Trends of Antibacterial Resistance at the National Reference Laboratory in Cameroon: Comparison of the Situation between 2010 and 2017.

INTRODUCTION: Antimicrobial resistance represents a growing public health threat. One of the World Health Organization's strategic objectives is "strengthening knowledge through surveillance and research." Sub-Saharan African countries are still far from achieving this objective. We aimed to estimate and compare the prevalence of antibacterial resistance in 2010 and 2017 in Cameroon. METHODS: We conducted a retrospective study on all clinical specimens cultured in Centre Pasteur du Cameroun (CPC) in 2010 and 2017. Data were extracted from the CPC's laboratory data information system software and then managed and analyzed using R. Bacterial resistance rates were calculated in each year and compared using chi-square or Fisher's tests, and relative changes were calculated. Outcomes included acquired resistance (AR), WHO priority resistant pathogens, some specific resistances of clinical interest, and resistance patterns (multi, extensively, and pan drug resistances) for five selected pathogens. RESULTS: A total of 10,218 isolates were analyzed. The overall AR rate was 96.0% (95% CI: 95.4-96.6). Most of WHO priority bacterial resistance rates increased from 2010 to 2017. The most marked increases expressed as relative changes concerned imipenem-resistant Acinetobacter (6.2% vs. 21.6%, +248.4%, p = 0.02), imipenem-resistant Pseudomonas aeruginosa (13.5% vs. 23.5%, +74.1%, p < 0.01), 3rd generation-resistant Enterobacteriaceae (23.8% vs. 40.4%, +65.8%, p < 10-15), methicillin-resistant Staphylococcus aureus (27.3% vs. 46.0%, +68.6%, p < 0.002), fluoroquinolone-resistant Salmonella (3.9% vs. 9.5%, +142.9%, p = 0.03), and fluoroquinolone-resistant Enterobacteriaceae (32.6% vs. 54.0%, +65.8%, p < 10-15). For selected pathogens, global multidrug resistance was high in 2010 and 2017 (74.9% vs. 78.0% +4.1%, p = 0.01), intensively drug resistance rate was 5.8% (7.0% vs. 4.7%; p = 0.07), and no pan drug resistance has been identified. CONCLUSION: Bacterial resistance to antibiotics of clinical relevance in Cameroon was high and appeared to increase between 2010 and 2017. There is a need for regular surveillance of antibacterial resistance to inform public health strategies and empirically inform prescription practices.

Spirometric restrictive ventilatory pattern and type 2 diabetes mellitus in a tertiary hospital in Cameroon: A comparative study.

BACKGROUND: The objective of this study was to assess the association between spirometric restrictive ventilatory pattern (sRVP) and type 2 diabetes mellitus (T2DM) and investigate factors associated with sRVP in subjects with T2DM. MATERIALS AND METHODS: In this comparative cross-sectional study, subjects with T2DM (diabetes group) were compared to a group of subjects without diabetes (non-diabetes group) from December 2018 to March 2019 (4months) at the National Obesity Center of the Yaoundé Central Hospital. sRVP was defined as the ratio of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) above the lower limit of normal, and FVC<80% of predicted values. Logistic regression was used to identify factors associated with sRVP. RESULTS: Overall 277 subjects were included in each group. The prevalence [95% confidence interval (95% CI)] of sRVP in the diabetes and non-diabetes groups was 39.4 (33.6-45.1) % and 34.3 (28.9-40.1) %, P=0.218. After multivariate analysis, we did not find an independent association between s sRVP and T2DM [odds ratio (95% CI): 1.13 (0.79-1.63), P=0.418]. The only independent factor associated with sRVP in subjects with T2DM was the presence of chronic vascular complications [odds ratio (95% CI): 1.99 (1.11-3.55), P=0.019]. CONCLUSION: One-third of patients with type 2 diabetes mellitus have sRVP. There is no independent association between sRVP and T2DM. The presence of chronic vascular complications is associated with sRVP in T2DM. Diagnosis of sRVP in subjects with T2DM presenting chronic vascular complications would help to provide a holistic management.

Prevalence and determinants of current asthma in Cameroon.

INTRODUCTION: The prevalence of asthma varies from one country to another due to differences in ethnicity, socio-economics status, environmental and climatic risk factors. The aim of this study was to determine the prevalence and determinants of current asthma in Cameroonian adults. MATERIAL AND METHODS: Data from 4 cross-sectional community-based studies from 2014 to 2018 were analyzed. Participants aged 19 years and above were selected through multilevel stratified random sampling methods across 2 urban areas, 2 semi-urban areas and 1 rural area. Current asthma was defined as "wheezing in the last 12 months in a subject with self-reported asthma or having used drugs for asthma treatment". Logistic regression was used to investigate the determinants of current asthma. RESULTS: A total of 10,707 adults [median age (interquartile range)=36 (26-52) years, 44.5% of men] were definitively enrolled in the study. The overall prevalence [95% confidence interval (CI)] of current asthma was 3.9% (3.5-4.3)%. Determinants [odd's ratio (OR), (95%CI)] of current asthma were: Sudanese ethnicity [1.9(1.4-2.7)], rural area [1.5(1.1-2.1)], urban area [1.6(1.2-2.2)], past history of pneumonia [1.9(1.1-3.4)], allergic rhino-conjunctivitis [6.5(4.7-8.9)], atopic eczema [2.3(1.5-3.6)], body mass index (BMI)≥40kg/m2 [1.9(1.0-3.4)] and BMI<18kg/m2 [1.8(1.2-2.9)]. CONCLUSION: The prevalence of current asthma is close to the low value of the Sub-Saharan African range. Sudanese ethnicity, rural area, urban area, history of pneumonia, allergic disease, severe obesity and underweight were determinants of current asthma in Cameroon. More research is surely warranted to understand the mechanisms underlying the association of asthma with Sudanese ethnicity.

[Kanamycin-induced ototoxicity during treatment of multidrug-resistant tuberculosis]. / Ototoxicité liée à la kanamycine au cours du traitement de la tuberculose multirésistante.

INTRODUCTION: Aminoglycosides are commonly used in the treatment of multidrug-resistant tuberculosis (MDR-TB). Their use can cause ototoxicity with irreversible hearing loss. The aim of this study was to determine the incidence and to identify factors associated to kanamycin-induced ototoxicity during MDR-TB treatment in Yaounde. METHODS: The records of patients hospitalized in the pulmonology department of the Jamot Hospital of Yaounde between May 2008 and July 2015 (7 years) for treatment of MDR-TB with regimens containing kanamycin were analyzed. Logistic regression was used to identify for factors associated with ototoxicity during this treatment. RESULTS: Of the 79 patients included, 60.7% were male and their median age (25th-75th percentile) was 31 (25-43) years. Eighteen (22.8%) patients had HIV infection. During treatment, the incidence of kanamycin-induced ototoxicity [95% confidence interval (95% CI)] was 36.7 (26.9-47.7) %. Factors independently associated with this ototoxicity [odds ratio (95% CI)] during MDR-TB treatment were age>40 years [13.47 (3.66-49.49)] and a body mass index<18.5kg/m2 [4.58 (1.36-15.44)]. CONCLUSION: The incidence of kanamycin-induced ototoxicity during MDR-TB treatment is relatively high. Taking these factors into consideration at the initiation of MDR-TB treatment would allow to reduce the occurrence of irreversible functional impairment induced by the treatment of MDR-TB.

Absence of hybridization with the wild-type and mutant rpoB probes in the Genotype MTBDRplus assay detects 'disputed' rifampicin mutations.

OBJECTIVE: Mycobacterium tuberculosis isolates that fail to hybridize to at least one rpoB wild-type or any mutation probe on the Genotype MTBDRplus strip are assumed to be rifampicin-resistant. However, the precise mutation(s) are unknown. We sought to identify the mutations in isolates with such hybridization patterns and determine if the mutations are associated with resistance to rifampicin. METHODS: In this study, 275 M. tuberculosis isolates were screened with the Genotype MTBDRplus assay to identify isolates with the hybridization pattern. These isolates were sequenced and their minimum inhibitory concentrations (MIC) determined using the Bactec MGIT 960 system. RESULTS: Among the 275 isolates tested, 15 (6%) isolates with the hybridization pattern were identified. Sequencing showed that failure to hybridize to rpoB wild-type probes resulted from the presence of 'disputed' rifampicin mutations, which are mutations not always associated with a rifampicin-resistant phenotype. All, except 3/15, isolates had a rifampicin-resistant phenotype (MIC > 1 µg/mL). One of the three isolates with a rifampicin-susceptible phenotype had the same mutation at position 526 (His526Leu) as another isolate that had a rifampicin-resistant phenotype. CONCLUSION: The recommendation of the Genotype MTBDRplus assay to assume rifampicin resistance based solely on failure to hybridize to rpoB wild-type probe allows the identification of important RIF-resistant isolates. About 20% (3/15) of such isolates could be missed by relying only on the standard MGIT 960 DST assay for drug susceptibility testing.

[Residual pleural opacity in patients treated for pleural tuberculosis in Yaounde]. / Opacité pleurale résiduelle en fin de traitement pour tuberculose pleurale à Yaoundé.

INTRODUCTION: The aim of this study was to evaluate the incidence and risk factors of residual pleural opacity (RPO) at the end and after 6 months (M12) of antituberculosis treatment (ATT) in adults with pleural tuberculosis. METHODS: In this prospective cohort study, all patients admitted for pleural tuberculosis between September 2010 and August 2012 in the pneumology A unit of Yaounde Jamot Hospital were included. Each patient was then followed up for 12 months. RPO was considered significant if it was measured 10mm or more on standard chest X-ray. The logistic regression model was used to investigate the risk factors of significant RPO at the end of antituberculosis treatment. RESULTS: Of the 193 patients included, median (interquartile range) age of 33 (25-42) years, 115 (59.6%) were men. The incidence (95% CI) of significant RPO was 22.0% (14.9-29.1) and 11.0% (4.9-17.1) at the end of ATT and at M12 respectively. In multivariate analysis, the risk factors of the occurrence of a significant RPO at the end of ATT and at M12 were smoking, associated parenchymal lesions, and hypoglycopleuria. CONCLUSION: Cumulative incidence of RPO ≥ 10 mm was 22% at the end of ATT and 11% after 12 months from the beginning of treatment. Patients with risk factors of RPO ≥ 10 mm should benefit from greater surveillance and appropriate management.

[Sensitization to Blomia tropicalis among asthmatic patients in Yaoundé, Cameroon]. / Sensibilisation à Blomia tropicalis chez les patients asthmatiques à Yaoundé, Cameroun.

INTRODUCTION: The aim of this study was to determine the prevalence and investigate associated factors for Blomia tropicalis (BT) sensitization in adolescent and adult patients with asthma in Yaoundé (Cameroon). METHODS: We performed a cross-sectional study of 18 months duration (January 2012 to June 2013). All asthmatic patients who were seen for a consultation during the study period and who had a skin prick testing for perennial aeroallergens were included in the study. RESULTS: Two hundred and one asthmatic patients (132 female patients, 65.7%) with median age (1st-3rd quartiles) of 35 (20-51.5) years were included in the study. Ninety-six (47.8%) patients had positive skin tests to BT. BT sensitization was associated with sensitization to two other dust mites (Dermatophagoides pteronyssinus [DP] and Dermatophagoides farinae [DF]) in 75 (86.2%) patients. The only clinical factor associated with BT sensitization was the presence of persistent rhinitis (odds ratio [confidence interval 95%]: 2.06 [1.12-3.81]). The independent allergenic factors associated with BT sensitization were sensitization to DP (3.49 [CI 95%: 1.49-8.19]), to DF (4.88 [CI 95%: 2.10-11.36]) and to German cockroach (4.16 [CI 95%: 1.72-10.09]). CONCLUSION: Blomia tropicalis sensitization is common in asthmatic patients in Yaoundé. It occurs most often in the context of sensitization to multiple aeroallergens, particularly with sensitization to other dust mites and German cockroach.

Impact dépressif de l'infection tuberculeuse sur les cellules immunitaires de défense

OBJECTIFS: La dépression de l'immunité cellulaire en relation avec la tuberculose est davantage évoquée au cours de ses rapports avec l'infection au VIH dont elle constitue l'infection opportuniste de première ligne. Dans le présent travail, nous avons voulu mettre en exergue la dépression de l'immunité causée par la tuberculose elle-même. MÉTHODES: A l'Hôpital Jamot, du 1er janvier au 30 mars 2013, nous avons recruté de façon consécutive 63 patients tuberculeux BK+. Nous avons inclus des patients des 2 sexes âgés de 18 ans au moins, VIH négatifs, en primo traitement et consentants. A J0 et à J60 du traitement antituberculeux, nous avons prélevé 5 ml de sang à chaque patient pour le comptage par cytométrie de flux des cellules immunitaires. Deux appareils ont été utilisés: le CELL-DYN 3200 pour les leucocytes totaux, les lymphocytes totaux et les granulocytes et le BD FACS Count pour la numération des lymphocytes T: CD4 et CD8. RÉSULTATS: Le traitement de la tuberculose nous a permis d'observer une augmentation des cellules immunitaires du sang. La moyenne absolue des CD4 est passée de 537 à 957/mm3 en 60 jours de traitement (p < 0,001). La moyenne des CD8 quant à elle est passée de 288 à 412/mm3 (p < 0,0039). Le rapport CD4/CD8 est passé de 1,6 à 2,04 (p < 0,001). Le taux moyen des lymphocytes totaux est passé de 1450 à 1960/mm3 (p <0,005). Celui des monocytes est passé de 125 à 584/mm3 (p < 0,001). Le taux moyen des PNN et granulocytes a légèrement baissé. CONCLUSION: La tuberculose, infection mycobactérienne, détruit gravement les cellules de l'immunité cellulaire comme cela est observé au cours de l'infection à VIH. La malnutrition dans nos milieux serait un facteur aggravant

[The impact of HIV infection on childhood tuberculosis in Yaounde, Cameroon]. / Impact de l'infection à VIH sur la tuberculose de l'enfant à Yaoundé, Cameroun.

OBJECTIVES: To define the prevalence of HIV infection in childhood tuberculosis and investigate its impact on the clinical presentation, radiographic findings and outcomes among children suffering from tuberculosis in Yaounde. METHODS: The medical records of 101 children aged less than 15years, hospitalized with tuberculosis in the chest clinic of the Yaounde Jamot Hospital between January 2005 and June 2010, were retrospectively reviewed. RESULTS: Twenty-five (24.8%) of the 101 patients were HIV positive. The occurrence of concomitant intrathoracic and extrathoracic tuberculosis was more frequently observed in HIV infected children (P=0.021). Parenchymal pulmonary lesions were bilateral in 20 (90.9%) of the HIV infected children against 31 (56.1%) in the non-infected children (P=0.003). Cavitating lesions were present in 49.1% of the cases in HIV negative group versus 13.6% in HIV positive group (P=0.004), but sub-group analysis restricted to those with confirmed tuberculosis no longer showed a significant difference. The success rate of treatment was 78.9% among HIV negative patients and 56% among HIV positive patients (P=0.024). CONCLUSION: HIV infection modifies the clinical presentation and radiographic features of tuberculosis in children. The treatment success rate is lower in HIV positive children, indicating a stricter medical supervision of these children and more targeted education of their parents.

[Nontuberculous purulent pleural effusion in adults in Yaounde, Cameroon]. / La pleurésie purulente non tuberculeuse de l'adulte à Yaoundé (Cameroun).

OBJECTIVE: The aim of this study is to analyze current etiologic, bacteriologic and prognostic features of nontuberculous purulent pleural effusion in adults in Yaounde, Cameroon. METHODS: This study prospectively included 54 adults hospitalized for community-acquired nontuberculous purulent pleural effusion in the chest-disease clinic of the Jamot Hospital in Yaounde from August 2007 to July 2010. RESULTS: The study included 34 men and 20 women with a mean age of 40.8 ± 16.4 years. At least one or more predisposing condition or underlying disease was found in 59.2%. The most frequent predisposing condition was HIV infection, seen in 35.2% of patients. In 92.6% of patients (n=50), purulent pleural effusion followed acute bronchopulmonary infection. Positive cultures of pleural fluid were found in half the patients. Streptococcus pneumoniae was the most common bacteria identified (41.4%) followed by Staphylococcus aureus (20.7%). Anaerobic bacteria were isolated in only 13.4% (n=4). Improvement was achieved in 79.6% of patients (n=43) and the in-hospital mortality rate was 3.7%. The mean duration of hospitalization was 26.8±15.6 days. CONCLUSION: This study indicates that HIV infection is the most frequent predisposing condition for community-acquired nontuberculous purulent pleural effusion in adults in Yaounde. The most commonly isolated bacterial pathogen was S. pneumoniae. Although the mortality rate of this disease is low, its prevention by proper management of acute respiratory tract infection is important.

[Clinical characteristics, microbiologic findings and outcome of non-tuberculous purulent pleural effusion in HIV-infected and non HIV-infected adult patients in Yaounde, Cameroon]. / Caractéristiques cliniques, bactériologiques et évolutives de la pleurésie purulente non-tuberculeuse chez les patients adultes séropositifs et séronégatifs au VIH à Yaoundé, Cameroun.

OBJECTIVE: To investigate the impact of HIV infection on clinical presentation, etiologic features and outcome of non-tuberculous purulent pleural effusion in adult patients in Yaounde. METHODS: We prospectively studied 55 consecutive patients aged 15 years and above, hospitalized in chest clinic of Yaounde Jamot Hospital for non-tuberculous purulent pleural effusion from August 2007 to September 2010. RESULTS: Twenty (36.4%) of the 55 patients were HIV-positive and 35 (63.6%) were HIV-negative. The mean age of HIV-positive patients was 37.5±11.7 years compare to 43.2 ±18.5 years on HIV-negative patients (P=0.159). Twelve (60%) HIV-positive patients were females compared to eight (22.6%) of HIV-negative patients (P=0.006). No significant differences were found between the two groups of patients in regard to clinical and radiological features. The mean hemoglobin level was 10.5±2.8g/L in HIV-negative patients and 8.8±2.2g/L in HIV-positive patients (P=0.031). Streptococcus pneumoniae was the most common single bacterial etiology in the two groups with four (50%) cases in HIV-positive and eight (38.1%) cases in HIV-negative. Poor outcome (failure of thoracocenthesis or chest tube drainage and death) was observed in eight (40%) HIV-infected patients and only in four (11.4%) non-infected-HIV patients (P=0.019). CONCLUSION: The prevalence of HIV infection among adult patients with non-tuberculous purulent pleural effusion in Yaounde is high. HIV infection does not seem to have any impact on clinical, radiological and bacteriologic characteristics of patients suffering from purulent pleural effusion, but it seems to modify hematologic parameters of these patients. Failure of thoracocenthesis or chest tube drainage was significantly most frequent in HIV-infected patients.

[Tuberculous pleural effusion in Yaounde, Cameroon: The influence of HIV infection]. / La pleurésie tuberculeuse à Yaoundé, Cameroun: influence de l'infection à VIH.

INTRODUCTION: The objective of this study was to investigate the current impact of HIV infection on the clinical presentation, laboratory features and outcome of tuberculous pleural effusion in adult patients in Yaounde. METHODS: We studied prospectively 196 consecutive patients, aged 15 years and above, hospitalized in the chest clinic of Yaounde Jamot Hospital with tuberculous pleural effusion between October 2007 and February 2010. RESULTS: Eighty-two (41.8%) of the 196 patients were HIV positive. Cough, sputum production, fever, night sweats and weight loss were significantly more common in HIV positive patients than in HIV negative patients. Pulmonary infiltrates were found in 39 (47.6%) of HIV positive patients versus 34 (29.8%) of HIV negative patients (P=0.011). No significant differences were found between HIV positive and HIV negative patients with regard to pleural granuloma formation. The therapeutic success rate was 80.7% among HIV negative patients and 72% among HIV positive patients (P=0.151). CONCLUSIONS: HIV infection modifies the clinical presentation and chest radiographic features of tuberculous pleural effusion, but not pleural granuloma formation or the therapeutic success rate of this affection.