Presumptive diagnosis of leptospirosis before seroconversion: a review of 338 cases in Wallis and Futuna 2008 to 2015.

Leptospirosis is a common condition in Wallis and Futuna, and the definitive diagnosis needs to be established urgently at the first patient consultation, which is usually one to two days after the onset of clinical signs. As a diagnostic aid, a composite index was established based on data from 338 patients seen by the Wallis and Futuna admissions services between 2008 and 2015. The data taken into account include: age and sex of the patient, their home island, the consultation period and the results of leukocytes, platelets, CRP, creatinine and GGT tests combined with 2 major clinical signs, headache and conjunctival suffusion. Then 5 threshold limits were defined for this index, which indicates from very low risk to almost certain biologically confirmed leptospirosis. Other febrile diseases responsible for thrombocytopenia are not found in Wallis and Futuna, which probably explains the good statistical qualities of this index with a value of area under the curve equal to 0.821.

An Unprecedented High Incidence of Leptospirosis in Futuna, South Pacific, 2004 - 2014, Evidenced by Retrospective Analysis of Surveillance Data.

Futuna is a small Polynesian island in the South Pacific with a population of 3,612 in 2013. The first human leptospirosis case was confirmed in 1997. Active surveillance started in 2004. Cases were confirmed by PCR or real time PCR, or by serology using MAT or a combination of IgM-ELISA and MAT. A retrospective analysis of surveillance data shows that the disease was endemic with a mean annual incidence of 844 cases per 100,000 over an 11-year period from 2004 to 2014. An epidemic peak as high as 1,945 cases per 100,000 occurred in 2008. Serogroup Australis was predominant until 2007, Icterohaemorrhagiae was dominant afterwards. Cluster analysis revealed different hot spots over time. Lifestyle habits, such as walking barefoot in irrigated taro fields or pig pens probably contributed to contamination from the swine and rodent reservoirs to humans. Severe forms were rare, and the case fatality rate was 0.5%. The medical community and general population were aware of leptospirosis and rapid treatment with amoxycillin was the main treatment, probably contributing to this low fatality rate.

Compound heterozygous PKHD1 variants cause a wide spectrum of ductal plate malformations.

Ductal plate malformations (DPM) present with a wide phenotypic spectrum comprising Von Meyenburg complexes (VMC), Caroli disease (CD), Caroli syndrome (CS), and autosomal recessive polycystic kidney disease (ARPKD). Variants in PKHD1 are responsible for ARPKD and CS with a high inter- and intra-familial phenotypic variability. Rare familial cases of CD had been reported and exceptional cases of CD are associated with PKHD1 variants. In a family of three siblings presenting with a wide spectrum of severity of DPM, we performed whole exome sequencing and identified two PKHD1 compound heterozygous variants (c.10444G>A; p.Arg3482Cys and c.5521C>T; p.Glu1841Lys), segregating with the symptoms. Two compound heterozygous PKHD1 variants, including one hypomorphic variant, were identified in two other familial cases of DPM with at least one patient presenting with CD. This report widens the phenotypic variability of PKHD1 variants to VMC, and others hepatic bile ducts malformations with inconstant renal phenotype in adults and highlights the important intra-familial phenotypic variability. It also showed that PKHD1 might be a major gene for CD. This work adds an example of the contribution of exome sequencing, not only in the discovery of new genes but also in expanding the phenotypic spectrum of well-known disease-associated genes, using reverse phenotyping.

[Evaluation of the Kato-Katz technique for monitoring Schistosoma mansoni infestation in endemic areas]. / Évaluation de la technique de Kato-Katz pour la surveillance des infestations à Schistosoma mansoni en zone d'endémie.

The Kato-Katz technique has become the gold standard for all studies on intestinal schistosomiasis. Though repeatability and reproducibility can be disappointing and the sensitivity is low, it remains easy, inexpensive, and fast and as such, is perfectly suited for epidemiological surveys or to monitor the effectiveness of mass treatment. For optimal interpretation of the Kato-Katz results in a recent study of three endemic villages in the Senegal River basin, a study of the measurement uncertainties of this analysis was conducted according to Cofrac and ISO 15189 guidelines. Repeat examinations of stool smears from the same individual, taken a few days apart, can significantly increase the sensitivity of the Kato-Katz test, which allows its use as a technique in clinical biology.

Epidemiologic pattern of meningococcal meningitis in northern Cameroon in 2007-2010: contribution of PCR-enhanced surveillance.

OBJECTIVES: Monitoring acute bacterial meningitis in northern Cameroon. METHODS: Health professionals collected cerebrospinal fluid (CSF) specimens from patients presenting with clinical symptoms of meningitis. Specimens were tested using gram stain, latex agglutination test, and culture. A PCR assay completed the diagnostic testing. Multilocus sequence typing (MLST) was performed on some Neisseria meningitidis (Nm) isolates. RESULTS: From 2007 through 2010, of the 1429 CSF specimens tested, 292 (20·4%) were positive, either for Nm (205), Streptococcus pneumoniae (Sp) (57), or Haemophilus influenzae (Hi) (30). From 2007 through 2009, the serogroup W135 represented 98·8% of 164 case isolates. Until 2008, most serogroup W135 isolates presented the sequence-type ST-2881 usually associated with sporadic cases. Since 2009, the ST-11 (an epidemic-associated clone) became predominant, although no epidemic occurred. Serogroup A ST-7 was observed in 2010 and caused a localized epidemic. Using the detection PCR on turbid CSF, a 2·7-fold increase in cases with etiologic diagnosis was obtained, compared to culture. All tested meningococcal isolates (42) were susceptible to ampicillin, chloramphenicol, and cefotaxim. CONCLUSIONS: Resurgence of serogroup A and recent increase in ST-11 among serogroup W135 isolates were worrying when considered with the epidemic wave of serogroup A meningitis, which affected neighboring countries and the serogroup W135 epidemic in Niger in 2009-2010.

High frequency and diversity of species C enteroviruses in Cameroon and neighboring countries.

Human enteroviruses (HEVs) are endemic worldwide and among the most common viruses infecting humans. Nevertheless, there are very limited data on the circulation and genetic diversity of HEVs in developing countries and sub-Saharan Africa in particular. We investigated the circulation and genetic diversity of HEVs among 436 healthy children in a limited area of the far north region of Cameroon in 2008 and 2009. We also characterized the genetic biodiversity of 146 nonpolio enterovirus (NPEV) isolates obtained throughout the year 2008 from stool specimens of patients with acute flaccid paralysis (AFP) in Cameroon, Chad, and Gabon. We found a high rate of NPEV infections (36.9%) among healthy children in the far north region of Cameroon. Overall, 45 different HEV types were found among healthy children and AFP patients. Interestingly, this study uncovered a high rate of HEVs of species C (HEV-C) among all typed NPEVs: 63.1% (94/149) and 39.5% (49/124) in healthy children and AFP cases, respectively. Besides extensive circulation, the most prevalent HEV-C type, coxsackievirus A-13, featured a tremendous intratypic diversity. Africa-specific HEV lineages were discovered, including HEV-C lineages and the recently reported EV-A71 "genogroup E." Virtually all pathogenic circulating vaccine-derived polioviruses (cVDPVs) that have been fully characterized were recombinants between oral poliovaccine (OPV) strains and cocirculating HEV-C strains. The extensive circulation of diverse HEV-C types and lineages in countries where OPV is massively used constitutes a major viral factor that could promote the emergence of recombinant cVDPVs in the Central African subregion.

Positive effect of the introduction of Haemophilus influenzae type b vaccination in the expanded program on immunization in Cameroon.

The microbiological surveillance of acute bacterial meningitis in the three northern provinces of Cameroon, namely North, Far North and Adamaoua shows the disappearance of Hib from cerebrospinal fluid specimens examined in the laboratory of the Centre Pasteur, in Garoua, using culture and/or soluble antigen testing, since the Hib immunization introduction on 1 February 2009.

Serogroup W135 meningococcal meningitis, Northern Cameroon, 2007-2008.

We analyzed results of recent microbiologic surveillance of meningitis in northern Cameroon. During the 2007 and 2008 meningitis seasons, all 57 identified meningococcal isolates were serogroup W135. This situation might indicate that the area is experiencing a period between epidemic waves due to 2 different clones of serogroup A meningococci.