Lessons learned about pneumonic plague diagnosis from two outbreaks, Democratic Republic of the Congo.

Pneumonic plague is a highly transmissible infectious disease for which fatality rates can be high if untreated; it is considered extremely lethal. Without prompt diagnosis and treatment, disease management can be problematic. In the Democratic Republic of the Congo, 2 outbreaks of pneumonic plague occurred during 2005 and 2006. In 2005, because of limitations in laboratory capabilities, etiology was confirmed only through retrospective serologic studies. This prompted modifications in diagnostic strategies, resulting in isolation of Yersinia pestis during the second outbreak. Results from these outbreaks demonstrate the utility of a rapid diagnostic test detecting F1 antigen for initial diagnosis and public health management, as well as the need for specialized sampling kits and trained personnel for quality specimen collection and appropriate specimen handling and preservation for plague confirmation and Y. pestis isolation. Efficient frontline management and a streamlined diagnostic strategy are essential for confirming plague, especially in remote areas.

Persistence of Mycobacterium ulcerans disease (Buruli Ulcer) in the historical focus of Kasongo Territory, the Democratic Republic of Congo.

Fifty years after the last report of Mycobacterium ulcerans infections (Buruli ulcer [BU]) in Kasongo Territory, Maniema Province, Democratic Republic of Congo (DRC), we conducted a small-scale cross-sectional survey to assess if this historical BU focus was still active and if so to explore the disease epidemiology. Seventy-five active and inactive BU cases were identified on clinical grounds of which two of 28 BU active cases were laboratory confirmed. We used a modified BU02 form to reconstruct the local disease dynamics and we believe that the horrific conflict in eastern DRC and exceptional flooding were the most likely causes of the re-emergence of the disease. There is a need in the DRC to decentralize and integrate surveillance and control activities at local level to increase the effectiveness of patient management.

Screen detection and the WHO stepwise approach to the prevalence and risk factors of arterial hypertension in Kinshasa.

BACKGROUND: The trend of hypertension and other risk factors of cardiovascular disease is changing because of epidemiological, demographic and nutritional transitions in sub-Saharan Africa. OBJECTIVES: The aim of this study is to determine the prevalence and risk factors of arterial hypertension in the Kinshasa region, Democratic Republic of Congo (DRC). DESIGN AND METHODS: Data were collected from random sample cross-sectional surveys of adult black Africans from Kinshasa, with the help of a structured questionnaire, physical examinations and blood samples, using the World Health Organisation (WHO) stepwise approach. Sex, age, place of residence (urban versus rural), psychosocial risk factors (socioeconomic status, stress), overweight status (BMI: 25-29.9 kg/m), general obesity (BMI: >or=30 kg/m), abdominal obesity (waist circumference: >or=94 cm) and diabetes mellitus were considered to be the potential risk factors for screen-detected hypertension. RESULTS: The weighted prevalences of hypertension, diabetes mellitus, overweight status, general obesity and abdominal obesity were 15.2, 140.2, 13.5, 4.8 and 7.5%, respectively. Blood pressure and the proportion of participants with hypertension increased with age and BMI group in the population, for both men and women. Age, rural residence, low socioeconomic status, high socioeconomic status, general obesity and abdominal obesity were the risk factors for hypertension. Women aged 55 years and above had higher levels of blood pressure and hypertension than men. CONCLUSION: Absolute levels of hypertension, all types of obesity and diabetes mellitus are high risk factors in the army camps and semiurban extension cities; general obesity and abdominal obesity are the risk factors for detectable hypertension. Effective control of general obesity and abdominal obesity and psychosocial strategies that target both semirural and urban areas of the Kinshasa region have the potential to prevent much premature cardiovascular disease.