Efficacité et tolérance de Malacur® (dihydroartémisinine-pipéraquine) dans le traitement du paludisme simple à Plasmodium falciparum chez les sujets âgés de plus de 14 ans au Cameroun

Introduction: Les combinaisons thérapeutiques à base d'artémisinine sont depuis quelques années le traitement antipaludique de première intention dans une grande partie des pays endémiques. Des souches résistantes à différentes combinaisons ont été décelées en Asie du sud-est, ce qui oblige à une surveillance continuelle dans le monde entier. Matériels et méthode : Pour cela, à Yaoundé (Cameroun), a été réalisée une étude prospective,ouverte, non-randomisée pour évaluer l'efficacité clinique et parasitologique de l'association dihydroar- témisinine-pipéraquine (DHA-PQ) dans le traitement du paludisme simple à P. falciparum, chez les sujets âgés de plus de 14 ans. Résultats : Les résultats ont montré que 100% des 47 patients inclus dans cette analyse ont été libres de parasitémie dès le premier jour après la fin du traitement et les résultats se sont maintenus jusqu'à la fin du suivi, le 28ème jour. De la même manière 78,7% des patients ont été apyrétiques le jour après la première prise et 100% après les 3 jours de traitement. Aucun patient n'a montré d'évènement indésirable grave ni n'a abandonné le traitement pour cette raison. Conclusion : Les résultats confirment l'efficacité de l'association DHA-PQ comme traitement de première intention dans le traitement du paludisme non-compliqué à Plasmodium falciparum

Asymptomatic carriage of malaria parasites in blood donors in Yaoundé.

BACKGROUND: Malaria can be transmitted through blood transfusion, but there is paucity of data concerning transfusion-transmitted malaria in Cameroun. OBJECTIVE: To determine prevalence of malaria infection and association with epidemiological and clinical data obtained from donors' responses. METHODS: Microscopic examination of stained thick and thin blood smears for the detection, quantification and specification of Plasmodium sp was performed on 493 blood donors in two main hospitals in Yaoundé during October and November 2007. RESULTS: Overall 6 · 5% of blood donors were detected positive for Plasmodium sp infection: 90 · 6% was Plasmodium falciparum and 9 · 4% was Plasmodium malariae. Parasite counts ranged from 80 to 800 µL(-1) with a median of 320 µL(-1). Asexual and sexual forms were found in 75 · 9 and 24 · 1% of cases, respectively. Age, sex, type of blood donor (voluntary non-remunerated vs familial/replacement) and fate of blood donation (selected vs discarded) did not affect the prevalence of malaria carriage. The lack of malaria prophylaxis as well as the manifestation of malaria symptoms within 2 weeks and 1 month preceding blood donation were significantly associated with high frequency of parasites carriage. CONCLUSION: Malaria parasites carriage is frequent among blood donors in Yaoundé. These data seem to describe high-risk donor profile and may help improving blood safety related to transfusion-transmitted malaria in Cameroon.

Serum lipid profile in highly active antiretroviral therapy-naïve HIV-infected patients in Cameroon: a case-control study.

BACKGROUND: HIV status has commonly been found to affect the serum lipid profile. OBJECTIVES: The aim of this study was to determine the effect of HIV infection on lipid metabolism; such information may be used to improve the management of HIV-infected patients. METHODS: Samples were collected from December 2005 to May 2006 at Yaounde University Teaching Hospital, Yaounde, Cameroon. Lipid parameters were obtained using colorimetric enzyme assays, while low-density lipoprotein cholesterol (LDLC) values were calculated using the formula of Friedewald et al. (1972) and atherogenicity index by total cholesterol (TC)/high-density lipoprotein cholesterol (HDLC) and LDLC/HDLC ratios. RESULTS: HIV infection was most prevalent in subjects aged 31 to 49 years. Most of the HIV-positive patients belonged to Centers for Disease Control and Prevention categories B (43.0%) and C (30.23%). Compared with control subjects, patients with CD4 counts<50 cells/microL had significantly lower TC (P<0.0001) and LDLC (P<0.0001) but significantly higher triglyceride (TG) values (P<0.001) and a higher atherogenicity index for TC/HDLC (P<0.01) and HDLC/LDLC (P=0.02); patients with CD4 counts of 50-199 cells/microL had significantly lower TC (P<0.001) and significantly higher TG values (P<0.001); patients with CD4 counts of 200-350 cells/microL had significantly higher TG (P=0.003) and a higher atherogenicity index for TC/HDLC (P<0.0002) and HDLC/LDLC (P=0.04); and those with CD4 counts >350 cells/microL had a higher atherogenicity index for TC/HDLC (P<0.0001) and HDLC/LDLC (P<0.001). HDLC was significantly lower in HIV-positive patients irrespective of the CD4 cell count. Lipid parameters were also influenced by the presence of opportunistic infections (OIs). CONCLUSION: HIV infection is associated with dyslipidaemia, and becomes increasingly debilitating as immunodeficiency progresses. HDLC was found to be lower than in controls in the early stages of HIV infection, while TG and the atherogenicity index increased and TC and LDLC decreased in the advanced stages of immunodeficiency.

Molecular Epidemiology of Malaria in Cameroon XXIX. Characterization of DHFR and Drug Resistance Markers and Efficacy of Sulfadoxine-Pyrimethamine Monotherapy in Children in Niete(HEVECAM)

In most African countries ; sulfadoxine-pyrimethamine ( Sp) had been the second-line drug to treat chloraquine in resistant Plasmodium falciparum infections in the 1990s and early 2000s . Although its use a monotherapy has been restricted in recent years ; SP has become important for intermittent preventive treatement (IPT) in pregnant women in Africa ; and some countries have been resorting to the combination artesunate -SP for the treatement of uncomplicated malaria .Therefore ; the evaluation of its efficacy remains relevant.In this study ; 58 symptomatic children were treated with SP according to the standard World Health Organization protocol and followed for 14 days .The sequences of P.Falciparum dihydrofolate reductase (dhfr)and dihydropteroate synthase (dhps) genes were determined to correlate these genetic markers and clinical outcome .In addition; blood samples form patients who did not satisfy the inclusion criteria were analysed for the presence of the key dhfr mutation .Results do not suggest any correlation between the observed mutations and SP treatement failure but show a high prevalence of mutations associated with resistance to antifolate drugs and sulfa drugs .However ; it will be important to pursue clinical studie on SP efficacy and epidemiological surveys using these molecular markers ; in particular because in Cameroon the major markers proposed to be highly associated with SP failure elsewhere in the world ; i.e.dhfr mutant codon Glu-540; have not yet been repoted

Etude comparative de l'efficacite et de la tolerance de l'association sulfadoxine-pyrimethamine versus l'association sulfadoxine-pyrimethamine dans le traitement du paludisme simple en zone d'endemie

En depit des efforts deployes a travers plusieurs initiatives internationales; le paludisme constitue toujours un veritable probleme de sante publique. La prise en charge des cas de la maladie s'est compliquee avec l'emergence et l'extension des resistances de plasmodium Falciparum aux antipaludiques usuels. Parmi les strategies de lutte; outre la prise en charge des cas; la prevention reste l'element majeur. La moustiquaire impregnee d'insecticides est une composante de la strategie de lutte antivectorielle. La chloroquine; utilisee il y a quelques annees dans la chimioprophylaxie chez la femme enceinte a ete abandonnee du fait de niveaux de resistance devenus trop eleves. Elle est desormais remplacee par l'association sulfadoxine-pyrimethamine en traitement preventif intermittent (TPI).Cependant; il est urgent aujourd'hui de trouver une alternative a cet antipaludique; en raison de taux de resistances de Plasmodium Falciparum en augmentation. Aussi; avons-nous juge opportun de mettre en ouvre une etude comparee de l'efficacite et de la tolerance de l'association sulfalene-pyrimethamine ou metakelfin (MK) et de l'association sulfadoxine-pyrimethamine (SP); molecule de reference dans le TPI de la femme en ceinte. L'etude; multicentrique; randomisee; comparative; s'est deroulee simultanement au Cameroun; en Cote d'Ivoire et au Senegal durant la seconde semestre de l'annee 2005. La methodologie OMS d'etude de l'efficacite des antipaludiques a ete utilisee. Au total; 444 patients ont ete inclus dans cette etude. L'efficacite des deux medicaments etaient comparable; avec des taux de reponses cliniques et parasitologiques adequat respectifs de 92pour l'association sulfalene-pyrimethamine et 92;1pour l'association sulfadoxine-pyrimethamine apres correction PCR. La tolerance dans les deux groupes de traitement etait egalement comparable. L'association sulfalene-pyrimethamine pourrait etre utilisee dans le TPI chez les femmes enceinte; ce qui pourrait diminuer la pression exercee sur l'association sulfadoxine-pyrimethamine

Impact of insecticide-treated bed nets implementation on the genetic structure of Anopheles arabiensis in an area of irrigated rice fields in the Sahelian region of Cameroon.

Variation at 12 microsatellite loci was investigated to assess the impact of the implementation of insecticide-treated bed nets (ITNs) on the genetic structure of Anopheles arabiensis in Simatou, a village surrounded by irrigated rice fields in the Sahelian area of Cameroon. The An. arabiensis population of Simatou was sampled twice before ITN implementation, and twice after. Effective population size estimates (N(e)) were similar across each time point, except for the period closely following ITN introduction where a nonsignificant reduction was recorded. Hence, we believe that ITN implementation resulted in a temporary bottleneck, rapidly followed by a demographic expansion. The genetic diversity of the population was not significantly affected since different genetic parameters (allele number, observed and expected heterozygosities) remained stable. Low estimates of genetic differentiation between the populations from Simatou and Lagdo, separated by 300 km, suggested extensive gene flow among populations of An. arabiensis in the Sahelian region of Cameroon. A decrease in the susceptibility to deltamethrin was observed following ITN introduction, but no kdr mutation was detected and a metabolic resistance mechanism is probably involved. The temporary effect of ITNs on the genetic structure of An. arabiensis population suggests that, to optimize the success of any control programme of this species based on ITNs, the control area should be very large and the programme should be implemented for a long period of time.

[Dynamics of intestinal schistosomiasis in Cameroon: evolution of transmission in the mixed zone of Nkolmébanga, Lékié]. / Dynamique des schistosomoses intestinales au Cameroun: évolution de la transmission dans le foyer mixte de Nkolmébanga, Lékié.

This study was undertaken to evaluate the current status of shistosomiasis in the Nkolmébanga region (Lékié) of Cameroon, previously determined to be a mixed zone harboring both Schistosoma mansoni and S. intercalatum. Study involved both malacology with collection and identification of freshwater snails in four waterpools and parasitology with collection and analysis of stools from schoolchildren. Five species of freshwater snails were identified including two that were intermediate host of Schistosomes, i.e., Biomphalaria pfeifferi and Bulinus forskalii. Only B. pfeifferi species collected from the Momboh and Mbonsoh Rivers shed Schistosoma cercaria. A total of 347 schoolchildren were enrolled but only 200 provided stools for parasitological testing. There were 93 boys and 107 girls. Parisitology demonstrated S. intercalatum eggs in the stools of no children. S. mansoni eggs were identified in the stools of 10 children for a prevalence of 5%. Parasitic load ranged from 24 to 1104 eggs per gram of stool. In this study both malacologic and parasitological findings suggested that S. mansoni persists in Nkolmébanga region but that S. intercalatum has disappeared probably as a result of deforestation and urbanization.

[Experimental study of the compatibility between Schistosoma haematobium and two species of Bulinus in Cameroon]. / Etude expérimentale de la compatibilité entre Schistosoma haematobium et deux espèces de bulins au Cameroun.

A study on the compatibility between Schistosoma haematobium from three remote localities (Mourtourwa, Gounougou and Kékem) and four populations of Bulinus truncatus (Gounougou, Ngaoundéré, Bertoua and Kékem) and four populations of B. globosus (Mourtourwa, Ouroudoukoudje, Bafia and Yaoundé) was undertaken in order to estimate the risk of extension of urinary schistosomiasis in Cameroon. First generation of offspring from wild Bulinus was exposed to miracidia liberated by schistosome eggs extracted from patient urine. Between the 25th and the 60th day post-infestation the number of snails still alive, the number emitting cercariae and the prepatent period duration were noted. Results showed that all B. truncatus samples were susceptible to the three strains of parasite whereas only B. globosus of Mourtourwa and Ouroudoukoudje were susceptible to S. haematobium from Mourtourwa. The schistosome infection rate was then significantly higher in B. truncatus and the prepatent period significantly lower than in B. globosus. The compatibility characterised by a high infection rate and a low prepatent period was significantly better in homopatric couples than in allopatric combinations. The results suggested that B. truncatus might be potentially more implicated than B. globosus to the extension of the urinary bilharziasis in Cameroon.

Dynamique des schistosomoses intestinales au Cameroun: evolution de la trasmission dans le foyer mixte de Nkolmebanga; Lekie

This study was undertaken to evaluate the current status of shistosomiasis in the Nkolmebanga region (Lekie) of Cameroon; p rev i o u s ly determined to be a mixed zone harboring both Schistosoma mansoni and S. intercalatum. Study invo lved both malacology with collection and identifi c ation of fre s h water snails in four wat e rpools and para s i t o l ogy with collection and analysis of stools from schoolchildren Five species of freshwater snails were identified including two that were intermed i ate host of Schistosomes; i.e.; Biomphalaria pfe i ffe ri and Bulinus fo rskalii. Only B. pfe i ffe ri species collected from the Momboh and Mbonsoh Rivers shed Schistosoma cercaria. A total of 347 schoolchildren were enrolled but only 200 provided stools for parasitological testing. There were 93 boys and 107 girls. Parisitology demonstrated S. intercalatum eggs in the stools of no children. S. mansoni eggs were identified in the stools of 10 children for a prevalence of 5. Parasitic load ranged from 24 to 1104 eggs per gram of stool. In this study both malacologic and parasitological findings suggested that S. mansoni persists in Nkolmebanga region but that S. intercalatum has disappeared probably as a result of deforestation and urbanization

A randomized, double-blind study on the efficacy and safety of a practical three-day regimen with artesunate and mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in Africa.

A randomized, double-blind, parallel-group study in 104 hospitalized patients with acute, uncomplicated Plasmodium falciparum malaria was performed in West and Central Africa from March to July 2001. Patients were randomized to receive simultaneous dosing (artesunate 200 mg/d plus mefloquine 250 mg/d from the first to the third day [investigational group]) or sequential dosing (artesunate 200 mg/d for 3 d plus mefloquine 250 mg on the second and 500 mg on the third day [reference group]). Patients were followed-up for 28 d, and clinical and parasitological outcomes were assessed. The 14-d cure rate was 100% in the investigational group and 98% in the reference group with no recrudescence until day 28. Mean times to fever and parasite clearance were similar between the 2 groups (32 h vs. 26 h and 45 h vs. 48 h) and tolerability was good in both groups. The number of patients with vomiting was statistically significantly lower in the investigational group compared to the reference group (3.8% vs. 19.2%, P = 0.014). A 3-d once-daily co-administration of artesunate and mefloquine starting on day one offers a practical dosing regimen, which is highly effective and well tolerated in patients with uncomplicated P. falciparum malaria.

[Visceral leishmaniasis in Cameroon. Seroepidemiologic survey in the Kousseri region, north Cameroon]. / Leishmaniose viscérale au Cameroun. Enquête séro-épidémiologique dans la région de Kousseri, Nord-Cameroun.

A sero-epidemiological survey of school children was carried out in Kousseri, a focus for visceral leishmaniasis. Sero-immunological assays for the detection of anti-Leishmania antibodies were based on the indirect immunofluorescence assay test and counter-immunoelectrophoresis. 9 out of 223 school children tested positive for visceral leishmaniasis (seroprevalence rate of 4%). These 9 cases had no history of the disease. The data obtained confirm the endemicity of visceral leishmaniasis in this focus and call for extensive studies in order to determine the prevalence of the disease in the entire population as well as the main components of the transmission cycle.

Chemoresistance of P. falciparum in urban areas of Yaounde, Cameroon. Part 1: Surveillance of in vitro and in vivo resistance of Plasmodium falciparum to chloroquine from 1994 to 1999 in Yaounde, Cameroon. / Chimiorésistance de P. falciparum en milieu urbain à Yaoundé, Cameroun. Part 1: S urveillance in vitro et in vivo de la résistance de Plasmodium falciparum à la chloroquine entre 1994 et 1999 à Yaoundé, Cameroun.

Chloroquine is indicated for the first-line treatment of uncomplicated malaria in most African countries. However, the spread of chloroquine-resistant Plasmodium falciparum requires periodic monitoring. Between 1994 and 1999, we studied the evolution of chloroquine resistance in adults (aged > 15 years) and children aged 5-15 years by using tests of therapeutic efficacy and in vitro assays. Responses to the 14-day in vivo test were classified according to the new criteria established by the World Health Organization. The results of the semi-microtest and the microtest were expressed as the 50% inhibitory concentration (IC50), and the threshold level of resistance was set at IC50 > 100 nM. The overall percentages of clinical and parasitological failures were 39.7% (31. 3% - 48.1%) and 48.8% (40.2% - 57.4%), respectively. Similarly, the percentage of isolates that were resistant in vitro was 52.5%. During the study, IC50 geometric mean varied between 84,6 nM and 149, 8 nM. The results of the in vitro assays agreed with those of tests of therapeutic efficacy (kappa coefficient = 0.69). The patients' chloroquine plasma levels were measured on day 0, day 3, day 7, and day 14. Drug measurement showed wide inter-individual variations and higher plasma levels in adults than in children. Some cases of therapeutic failure were associated with inadequate plasma levels of chloroquine. Our results confirm the high level of chloroquine resistance in Yaoundé and suggest that the use of an alternative antimalarial drug for the first-line treatment of uncomplicated malaria is warranted.

Chemoresistance of Plasmodium falciparum in the urban region of Yaounde, Cameroon. Part 2: Evaluation of the efficacy of amodiaquine and sulfadoxine-pyrimethamine combination in the treatment of uncomplicated Plasmodium falciparum malaria in Yaounde, Cameroon. / Chimiorésistance de P. falciparum En milieu urbain à Yaoundé, Cameroun. Part 2: evaluation de l'efficacité de l'amodiaquine et de l'association sulfadoxine-pyriméthamine pour le traitement de l'accès palustre simple à Plasmodium falciparum à Yaoundé, Cameroun.

The spread of chloroquine resistance or its stabilization at a high level calls for a change in the therapeutic strategy, including a possible replacement of chloroquine. We assessed and compared the efficacy of amodiaquine and sulfadoxine-pyrimethamine in Yaoundé. Of 140 adults and children > 5 years enrolled in the study, 59 in the amodiaquine and 58 in the sulfadoxine-pyrimethamine treatment group were followed until day 14. The efficacy of amodiaquine was 100%, whereas 12.1% of the patients treated with sulfadoxine-pyrimethamine responded with an early treatment failure. Side effects in both treatment groups were mild and did not require any specific treatment. We did in vitro drug assays for monodesethylamodiaquine (active metabolite of amodiaquine) and pyrimethamine and measured plasma levels of monodesethylamodiaquine, sulfadoxine, and pyrimethamine. Unlike amodiaquine, the results of the in vitro drug sensitivity test for pyrimethamine were not concordant with the clinical response. A wide inter-individual variation in the plasma drug levels was observed. Unlike chloroquine, the mean plasma concentrations did not vary with age. There was no significant difference in the plasma concentrations of sulfadoxine and pyrimethamine between patients responding with an adequate clinical response and those responding with treatment failure. Amodiaquine has several advantages over sulfadoxine-pyrimethamine combination and may be considered to be an effective drug in an endemic zone with a moderate level of chloroquine resistance.

The epidemiology of Plasmodium falciparum malaria in two Cameroonian villages: Simbok and Etoa.

In support of ongoing immunologic studies on immunity to Plasmodium falciparum, demographic, entomologic, parasitologic, and clinical studies were conducted in two Cameroonian villages located 3 km apart. Simbok (population = 907) has pools of water present year round that provide breeding sites for Anopheles gambiae, whereas Etoa (population = 485) has swampy areas that dry up annually in which A. funestus breed. Results showed that individuals in Simbok receive an estimated 1.9 and 1.2 infectious bites per night in the wet and dry season, respectively, whereas individuals in Etoa receive 2.4 and 0.4 infectious bites per night, respectively. Although transmission patterns differ, the rate of acquisition of immunity to malaria appears to be similar in both villages. A prevalence of 50-75% was found in children < 10 years old, variable levels in children 11-15 years old, and 31% in adults. Thus, as reported in other parts of Africa, individuals exposed to continuous transmission of P. falciparum slowly acquired significant, but not complete, immunity.

[Severe forms of malaria in children in a general hospital pediatric department in Yaounde, Cameroon]. / Les formes graves du paludisme de l'enfant dans un service de pédiatrie générale à Yaoundé, Cameroun.

Severe forms of malaria in children are responsible for 1 million deaths yearly in young children in hyperendemic areas. The main objective of this study was to identify and compare common manifestations of different forms of severe malaria and to evaluate the prognosis for hospital treatment in an endemic area. 271 files of children admitted into hospital between March 1991 and September 1996 were analysed. These children were confirmed to have Plasmodium falciparum in their peripheral blood. 78 patients (29%) had the severe form of malaria. 43 patients (53%) were under 5 years of age. The 5 severe types identified were characterized by very high temperatures 28 cases (36%), cerebral malaria 20 cases (26%), prostration and weakness 15 cases (19%), severe anaemia 14 cases (18%) and haemoglobinuria 1 case (1.3%). Cerebral malaria and severe anaemia were more common in children under 5 years old. The average parasitemia was 16,366 +/- 1390 parasites per microlitre. Clearance of parasitemia was obtained on day 3 in almost all cases; 6 patients with very high temperatures presented neither sign of visceral complications nor convulsions. The average period in coma for cases of cerebral malaria was 1.7 days; 12 anaemic patients were transfused. There were no deaths. No abnormality was found on physical examination after an average hospitalisation of 5.3 days. An early diagnosis and adequate treatment of severe forms of malaria in children by qualified personnel will usually result in a favourable prognosis in our area.

[Rapid resolution of Plasmodium ovale malarial attacks using artesunate (Arsumax)]. / Resolution rapide des acces palustres à Plasmodium ovale par l'artésunate (Arsumax).

This randomized, non-comparative clinical trial without placebo was carried out to assess the efficacy and tolerance of artesunate for treatment of acute Plasmodium ovale malarial attacks. Thirty Cameroonese patients were included. All presented acute Plasmodium ovale malarial attacks with parasitemia in excess of 500 asexual forms per mm3. Four days after treatment with artesunate, all 30 patients were asymptomatic with no parasitemia. Reduction rates were 93.9 p. 100 for asexual forms and 75.4 p. 100 for gametocytes. Parasite clearance was achieved within 38.8 hours and fever disappeared within 36.6 hours. Tolerance was excellent in 29 patients. The remaining patient briefly complained of mild vertigo. A transient decrease in reticulocyte levels was observed in one patient initially presenting anemia. Artesunate appears to achieve rapid and complete resolution of acute Plasmodium ovale malarial attacks. Since artesunate eliminates both asexual forms and gametocytes, it also acts on transmission by limiting the duration of survival of asexual forms.

[Variations under genetic control of onchocerca infection as a function of clinical profile in the endemic center of Cameroon]. / Variations sous contrôle génétique de l'infection onchocerquienne en fonction du profil clinique dans les foyers endémiques du Cameroun.

Onchocerciasis, also known as "river blindness", presents a plenum of clinical manifestations which vary from one individual to another, and from one area to another. This large spectrum of clinical manifestations of the disease is an indication of the complexity of the pathogenesis of onchocerciasis and suggests that many interacting factors might influence the clinical features of the disease. The present study has focused on the heterogenicity of the host immune response as a plausible explanation for differences in clinical manifestations of the infection. Host genetic factors, namely HLA genes, might play an important role in determining the nature of the immune response mounted against the parasite Onchocerca volvulus, and thus the development of different manifestations of the infection. Genetic diversity of onchocerciasis was assessed in different endemic foci in Cameroon. In order to investigate the possibility that the Major Histocompatibility Complex (MHC) genes might be associated with the different clinical types of onchocerciasis, 146 subjects living in three endemic areas of Cameroon were studied. They were classified in four groups: A (asymptomatic subjects), P (putatively immune subjects) L (patients with localised disease) and G (patients with generalised disease). The four groups differed in the distribution of HLA class II alleles as determined by Direct Heteroduplex Analysis. On the one hand, allele HLA-DQA1*0501 appeared to be associated with protection against severe onchocerciasis; on the other, allele HLA-DQB1*0201 might play an important role in the severe form of the disease.

Clinical and parasitological prevalence of cutaneous leishmaniasis in Mokolo focus; Far Province of Cameroon

Clinico-parasitological screening of 3866 individuals in the Mokolo region of northern Cameroon gave 0.94 percent of those with active lesions. The diagnosis of scars was mainly clinical. For lesions; the clinical diagnosis was confirmed by the demonstration of parasites on Giemsa stained smears. Both sexes were equally infected. The highest number of people with active lesions (51.43 percent) was recorded in the 2-15 years age group; most being students. It was during the rainy season that many people acquired the infection. The localization of lesions and/or scars on the body was considered in the study and gave the following repartition : 43.16 percent on the upper limbs; 28.42 percent on the lower limbs; 21.05 percent on the head and 7.37 percent on the trunk. A therapeutic regime of amphotericin B (topical application) and metronidazole (per os) was administered to some patients who responded satisfactorily

Pyronaridine for treatment of Plasmodium ovale and Plasmodium malariae infections.

The clinical efficacy of oral pyronaridine was assessed in 22 symptomatic Cameroonian patients infected with Plasmodium ovale or Plasmodium malariae. All patients were cured on or before day 4. In vitro drug assays confirmed the sensitivity of P. ovale and P. malariae isolates to chloroquine and pyronaridine.