Epidemiology and Performances of Typhidot Immunoassay and Widal Slide Agglutination in the Diagnosis of Typhoid Fever in Febrile Patients in Bafoussam City, Cameroon: A Cross-Sectional Comparative Study.

Background: Enteric fever is a great public health problem associated with significant illness and death in many endemic countries, and its clinical diagnosis is still daunting. The aim of this study was to determine the prevalence and risk factors of S. Typhi among febrile patients in Bafoussam and to evaluate the diagnostic performances of Widal and Typhidot tests. Methods: This was a cross-sectional study among 336 participants visiting three hospitals in Bafoussam from August 1, 2021, to November 31, 2021. Widal test, Typhidot assay, and stool culture were used to screen for salmonellosis with the help of a structured questionnaire. Results: The prevalence of S. Typhi and S. Paratyphi was found to be 62.85% and 37.14%, respectively. The overall prevalence of typhoid fever using stool culture was 20.86%. The significant risk factors associated with enteric fever were lack or insufficient knowledge of typhoid fever, poor hand hygiene, and anorexia. Typhidot immunoassay was more sensitive (100%) and specific (82.3%) than the Widal test. Both were analytically inferior to stool culture. Conclusions: High prevalence of typhoid fever (20.86%) was observed which was largely associated with lack or insufficient knowledge of typhoid fever, poor hygiene measure, and anorexia as risk factors. The performances of the Widal and Typhidot test against a stool culture were inferior but with Typhidot better than the Widal slide agglutination.

Multidrug-Resistant Escherichia coli Causing Urinary Tract Infections among Controlled and Uncontrolled Type 2 Diabetic Patients at Laquintinie Hospital in Douala, Cameroon.

Urinary tract infections (UTIs) in patients with diabetes are a major public health problem worldwide, particularly in developing countries. This study assessed the resistance profile of Escherichia coli and biochemical abnormalities in controlled and uncontrolled type 2 diabetic patients. A cross-sectional study was conducted at the Douala Laquintinie Hospital from January, 2020, to July, 2021, on the diabetic and nondiabetic participants. The clinical symptoms and biochemical parameters of patient having UTIs were measured using standard methods. E. coli was isolated from urine and an antibiotic susceptibility test was performed using the Kirby-Bauer Agar diffusion method. A total of 851 participants were included with a mean age of 48.54 years. Three hundred and forty-six (40.67%) were nondiabetic, 226 (26.56%) were diabetic patients with balanced blood sugar levels (i.e., glycosylated haemoglobin (HbA1c) is normal), and 279 (32.78%) were diabetic patients with unbalanced blood sugar levels (i.e., patients having an abnormal HbA1c). The prevalence of UTI caused by E. coli was significantly (p < 0.001) higher in diabetics with unbalanced blood sugar levels (15.41%) and diabetics with balanced blood sugar levels (9.73%) compared to nondiabetics (0.87%). Significant (p < 0.001) high frequencies of polyuria (48.39%), proteinuria (29.75%), leukocyturia (27.96%), and polyphagia (8.24%) were observed in diabetic participants with unbalanced blood sugar levels. Significantly (p < 0.001) high average values of aspartate transaminase (25.34; 27.07; 29.93), alanine transaminase (26.08; 27.38; 28.20), creatininemia (8.15; 9.67; 11.31), total cholesterol (1.57; 1.83; 2.63), and atherogenic index (3.81; 6.56; 11.73) were noted in nondiabetics, balanced, and unbalanced blood glucose diabetics, respectively. E. coli showed a high level of resistance to ciprofloxacin (30%), amoxicillin (10.8%), and ofloxacin (9.3%) in diabetic participants with unbalanced blood sugar levels. The antibiotic resistance patterns of the E. coli to triple, quadruple, and quintuple antibiotics were higher when participants had diabetes and even more when diabetes was not controlled. The present findings underline an increased susceptibility of diabetic patients with unbalanced blood sugar levels to multidrug resistant E. coli. Further studies should be conducted to determine the causal association between uncontrolled diabetes and bacterial multidrug resistance.

Évaluation des performances des mutuelles de santé communautaire de Douala et Yaoundé, Cameroun.

INTRODUCTION: The longevity of Mutual Health Organization (MHOs) in Cameroon is not guarantee, and it tends to fail after a very short period of functioning. Very little studies talks about the performance of MHOs. Therefore, we will like to measure the financial, economic and mutualist satisfactory performance indicators in two community-based mutual health organizations. That is the Mutual health organization of Douala V (Musocom) and Yaoundé I (Mucamaadd). METHODOLOGY: It is a descriptive and analytical study in which sampling was conducted using a non-probability method using a self-administered questionnaire and evaluation grid. RESULTS: It revealed an overall satisfaction of 69%; an availability rate of management tools and activities of 85.5%; a solvency ratio of 34.2%; an expense coverage ratio of 37.4%; an equilibrium ratio of 50.9%; an operating expense ratio of 76% and a loss ratio of 133%. There is a significant association between beneficiary satisfaction and the fact of belonging to a household or small medium size enterprise, enrolling in groups of 6-11 people or > 22 people, being from the private sector or retired and having a salary > 100.000 frs (OR> 1 and P-Value < 0.05). DISCUSSION: The measure of Mutual health organization performance permitted to bring out difficulties, gaps in line with their professionalism, organization and technicality. The findings present a more significant measure of performance in Mucamaadd than in Musocom due to its constant ability in research of amelioration in rendering services.

Effects of Vitellaria paradoxa (C.F. Gaertn.) aqueous leaf extract administration on Salmonella typhimurium-infected rats.

BACKGROUND: The present study investigates the effects of Vitellaria paradoxa crude extract administration on Salmonella typhimurium infected Wistar rats. METHODS: Rats were infected by single dose oral administration of Salmonella typhimurium (1.5×108 CFU). Negative control groups were infected and treated orally with distilled water (vehicle), neutral control group were not infected, while the four test groups were treated up to 18 days with 55 mg/kg, 110 mg/kg, 220 mg/kg and 440 mg/kg body weight of aqueous extract of V. paradoxa respectively. The effects of this extract administration on serum markers (total protein, creatinine, transaminases, bilirubin and lipid profile) as well as acute toxicity test and phytochemical screening were also investigated. RESULTS: Following in vivo studies, aqueous extract of V. paradoxa allowed to clear salmonellosis in previously infected rats within twelve days of treatment. Infection has resulted in a significant increase of transaminases activity. Besides, significant decrease was observed in liver and kidney relative weight and their protein content. Nevertheless, administration of this plant extract at higher doses has resulted in the correction of some of these injuries. Results obtained from acute toxicity study showed that mice administered with the aqueous leaf extract exhibited a mild reaction to noise and pinch; excreted watery discharges and the LD50 value was 12.0 g/kg. In addition, the extract showed no toxic effect after 14 days. However, it may have a sedative effect or depressant effect on the central nervous system, may induce a decrease in plasma levels of algogenic substances, and may cause diarrhea at high doses. Phytochemical screening of the extract revealed the presence of flavonoids, alkaloids, tannins, phenols and polyphenols, saponins, anthocyanins, steroids and anthraquinones. CONCLUSIONS: These results support the ethnomedicinal use of V. paradoxa, and suggest that its leave can be used in the management antibacterial phytomedicine.

Antibacterial activities and toxicological study of the aqueous extract from leaves of Alchornea cordifolia (Euphorbiaceae).

BACKGROUND: A. cordifolia is a plant widely used in Africa to solve many health problems. In Cameroon, it is used in the treatment of urogenital infections. As a continuation of our search for pharmacologically active agents from natural sources, the antimicrobial activity of A. cordifolia leaf extracts against E. coli and the toxicity of this extract were investigated. METHODS: The antibacterial activity of the aqueous extract from leaves of Alchornea cordifolia was carried out in vitro on Escherichia coli, as well as in vivo on E. coli-infected rat model. Phytochemical screening was performed using standard methods. The acute toxicity was investigated in mice, while at the end of treatment of infected rats, some biochemical, hematological and histological markers of toxicity were evaluated. RESULTS: The extract exhibited a bacteriostatic activity with MIC value of 1500 µg/ml. Phytochemical screening revealed the presence of phenols, tannins, triterpens, flavonoids, alkaloids, anthraquinones, anthocyanins, saponins and coumarins in the extract. The acute toxicity study showed LD50 values of 8.6 g/kg and 3.8 g/kg in male and female mice respectively. In vivo, the oral administration of the extract showed a dose-dependent decrease of the bacterial load as the extract at 232, 112 and 58 g/kg were able to eradicate the infection after 9, 11 and 13 days of treatment. The infected rats showed a significant (p < 0.05) increase in the level of serum creatinine, ALAT, white blood cells, and a significant (p < 0.05) decrease in the level of food and water intake, the relative weight of lungs, heart and spleen. In the treated rats, a significant (p < 0.05) increase in food and water intake and ALAT was observed at the doses of 116 and 232 mg/kg. A decrease in the red blood cells count and serum protein levels was also observed. These observations corroborate liver damages as revealed by the histopathological examination of the cross sections of this organ. CONCLUSION: The results of this assay thus showed that the extract of A. cordifolia is bacteriostatic, therapeutic at 58 g/kg bw and may be considered as slightly and almost non-toxic on females and males mice respectively.

Antibacterial and antioxidant properties of crude extract, fractions and compounds from the stem bark of Polyscias fulva Hiern (Araliaceae).

BACKGROUND: In our previous work, the dichloromethane-methanol (1:1 v/v) extract, fractions and isolated compounds from Polyscias fulva stem bark showed interesting antifungal activity. As a continuity of that work, this study aimed to bring out complementary informations about the antimicrobial properties of P. fulva stem bark that may be useful in the standardization of phytomedicine from this plant. METHODS: The antibacterial activities of the crude extract, fractions (n-hexane, ethyl acetate, n-butanol and residual) and isolated compounds from Polyscias fulva stem bark were assayed by broth microdilution techniques. Their antioxidant activity were evaluated using 2,2-diphenyl-1-picrylhydrazyl (DPPH), pyrogallol (superoxide anion) and ß-carotene - linoleic acid assays. RESULTS: The crude extract presented antibacterial activities against S. typhi (ATCC 6539), E. aerogenes (ATCC 13045), P. aeruginosa (PA01) and E. coli (ATCC 10536) with MIC values of 2000 to 8000 µg/ml. The fractionation led the ethyle acetate and n-butanol fractions relatively more active (MIC = 500 to 1000 µg/ml) as compared to the crude extract. ß-sitosterol and 3-O-α-L- arabinopyranosyl-hederagenin were the most active compounds on the tested bacteria with MIC values ranging from 6.25 to 100 µg/ml. The most sensitive was P. aeruginosa (PA01) on which all the tested compounds were active with MICs ranging from 6.25 to 400 µg/ml. Among all the tested substances, the crude extract (RSa50 = 84.86 µg/ml) and the methyl atrarate (RSa50 = 14.77 µg/ml), showed the highest scavenging activities against DPPH free radicals and those arising from the oxidation of the linoleic acid respectively. CONCLUSION: From this study, the results obtained reveal that the stem bark of P. fulva possesses antibacterial and antioxidant activities. It may then be useful in the development of an antimicrobial phytomedicine with a large spectrum of actvity endowed with antioxidant properties which can be standardised based on the isolated compounds.

Antifungal properties of a new terpernoid saponin and other compounds from the stem bark of Polyscias fulva Hiern (Araliaceae).

BACKGROUND: In our previous studies, it was evident that the dichloromethane-methanol (1:1 v/v) stem barks extract of Polyscias fulva and fractions (ethyl acetate, n-butanol and residue) demonstrated interesting antidermatophytic activities. So, as a continuity of that, this work aimed at identifying active principles with antifungal properties from P. fulva that could be used as markers for possible standardization of this plant as phytomedicine. METHODS: The ethyl acetate, n-butanol and residual fractions of the dichloromethane-methanol (1:1 v/v) stem bark extract of Polyscias fulva were further fractionated by column chromatography and the structures of isolated compounds elucidated based on their spectroscopic data in comparison with existing literature information. Antifungal activity was assayed by broth microdilution techniques on yeasts and dermatophytes spores. RESULTS: The fractionation of the crude dichloromethane-methanol (1:1 v/v) stem bark extract of Polyscias fulva led to the isolation of 10 known compounds (1 to 10) and one new saponin (11: 3-O-[α-L-rhamnopyranosyl (1-2)-α-L-arabinopyranosyl]-28-O-[α-L-4-O-acetyl-rhamnopyranosyl (1-4)-ß-D-glucopyranosyl-(1-6)-ß-D-glucopyranosyl]-hederagenin). Among these compounds, 3-O-α-L- arabinopyranosyl-hederagenin and 3-O-[α-L-rhamnopyranosyl (1-2)-α-L-arabinopyranosyl]-hederagenin were the most active on the tested fungi with MIC values ranging from 0.78 to 100 µg/ml against both yeasts and dermatophytes. CONCLUSION: The results of this work constitute a step forward in the possible development of an antidermatophytic phytomedicine from Polyscias fulva stem bark, the isolated compounds being possible markers for the standardisation.

Antimicrobial steroidal saponin and oleanane-type triterpenoid saponins from Paullinia pinnata.

BACKGROUND: Paullinia pinnata L. (Sapindaceae) is an African woody vine, which is widely used in traditional medicine for the treatment of human malaria, erectile dysfunction and bacterial infections. A phytochemical investigation of its methanol leaf and stem extracts led to the isolation of seven compounds which were evaluated for their antimicrobial properties. METHODS: The extracts were fractionated and compounds were isolated by chromatographic methods. Their structures were elucidated from their spectroscopic data in conjunction with those reported in literature. The antimicrobial activities of the crude extracts, fractions and compounds were evaluated against bacteria, yeasts and dermatophytes using the broth micro-dilution technique. RESULTS: Seven compounds: 2-O-methyl-L-chiro-inositol (1), ß-sitosterol (2), friedelin (3), 3ß-(ß-D-Glucopyranosyloxy) stigmast-5-ene (4), (3ß)-3-O-(2'-Acetamido-2'-deoxy-ß-D-glucopyranosyl) oleanolic acid (5), (3ß,16α-hydroxy)-3-O-(2'-Acetamido-2'-deoxy-ß-D-glucopyranosyl) echinocystic acid (6) and (3ß)-3-O-[ß-D-glucopyranosyl-(1″-3')-2'-acetamido-2'-deoxy-ß-D-galactopyranosyl]oleanolic acid (7) were isolated. Compounds 5 and 7 showed the best antibacterial and anti-yeast activities respectively (MIC value range of 0.78-6.25 and 1.56-6.25 µg/ml), while 6 exhibited the best anti-dermatophytic activity (MIC value range of 6.25-25 µg/ml). CONCLUSION: The results of the present findings could be considered interesting, taking into account the global disease burden of these susceptible microorganisms, in conjunction with the search for alternative and complementary medicines.

In vitro and in vivo antidermatophytic activity of the dichloromethane-methanol (1:1 v/v) extract from the stem bark of Polyscias fulva Hiern (Araliaceae).

BACKGROUND: During the last decades, the number of people suffering from dermatophytoses has seriously increased, mainly due to the development of resistant strains of microorganisms to a range of formally efficient antibiotics. Polyscias fulva, a medium size tree which grows in the West Region of Cameroon is traditionally used for local application against dermatoses and orally against venereal infections. The dichloromethane-methanol (1:1 v/v) extract from the stem bark of Polyscias fulva was evaluated for its in vitro and in vivo antifungal activities. METHODS: The plant extract was prepared by maceration of its stem bark powder in CH(2)Cl(2)-MeOH (1:1 v/v). The extract obtained was successively partitioned in hexane, ethyl acetate and n-butanol. Phytochemical screening was performed using standard methods. In vitro antidermatophytic activity was assayed by the well diffusion and broth microdilution methods. The degree of dermal irritation of the crude extract was determined in guinea pigs using the occluded dermal irritation test method. The in vivo antidermatophytic activity of the extract-oil formulation (1.25, 2.5 and 5% w/w concentrations) was evaluated using Trichophyton mentagrophytes-induced dermatophytosis in a guinea pigs model. RESULTS: Phytochemical screening indicated that, the crude extract, ethyl acetate, n-butanol and residue fractions contain in general saponins, tannins, alkaloids, anthraquinones and phenols while the hexane fraction contains only alkaloids. The ethyl-acetate, n-butanol and residue fractions displayed higher antifungal activities (MIC = 0.125-0.5 mg.mL(-1)) against eight dermatophytes as compared to the crude extract (MIC = 0.5-1 mg.mL(-1)). This latter appeared to have slight perceptible erythema effects on guinea pigs as the primary irritation index (PII) was calculated to be 0.54. In vivo, the antidermatophytic activities of the extract-oil formulations were dose-dependent. Griseofulvin-oil 5% at 0.01 g/kg and formulated extract-oil (5%) at 0.1 g/kg eradicated the microbial infection after thirteen and fourteen days of daily treatment respectively. CONCLUSIONS: The results of preclinical in vitro and in vivo evaluations indicate that the extract-oil formulation at 5% may constitute an alternative means to alleviate fungal infections caused by dermatophytes.

In vitro anti-Herpes simplex virus activity of crude extract of the roots of Nauclea latifolia Smith (Rubiaceae).

BACKGROUND: Nauclea latifolia Smith, a shrub belonging to the family Rubiaceae is a very popular medicinal plant in Cameroon and neighboring countries where it is used to treat jaundice, yellow fever, rheumatism, abdominal pains, hepatitis, diarrhea, dysentery, hypertension, as well as diabetes. The ethno-medicinal use against yellow fever, jaundice and diarrhea prompted us to investigate on the antiviral activity of the root bark of N. latifolia. In this study, HSV-2 was chosen as a viral model because of its strong impact on HIV transmission and acquisition. METHODS: The crude extract under study was prepared by maceration of air-dried and powdered roots barks of N. latifolia in CH2Cl2/MeOH (50:50) mixture for 48 hours, then it was subjected to filtration and evaporation under vacuum. A phytochemical analysis of the crude extract was performed by High Performance Liquid Chromatography coupled with a photodiode array and mass spectrometry (HPLC-PDA-ESI-qMS). The anti-HSV-2 activity was assayed in vitro by plaque reduction and virus yield assays and the major mechanism of action was investigated by virucidal and time of addition assays. Data values were compared using the Extra sum of squares F test of program GraphPad PRISM 4. RESULTS: The main components detected in the extract belong to the class of indole alkaloids characteristic of Nauclea genus. Strictosamide, vincosamide and pumiloside were tentatively identified together with quinovic acid glycoside. N. latifolia crude extract inhibited both acyclovir sensitive and acyclovir resistant HSV-2 strains, with IC50 values of 5.38 µg/ml for the former and 7.17 µg/ml for the latter. The extract was found to be most active when added post-infection, with IC50 of 3.63 µg/ml. CONCLUSION: The results of this work partly justify the empirical use of N. latifolia in traditional medicine for the treatment of viral diseases. This extract could be a promising rough material for the development of a new and more effective modern anti-HSV-2 medication also active against acyclovir-resistant HSV-2 strains.