the prevalence of chloroquine- and quinine-resistant parasites remained fairly stable from 1986 to 1988. The stable difference between the northern and southern areas is believed to be related to both the lower rate of transmission and lower chloroquine drug pressure in the north.

Multi-drug resistant falciparum malaria in Cameroon in 1987-1988. II. Mefloquine resistance confirmed in vivo and in vitro and its correlation with quinine resistance.

To further document the phenomenon of Plasmodium falciparum resistance to mefloquine formerly described in Cameroon, complementary in vivo and in vitro studies were conducted. Two hundred six P. falciparum isolates were studied in vitro using an isotopic microassay with mefloquine solutions prepared daily. Using the cutoff limit of 30 nmol, 26 (20%) of 133 isolates from the northern part of the country were defined as being resistant to mefloquine. In contrast, only one of 73 isolates collected in the southern part of the country was resistant. In vivo 7-day assays were performed in the northern area in 57 asymptomatic P. falciparum carriers (age range 1-10 years) who were given a single 25 mg/kg dose of mefloquine (Lariam). Among 46 cases in which followup was possible, P. falciparum asexual parasites were cleared within five days in 38 cases, by days 6 and 7 in two cases, and remained detectable up to day 7 in six cases. Thus, these latter patients have a RII-RIII level of resistance by in vivo criteria. No resistance was found in 40 additional patients studied similarly in the southern region. These observations were made before any mefloquine drug pressure was exerted in the country, but results of cross-resistance and drug consumption studies support the hypothesis that in the northern region, where a close correlation (r = 0.67) was found between the response to quinine and mefloquine, the more frequent use of quinine may have induced a primary quinine resistance and a secondary mefloquine resistance (without chloroquine resistance).(ABSTRACT TRUNCATED AT 250 WORDS)

Aspects epidemiologiques du paludisme dans la ville de Kumba (Cameroun-Province du Sud Ouest)

L'enquete paludometrique effectuee en fin de saison des pluies en octobre 1987 a Kumba; ville du Sud Ouest du Cameroun; a partir d'un echantillon de 804 sujets etabli montre la frequence des acces febriles et des automedications inadequates pratiquees. Elle apprecie le retentissement du paludisme sur la morbidite et la mortalite dans cette region forestiere. Plasmodium falciparum est l'hematozoaire le plus frequent; present sur 26;1 pour cent des lames examinees et responsable de 97;7 pour cent des infestations

Chloroquine resistant Plasmodium falciparum in indigenous residents of Cameroon.

Thirty-nine percent (36 of 92) of children in Limbe, Cameroon, treated with chloroquine (10 mg/kg body weight on days 1 and 2, and 5 mg/kg on day 3) for falciparum malaria failed to respond within 7 d of treatment. Twenty-two of these children with chloroquine-resistant malaria were successfully treated with Fansidar [one-half tablet (250 mg sulfadoxine and 25 mg pyrimethamine) per 10 kg body weight], while the other 14 children were cured with mefloquine (25 mg/kg body weight). In vitro, a combination of verapamil at 1.0 x 10(-6) M with chloroquine or desethylchloroquine reversed resistance to the antimalarial drug and its primary metabolite in each of the 2 isolates successfully adapted and maintained in continuous culture. Similar combinations had no effect on susceptibilities of a sensitive reference clone, D6, used as control. Both chloroquine-resistant isolates from Cameroon were significantly more susceptible to mefloquine and halofantrine in vitro than the chloroquine-sensitive reference clone. Clinical observation, and in vitro confirmation, of chloroquine-resistant falciparum malaria in these indigenous children from Cameroon, and the current socio-economic condition in West Africa, underscore the need for pragmatic health management policies for efficient use of alternative antimalarial drugs in controlling drug resistant Plasmodium falciparum in the region. This observation of reversal of chloroquine resistance in isolates of P. falciparum obtained from West Africa, and a previous report on clones obtained from south-east Asia and South America, suggest that the mechanism(s) of resistance to chloroquine may be identical in resistant parasites from the 3 continents.

[An echographic study of the urologic lesions of urinary bilharziasis in children in Barombi Kotto (Cameroon)]. / Etude échographique des lésions urologiques de la bilharziose urinaire chez les enfants de Barombi Kotto (Cameroun).

Ultrasonographic examination was performed on 212 school age children (152 proven Schistosomiasis, 60 normal) living in the endemic area of Barombi Kotto (Cameroon). 86.8% of urologic lesions were observed in the diseased group. 73 renal lesions were detected: these consisted of various degrees of dilatations. Urinary bladder lesions were present in 132 cases: they consisted of wall thickenings (84.9%), wall irregularities (79.6%) and localized hypertrophies (24.3%). 11 normal (18.4%) children presented with urologic complications. The prevalence of urologic lesions increased with the intensity of infection as measured by urinary egg output, but there seemed to be no direct relationship between the parasitic load and the severity of morbidity in the study. The authors recommend the use of ultrasonography as a public health tool for the diagnosis and control of disease complications in endemic areas.

Patterns of in vitro resistance to chloroquine, quinine, and mefloquine of Plasmodium falciparum in Cameroon, 1985-1986.

The drug sensitivity of 246 Plasmodium falciparum isolates was studied in vitro in five areas of Cameroon at the end of 1985. Results demonstrate that parasites resistant either to chloroquine, quinine, or mefloquine, or to two of these drugs, were prevalent in four of the areas investigated, but the drug response pattern varies widely from one area to another. The recent explosive emergence of chloroquine resistance in the south of the country, where both prevalences and levels are very high (up to 86%), contrasts with only moderate levels of resistance in the north. This may be related to differences in transmission by mosquitoes between Sahel and forest areas. Quinine resistance was observed in 24% of the isolates studied in vitro and was frequently associated with chloroquine resistance. The presence of isolates responding poorly to mefloquine, observed mainly in northern Cameroon, suggests that resistance may occur in areas where the drug has never been used.

Detection with a monoclonal antibody of an antigen, characteristic of the genus Schistosoma, excreted in the urine.

In the host, the antigen excreted by schistosomes in the circulating blood is concentrated in the urine. A mouse monoclonal antibody of the IgM class type lambda, directed against an epitope of the intestinal epithelium of the adult worm, is obtained. The antigen found in the urine of the host as well as the monoclonal antibody has been previously characterized. It is of a polysaccharidic nature, is thermostable and specific for the genus Schistosoma. The antigen is found at all stages of the life cycle and, particularly, in the egg where it is found in large amounts. Detection of the antigen is by means of inhibition of the passive haemagglutination test. There is a fundamental advantage in detecting the metabolic antigen excreted by schistosomes instead of looking for circulating antibodies. The antigen is directly released by the parasite itself, antibodies being, by contrast, produced by the host, indirectly therefore, and in a way that varies from one individual to the next. Collecting urine specimens is, for field workers, easier than obtaining blood from the inhabitants. The detection of the antigen in the urine is made a rather simple procedure since the antigen is concentrated by the kidney and free in urine, instead of remaining conjugated with antibodies like it is in the blood. When used in the Cameroon for the study of prevalence in two foci of schistosomiasis, intestinal (Nalassi Emana) and urinary (Barombi Kotto), the test detecting the antigen in urine gives good correlations with the parasitological examinations looking for eggs of S. mansoni and S. haematobium in feces and urine.

[Epidemiologic and radiologic study of urinary bilharziosis in a focus at the Barombi Lakes (Mémé Department), Cameroon]. / Etude épidémiologique et radiologique de la bilharziose urinaire dans le foyer des lacs Barombi (Département de la Mémé) Cameroun.

A recent epidemiological and radiological study of urinary schistosomiasis in the Barombi lake foci (South West Cameroon) shows that the intensity of the disease is very high, 76% and 50% in Barombi Kotto and Barombi Mbo respectively, when compared to the level observed by DUKE and MOORE during a five year control period, from 1970 to 1975, respectively 6.9% and 2.4% in Barombi Kotto and Barombi Mbo. The endemicity is not influenced by age or sex. On the average, the parasitic load is highest in the 5-15 years age group. Bulinus camerunensis and B. rohlfsi are the known intermediary hosts of this parasite, with an infection rate of 17.2%. B. camerunensis is the most abundant species, but B. rohlfsi is the frequently infected. The bilharzia patient had very important and very frequent lesions of the urinary system. A normal X-ray shows calcifications localised on the ureter and more often on the bladder. The frequency of these calcifications increases with age. The intravenous pyelography (IVP) shows functional (delay in secretion observed in 47% of cases) and morphological lesions (87% of the patients). Morphologically, the bladder present irregularities of the contours and the mucosa. Irregular contours of the ureters with strictures, including dilation and stenosis, are observed. On the kidney, dilated calyces (hydronephrosis due to obstruction on lower side) are evident. There does not seem to be any relation between the number of eggs discharged by the patient and the importance or frequency of lesions observed in a normal X-ray or IVP.

[Epidemiological aspects of malaria in 2 villages of the Manyemen forest region (Cameroon, southwest province)]. / Aspects épidémiologiques du paludisme dans deux villages de la région forestière de Manyemen (Cameroun-province du Sud-ouest).

In terms of parasitaemia in blood, the prevalence was 18.7% for Plasmodium falciparum, 10.5% for P. ovale and 1% for P. malariae in the villages of Mungo Ndor and Kokobuma. The plasmodial index of children from 2 to 9 years of age was 38.2% and the spleen index 26.6%, with a mean HACKETT score of 1.56. Malaria is thus meso-endemic in the region. The immunofluorescent test performed with a P. falciparum antigen was positive in 66% of the children in the same age group. Parasites were seen in 15% of new-born children. The malaria infection indices were higher in Mungo Ndor, which is located on the main road in the vicinity of the Manyemen hospital, than in Kokobuma. Morbidity and mortality due to malaria remain major problems in this part of the South-West Province, in spite of improving primary health care facilities and free chloroquine distribution. Anopheles gambiae is the main vector of malaria in the area, and transmission is interrupted only during the short dry season.

[Epidemiological study of intestinal helminthiasis in 4 Barombi villages (Cameroon-South-West Province)]. / Etude épidémiologique des helminthiases intestinales dans quatre villages Barombi (Cameroun-Province du Sud-Ouest).

The prevalence of intestinal helminthiasis is measured by means of stool examinations. Larvae of S. stercoralis are seen in 9.8% of the specimens, eggs of A. lumbricoides in 51.4%, eggs of T. trichiura in 85.2% and eggs of N. americanus in 64.1%. Strongyloidiasis occurs in foci and affects 16.8% of the inhabitants in one of the studied villages.

[Changes in Plasmodium berghei berghei in mice maintained at high temperatures]. / Modification de Plasmodium berghei berghei chez la souris maintenue dans une atmosphère chaude.

The study of the evolution of Plasmodium berghei berghei is made in mice kept in a high temperature (35 degrees C) throughout the experiment. Some of these mouse parasites (less than 30%) show a gigantic atypical morphology. In the parasite growing in animals kept at 35 degrees C, the amount of DNA is higher than DNA rate of the parasites growing in control mice (20-22 degrees C). There is no evidence of any relation between the increase of DNA amount and the morphological modification of these parasites.

[Influence of a hot environmental temperature on the evolution of experimental paludism of the mouse with Plasmodium berghei berghei]. / Influence d'une ambiance thermique chaude sur l'évolution du paludisme expérimental de la souris à Plasmodium berghei berghei.

Swiss Mice infected with Plasmodium berghei berghei and maintained in permanence in a hot environmental temperature undergo a chronic infection whereas controls maintained at the laboratory temperature develop always an acute and lethal infection. The hot environmental temperature does not seem to have any action on the pathogenicity of the parasites. Host defences are stimulated.