Identifying Potential Mutations Responsible for Cases of Pulmonary Arterial Hypertension.

Pulmonary Arterial Hypertension (PAH) is a progressive and devastating disease for which there is an escalating body of genetic and related pathophysiological information on disease pathobiology. Nevertheless, the success to date in identifying susceptibility genes, genetic variants and epigenetic processes has been limited due to PAH clinical multi-faceted variations. A number of germline gene candidates have been proposed but demonstrating consistently the association with PAH has been problematic, at least partly due to the reduced penetrance and variable expressivity. Although the data for bone morphogenetic protein receptor type 2 (BMPR2) and related genes remains undoubtedly the most extensive, recent advanced gene sequencing technologies have facilitated the discovery of further gene candidates with mutations among those with and without familial forms of PAH. An in depth understanding of the multitude of biologic variations associated with PAH may provide novel opportunities for therapeutic intervention in the coming years. This knowledge will irrevocably provide the opportunity for improved patient and family counseling as well as improved PAH diagnosis, risk assessment, and personalized treatment.

Genetic diversity of Plasmodium falciparum and genetic profile in children affected by uncomplicated malaria in Cameroon.

BACKGROUND: Malaria is a major public health problem in Cameroon. The study of the genetic diversity within parasite population is essential for understanding the mechanism underlying malaria pathology and to determine parasite clones profile in an infection, for proper malaria control strategies. The objective of this study was to perform a molecular characterization of highly polymorphic genetic markers of Plasmodium falciparum, and to determine allelic distribution with their influencing factors valuable to investigate malaria transmission dynamics in Cameroon. METHODS: A total of 350 P. falciparum clinical isolates were characterized by genotyping block 2 of msp-1, block 3 of msp-2, and region II of glurp gene using nested PCR and DNA sequencing between 2012 and 2013. RESULTS: A total of 5 different genotypes with fragment sizes ranging from 597 to 817 bp were recorded for GLURP. Overall, 16 MSP-1 genotypes, including K1, MAD20 and RO33 were identified, ranging from 153 to 335 bp. A peculiarity about this study is the RO33 monomorphic pattern revealed among the Pfmsp-1 allelic type. Again, this study identified 27 different Pfmsp-2 genotypes, ranging from 140 to 568 bp in size, including 15 belonging to the 3D7-type and 12 to the FC27 allelic families. The analysis of the MSP-1 and MSP-2 peptides indicates that the region of the alignment corresponding K1 polymorphism had the highest similarity in the MSP1and MSP2 clade followed by MAD20 with 93% to 100% homology. Therefore, population structure of P. falciparum isolates is identical to that of other areas in Africa, suggesting that vaccine developed with K1 and MAD20 of Pfmsp1 allelic variant could be protective for Africa children but these findings requires further genetic and immunological investigations. The multiplicity of infection (MOI) was significantly higher (P < 0.05) for Pfmsp-2 loci (3.82), as compare with Pfmsp-1 (2.51) and heterozygotes ranged from 0.55 for Pfmsp-1 to 0.96 for Pfmsp-2. CONCLUSION: High genetic diversity and allelic frequencies in P. falciparum isolates indicate a persisting high level of transmission. This study advocate for an intensification of the malaria control strategies in Cameroon. Trial registration This study was approved by Cameroon National Ethics Committee. It is a randomized controlled trial retrospectively registered in NIH U.S. National Library of Medicine, ClinicalTrials.gov on the 28/11/2016 at https://clinicaltrials.gov/ct2/show/NCT02974348 with the registration number NCT02974348.

Host Regulators of Liver Fibrosis During Human Schistosomiasis.

Liver fibrosis is a wound-healing process purposely aimed at restoring organ integrity after severe injury caused by autoimmune reactions, mechanical stress or infections. The uncontrolled solicitation of this process is pathogenic and a pathognomonic feature of diseases like hepatosplenic schistosomiasis where exacerbated liver fibrosis is centrally positioned among the drivers of the disease morbidity and mortality. Intriguingly, however, liver fibrosis occurs and progresses dissimilarly in schistosomiasis-diseased individuals with the same egg burden and biosocial features including age, duration of residence in the endemic site and gender. This suggests that parasite-independent and currently poorly defined host intrinsic factors might play a defining role in the regulation of liver fibrosis, the hallmark of morbidity, during schistosomiasis. In this review, we therefore provide a comprehensive overview of all known host candidate regulators of liver fibrosis reported in the context of human schistosomiasis.

Schistosomiasis Burden and Its Association With Lower Measles Vaccine Responses in School Children From Rural Cameroon.

Background and Methods: Schistosomiasis is debilitating and reported to impair immune responsiveness of infected hosts. In Cameroon, mass drug administration (MDA) is used in schoolchildren to reduce transmission of S. haematobium and S. mansoni. The effects of MDA and the impact of schistosomiasis on the titers of antibodies in vaccinated children have been poorly studied. We therefore assessed the prevalence of schistosomiasis in schoolchildren, eight months after MDA, in two locations: Barombi Koto (BK), endemic for S. haematobium (N = 169) and Yoro (Y), endemic for S. mansoni (N = 356). Age, gender, residence time and frequency of contact with river water were assessed as risk factors for infection and morbidity in both localities. In 70 schoolchildren from BK and 83 from Y, ultrasound was used to assess morbidity according to the WHO guidelines. Evaluation of measles antibodies was performed in previously vaccinated schoolchildren (14 with S. haematobium and 12 egg-negative controls from BK and 47 with S. mansoni and12 egg-negative controls from Y). Principal Findings and conclusions: The prevalence of S. haematobium was 25. 4% in BK (43/169) and 34.8% for S. mansoni in Y (124/356), indicating the persistent transmission of schistosomiasis despite MDA. Older age (AOR 1.31; 95%CI 1.12-1.54) and higher frequencies of exposure to river water (AOR 1.99; 95%CI 1.03-3.86) were identified as risks for infection in BK whereas only older age (OR 1.15; 95%CI 1.04-1.27) was a risk for infection in Y. Bladder pathology (score 2 to 5) was observed in 29.2% (7/24) of egg-positive children in BK and liver pathology (pattern C) in 31.1% (19/61) of egg-positive children in Y. There was a positive correlation between S. haematobium egg burden and bladder pathology (AOR 1.01; 95% CI 0.99-1.02) and positive correlation between S. mansoni-driven liver pathology and female gender (AOR 3.01; 95% CI 0.88-10.26). Anti-measles antibodies in vaccinated children were significantly lower in S. mansoni-infected when compared to egg-negative controls (p = 0.001), which was not observed in the S. haematobium-infected group from BK. Our results demonstrate a questionable efficacy of MDA alone in halting schistosomiasis transmission and confirm a possible immunomodulatory effect of S. mansoni on response to vaccines.

Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon.

BACKGROUND/OBJECTIVES: There is little data on the profile and magnitude of scabies in sub-Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon. METHODS: We conducted a cross-sectional study from March to August 2014, and consecutively recruited volunteer detainees of three randomly selected prisons in the West Region of Cameroon. The diagnosis was based on clinical findings after assessment by two experienced and well-trained dermatologists. RESULTS: We enrolled 755 prisoners, 17 (2%) of whom were women. Their mean age was 32 ± 12 years. There were 242 cases (32%) of scabies, with significantly more cases in the most crowded prison (P < 0.0001). Men were significantly more affected than women (P = 0.004) and the prevalence of scabies significantly decreased when the level of education increased (P < 0.0001). In addition to a low level of education (adjusted odds ratio (aOR) 1.90; P < 0.0001), sharing clothes/bedding (aOR 2.72; P < 0.0001) and the number of detainees per cell > 10 (aOR 1.89; P = 0.002), but not age, duration of incarceration, number of baths/week and washing/week, were independent drivers of scabies occurrence. CONCLUSION: Almost one-third of prisoners suffered from scabies in our prisons. A low educational level, the sharing of clothes/bedding and number of detainees/cell > 10 were independent determinants of the disease. Urgent measures must be undertaken to reduce the burden of scabies in our prisons.

Seroprevalence and risk factors of human cysticercosis and taeniasis prevalence in a highly endemic area of epilepsy in Bangoua, west Cameroon.

Cysticercosis caused by the larvae of Taenia solium is a serious and emerging threat to public health in the endemic areas as well as in the non-endemic areas.　Neurocysticercosis, an affection of the central nervous system is a leading cause of epilepsy in endemic areas. This study was carried out to investigate human cysticercosis, taeniasis and risk factors, and also their association with epilepsy in Bangoua, west Cameroon where epilepsy is highly prevalent. Out of 384 people investigated, 12 (3.1%) exhibited antibody response against low molecular weight antigens of T. solium by ELISA. Immunoblot revealed that six persons (1.6%) were seropositive with the same antigens. Among 61 epileptic patients, only one was seropositive by immunoblot and the study did not find any statistically significant difference (P>0.05) in seropositivity to T. solium between epileptic persons (1/61, 1.6%) and non-epileptic group (5/323, 1.5%). In addition, cysticercosis was associated with households eating pork meat from pigs slaughtered at home, but not with other factors. The risk factors including pig farming, the consumption of pork meat, vegetables, and non-drinkable water were attenuated by the relatively good hygiene and pig husbandry practices of the population. No egg of Taenia was found in stool by microscopic examination. All data obtained in this study suggested that cysticercosis might not be the principal causative agent of epilepsy in this area.

Sensibilite aux antifongiques des Candida spp isoles dans les candidoses digestives chez les sujets seropositifs au VIH a Yaounde-Cameroun

Les mycoses digestives sont habituellement retrouvees chez les sujets immunodeprimes en particulier les patients atteints de SIDA; Le but de cette etude etait de contribuer a une meilleure prise en charge des candidoses digestives chez les sujets positifs au VIH. L'objectif principal etait d'etudier le profil de sensibilite aux antifongiques des Candida spp isoles chez ces patients.MeTHODES Il s'agit d'une etude transversale et descriptive realisee de septembre 2011 a janvier 2012. Apres avoir obtenu le consentement des patients; un ecouvillonnage du muguet buccal et les selles ont ete ensemences sur milieu selectif Candichrom II. Le test de filamentation a permis de discriminer C. albicans de C. dublinensis. L'antifongigramme a ete realise par methode de diffusion sur gelose casitone. Les antifongiques testes etaient : amphotericine B; fluconazole; ketoconazole; miconazole; nystatine; itraconazole. Le logiciel EPI info 7 a ete utilise pour l'analyse des donnees et Excel pour les graphiques. ReSULTATS Nous avons identifie 4 especes : Candida albicans; Candida glabrata; Candida dublinensis et Candida tropicalis avec une predominance de Candida albicans (45;65) et Candida glabrata (44;92). La quasi-totalite des souches 99 etaient sensibles au miconazole; 87 au ketoconazole; 62 a l'itraconazole; 38 au fluconazole; 5a l'amphotericine B. L'espece ayant presente le plus de resistance aux antifongiques etait Candida glabrata. CONCLUSION :Les derives azoles sont plus actifs que les polyenes. L'activite du fluconazole est limitee. Nous recommandons aux prescripteurs de preconiser l'utilisation du ketoconazole qui est plus actif et peut etre une alternative au fluconazole

A public private partnership to fight against malaria along the Chad-Cameroon pipeline corridor: I. Baseline data on socio-anthropological aspects, knowledge, attitudes and practices of the population concerning malaria.

BACKGROUND: Malaria is ranked as the major public health problem in Cameroon, representing 50% of illness in less than five year old children, 40-45% of medical consultation and 40% of the annual home income spent on health. The Cameroon Oil Transportation Company (COTCO) that exploits the Chad-Cameroon pipeline in Cameroon territory, initiated in 2010, a public private partnership project to control malaria along the pipeline corridor. A research component was included in the project so as to guide and evaluate the control measures applied in this pipeline corridor. This study presents the baseline socio-anthropological data as well as the knowledge, attitudes and practices of the local population concerning malaria, its transmission, management and prevention. METHODS: A descriptive cross-sectional survey was undertaken in four sentinel sites (one site per ecological zone) along the Chad-Cameroon pipeline corridor. Three structured questionnaires were used for the survey. Two of them were addressed to the heads of households (one for census and the other to collect information concerning the characteristics of houses and living conditions in households as well as their knowledge, attitudes and practices concerning malaria). The last questionnaire was used to collect information on malaria management and prevention. It was addressed to women who had delivered a living child within the past three years. Interviewers were recruited from each village and trained for two consecutive days on how to fill the different questionnaires. All data were analysed at 5% significant level using Epi-Info, SPSS and Cs PRO 4.0 STATA. Values of p ≤ 0.05 were considered statistically significant. RESULTS: Interviews were conducted in 2597 households (Bipindi 399, Bélabo 835, in Meidougou 820 and Dompta 543). Whatever the study site, 50% of the heads of household were workers of the agro-pastoral sector. Most of the heads of household were men (average 77.4% for men and 22.6% for females). The walls of households were mostly made-up of earth blocks and access to media was low. There were significant differences between mean ages and educational level of the heads of household. Significant differences were also observed between the characteristics of houses and the sites located in the southern regions (Bipindi and Bélabo) and those located in the northern regions (Meidougou and Dompta). The later household heads were younger and less educated than those in the other regions.In most of the study sites, paracetamol was cited as the first intention drug for malaria treatment, followed by chloroquine, a banned drug. More than half of the households studied had a correct knowledge of malaria and its mode of transmission: 120/155 (77.1%) in Bipindi, 244/323 (74.5%) in Bélabo, 171/235 (72.8%) in Meidougou and 118/218 (54.1%) in Dompta. Fever and headache were the malaria signs/symptoms most often cited by the households. An important percentage of pregnant women did not take any malaria prophylaxis during their last pregnancy (up to 43.4% in Bélabo). CONCLUSION: In all the study sites, there were conditions that indicated the all year round transmission of malaria (characteristics of houses and limited access to media making sensitization campaigns difficult). In general, most households had a good knowledge of malaria and its mode of transmission. However, malaria treatment drugs were most often inappropriate. In this study, recommendations were made in order to guide the implementation of control measures.

Field evaluation of rapid diagnostic tests for malaria in Yaounde, Cameroon.

Rapid diagnostic tests (RDTs) are affordable, alternative diagnostic tools. The present study aimed to evaluate RDTs available in Cameroon and compare their characteristics to follow the parasitological response of patients for 28 days. Malaria diagnosis was assessed in 179 febrile patients using conventional microscopy as the reference method. Parascreen detects both Plasmodium falciparum-specific histidine-rich protein 2 (Pf HRP-2) and Pan-specific plasmodial lactate dehydrogenase (pLDH) in all four human Plasmodium spp. Diaspot is based on the detection of Pf HRP-2. OptiMAL-IT (pLDH specific for P. falciparum and pLDH for all four human Plasmodium spp.) was assessed for comparison. The reliability of RDTs was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate, false-negative rate, and likelihood ratio. The clinical outcome of 18 children treated with atovaquone-proguanil and followed for 28 days was evaluated using microscopy and RDTs. Of 179 samples, 133 (74.3%) were pure P. falciparum-positive smears, 4 (2.2%) pure P. malariae-positive smears, and 42 (23.5%) negative smears. Parascreen and Diaspot had high sensitivity (>92%) and positive predictive values (>94%). The specificities for Parascreen and Diaspot were 81.0% and 90.5%, respectively. The false-positive rates and the false-negative rates were 19.0% and 4.5% for Parascreen and 9.5% and 8.3% for Diaspot, respectively. Most false-negatives occurred in samples with low parasitaemia (<500 asexual parasites/µL). The performance of RDTs was better at higher parasitaemia (>500 asexual parasites/µL). Four pure P. malariae were only detected by the pan-Plasmodium bands of Parascreen and OptiMAL-IT. In blood samples from patients treated and followed-up for 28 days, HRP2-based RDTs remained positive in most samples until Day 28. Despite negative smears, OptiMAL-IT remained positive in several patients until Day 7 but was negative in all patients from Day 14 onwards. RDTs can improve the management of febrile patients. The validity, ease of use, and cost of HRP2-based tests were comparable. However, one of the current weaknesses of the RDT-based strategy using the tests available in Cameroon is inadequate sensitivity for low parasitaemia. In some cases, RDT results may require correct interpretation based on clinical history, clinical examination, and microscopic diagnosis.

Serological and molecular tools to detect neurologic parasitic zoonoses in rural Cameroon.

Parasitic helminthiases, such as toxocariasis, cysticercosis and paragonimiasis are a public health threat, since they can affect the brain leading to neurological disorders. Epilepsy and paragonimiasis are common in southwestern Cameroon. We reviewed the literature for studies using antigens to diagnose toxocariasis, cysticercosis, and paragonimiasis. Serology revealed that 61 (36.3%), 26 (15.5%) and 2 (1.2%) of 168 persons examined [78 males (15.2 +/- 8.2 years old), 90 females (12.9 +/- 5.9 years old), 143 persons < 20 years old] had antibody responses to toxocariasis, paragonimiasis and cysticercosis, respectively. Of the 14 people with epilepsy, 5 were seropositive for Toxocara antigens and 1 was positive for both Toxocara and Paragonimus antigens. Two children were serologically confirmed to have cysticercosis. Serologic screening for cysticercosis may be feasible to detect asymptomatic cysticercosis in children in endemic areas leading to early treatment. The causative Paragonimus species was confirmed to be P. africanus by molecular sequencing. Education, screening and confirmation test for these diseases may be needed for control in Cameroon.

Serological studies of neurologic helminthic infections in rural areas of southwest cameroon: toxocariasis, cysticercosis and paragonimiasis.

BACKGROUND: Both epilepsy and paragonimiasis had been known to be endemic in Southwest Cameroon. A total of 188 people (168 and 20 with and without symptoms confirmed by clinicians, respectively, 84.6% under 20 years old) were selected on a voluntary basis. Among 14 people (8.3%) with history of epilepsy, only one suffered from paragonimiasis. Therefore, we challenged to check antibody responses to highly specific diagnostic recombinant antigens for two other helminthic diseases, cysticercosis and toxocariasis, expected to be involved in neurological diseases. Soil-transmitted helminthic infections were also examined. METHODOLOGY/PRINCIPAL FINDINGS: Fecal samples were collected exclusively from the 168 people. Eggs of Ascaris lumbricoides, Trichuris trichiura and hookworms were found from 56 (33.3%), 72 (42.8%), and 19 (11.3%) persons, respectively. Serology revealed that 61 (36.3%), 25 (14.9%) and 2 (1.2%) of 168 persons showed specific antibody responses to toxocariasis, paragonimiasis and cysticercosis, respectively. By contrast, 20 people without any symptoms as well as additional 20 people from Japan showed no antibody responses. Among the 14 persons with epilepsy, 5 persons were seropositive to the antigen specific to Toxocara, and one of them was simultaneously positive to the antigens of Paragonimus. The fact that 2 children with no history of epilepsy were serologically confirmed to have cysticercosis strongly suggests that serological survey for cysticercosis in children is expected to be useful for early detection of asymptomatic cysticercosis in endemic areas. CONCLUSIONS/SIGNIFICANCE: Among persons surveyed, toxocariasis was more common than paragonimiasis, but cysticercosis was very rare. However, the fact that 2 children were serologically confirmed to have cysticercosis was very important, since it strongly suggests that serology for cysticercosis is useful and feasible for detection of asymptomatic cysticercotic children in endemic areas for the early treatment.

Use of a histidine-rich protein 2-based rapid diagnostic test for malaria by health personnel during routine consultation of febrile outpatients in a peripheral health facility in Yaounde, Cameroon.

The role of a rapid diagnostic test (RDT) in the case management of Plasmodium falciparum malaria infections has not been determined in Africa. Our study was conducted during November 2007-January 2008 to assess test accuracy of an RDT in the management of febrile outpatients in a peripheral urban health facility in Cameroon. We found the overall sensitivity to be 71.4% and a specificity of 82.2%; the positive predictive value and negative predictive value were 73.8% and 80.4%, respectively. False-negative and false-positive cases represented 11.8% and 10.5% of all febrile patients. Malaria alone (31.3%) was the first cause of fever; 33.5% of fever cases were of unknown origin. Acute respiratory infections were common among children 0-2 years of age (25.5%) and decreased with age. The risk of having a clinical failure with the presumptive treatment of febrile children was seven times greater than that of the RDT-oriented management (relative risk = 6.8, 95% confidence interval = 0.88-53.4, P = 0.03) because of the delay of appropriate treatment of non-malarial febrile illness. Our results suggest that the RDT may be of limited utility for children greater than five years of age and adults and that diagnosis based on microscopic examination of blood smears should be recommended for these patient populations, as well as in areas of low transmission.

Paragonimiasis in Cameroon: molecular identification, serodiagnosis and clinical manifestations.

Paragonimiasis is a common parasitic zoonosis in Cameroon and neighbouring countries in Western Africa. Serum, sputum and faecal samples were collected in an endemic area of South West Province, Cameroon, after administration of a questionnaire to identify individuals with appropriate symptoms and histories. Microscopic examination revealed eggs in sputum from 16 people, but none in any faecal sample. These 16 were among the 25 and 26 people, respectively, positive by ELISA and by immunoblot using Paragonimus africanus crude antigens. Copro-DNA detection was attempted using 23 faecal samples (18 from sputum egg-negative and five from sputum egg-positive individuals). Copro-DNA was detected in four of the five sputum egg-positive individuals. These results strongly suggest that: (1) serology is much more sensitive than sputum examination for diagnosis of paragonimiasis; and (2) a copro-DNA test may be more sensitive than a microscopic search for eggs in faeces. Molecular sequence data from ITS2 and cox1 genes confirmed that adult worms experimentally raised in cats were P. africanus and that eggs from sputum or other worm products from human faeces also belonged to this species. Based on these results, 26 of 168 persons (15.5%) were diagnosed as suffering from paragonimiasis.

Prevalence of intestinal parasites including microsporidia in human immunodeficiency virus-infected adults in Cameroon: a cross-sectional study.

To assess the prevalence of intestinal parasites in a cohort of human immunodeficiency virus (HIV)-infected adults in Cameroon, a cross-sectional study was conducted. Detection of parasites was performed in 181 stool samples from 154 HIV-infected patients with a mean CD4 cell count of 238 cells/mm(3). Only 35 patients (22%) were receiving antiretroviral therapy at the time of stool sampling, and 46 (29%) had diarrhea. Opportunistic protozoa were found in 15 patients (9.7%), 8 of whom (53%) had diarrhea. Enterocytozoon bieneusi was found in eight patients, C. parvum in six patients, and Isospora belli in three patients. All E. bieneusi isolates tested belonged to the same genotype. The prevalence of opportunistic protozoa among patients with CD4 cell counts less than 50/mm(3) was 32%.

[Efficacy of therapeutic combinations with artemisinin derivatives in the treatment of non complicated malaria in Burundi]. / Efficacité de combinaisons thérapeutiques avec des dérivés de l'artémisinine dans le traitement de l'accès palustre non-complique au Burundi.

Faced with the problem of resistance to chloroquine and sulfadoxine-pyrimethamine, the Ministry of Public Health of Burundi decided to study the efficacy of two artemisinin-based combinations, the fixed combination of artemether-lumefantrine and the combination of amodiaquine + artesunate. The efficacy of these combinations for the treatment of uncomplicated falciparum malaria was studied in two sites representative of the country, in Kigobe neighbourhood of Bujumbura, the capital city, and in Buhiga, a rural area. The study followed the standardized WHO protocol from October 2001 to November 2002. A total of 295 children under 5 years were included; 153 children were treated with artesunate and amodiaquine (77 at Buhiga and 76 at Kigobe), and 142 children with the combination of artemether-lumefantrine (64 at Buhiga and 78 at Kigobe). Among the 295 children, 290 were followed up to 14 days. In the group of 149 children treated with artesunate and amodiaquine, 142 (95.3%, 95% CI: 91.9-98.7%) presented with adequate clinical and parasitological response, five (3.3%) with late parasitological failure, one (0.7%) with late clinical failure and one (0.7%) with early treatment failure. Among the 141 children treated with artemether-lumefantrine, 140 (99.3%, 95% CI: 97.9-100%) presented with adequate clinical and parasitological response and one (0.7%) with late parasitological failure at Buhiga. Side-effects were comparable in both groups except for the vomiting. Vomiting was more frequent in the artesunate + amodiaquine on D1 and D2. Both treatments decreased the gametocyte carriage but without getting full clearance in all the patients. During a consensus workshop, the Ministry of Public Health agreed on the combination of artesunate and amodiaquine as the first line drug for the treatment of uncomplicated falciparum malaria in Burundi including epidemic outbreak.

An epidemiological study of pleuropulmonary paragonimiasis among pupils in the peri-urban zone of Kumba town, Meme Division, Cameroon.

BACKGROUND: Paragonimiasis have previously been reported in two zones of the Southwest Province of Cameroon including the Kupe mountain and Mundani foci. The aim of this study was to investigate the presence and epidemiology of paragonimiasis in the peri-urban zone of Kumba, Meme Division, located about 50 km away from the Kupe mountain focus. METHODS: Pupils of several government primary schools in 5 villages around Kumba underwent both parasitologic and clinical investigations in search of signs and symptoms of paragonimiasis. Mycobacterium tuberculosis was also searched for in the differential diagnosis. Freshwater crabs from neighbouring streams in the five villages were dissected in search of paragonimus metacercariae. RESULTS: Out of a total of 1482 pupils examined in all five villages, 309 individuals (147 males and 162 females) were recruited for this study based on the presence of one or more signs or symptoms of paragonimiasis. Eggs of Paragonimus africanus were found in stools and/or sputum of pupils from all five villages, giving an overall paragonimus prevalence of 2.56%. There was no significant difference in the disease prevalence between the villages (Chi2 = 8.36, P = 0.08). The prevalence of Paragonimus africanus eggs amongst pupils with symptoms of paragonimiasis was 12.3% (38 of 309). Males were infected more than females (17.0% versus 8.0%), but the difference was not significant (Chi2 = 5.76, P = 0.16). All the 38 paragonimus egg positive subjects presented with cough, 23 (60.53%) complained of chest pain while 16 (42.11%) had haemoptysis. Stool examinations also detected some intestinal parasites including Ascaris lumbricoides (29.45%), Trichuris trichiura (6.47%), Necator americanus (2.27%), Strongyloides stercoralis (1.62%), Enterobius vermicularis (0.65%), and Entamoeba histolytica (4.53%). No case of M. tuberculosis was noted. Out of a total of 85 dissected crabs (Sudanonautes africanus), 6.02 % were infected with paragonimus metacercariae. CONCLUSION: In addition to the two previously described paragonimiasis foci of Kupe mountain and Mundani, the identification of autochthonous cases of paragonimiasis in the peri-urban zone of Kumba town, makes the South West Province the most endemic zone of paragonimiasis in Cameroon at present.

A new focus of Schistosoma mansoni in Yoro village, Mbam and Inoubou Division, Cameroon.

Investigations on intestinal schistosomiasis were carried out in Yoro, a small village located in the transitional zone between forest and savannah, in the Mbam and Inoubou Division of Cameroon. Four human-water contact points were identified in the village and sampled for snails, and the inhabitants underwent parasitologic and clinical surveys to search for signs and symptoms of intestinal schistosomiasis. The results indicated the presence of two freshwater snails, both potential intermediate hosts of Schistosoma sp: Biomphalaria pfeifferi and Bulinus forskalii. However, only the former species was incriminated in the transmission of the disease, with the prevalence of snail infection being 10% (1 of 10) and 14.3% (2 of 14), respectively, during surveys 1 (in the dry season) and 2 (in the rainy season). The overall prevalence of Schistosoma mansoni eggs in stool samples was 54.4% (98 of 180). The mean +/- SD intensity of infection was 100.3 +/- 114.7 eggs per gram of stool. Eggs of S. intercalatum were not detected during parasitologic examination of stool specimens. In Cameroon, it appears that unlike the distribution of S. mansoni, which usually follows that of B. pfeifferi, B. forskalii is commonly found where S. intercalatum does not exist due to competitive exclusion through introgressive hybridization. Of the 180 people included in the study, 52.3% reported abdominal pain and 37.5% had bloody stools. Splenomegaly and hepatomegaly were noted in 11.7% and 3.9%, respectively, of the subjects examined. Three foci of S. mansoni were previously described in the Mbam and Inoubou Division, including Bafia town, Makenene, and Kinding Djabi villages. With the present focus in Yoro, the Mbam and Inoubou Division appears to be the most important endemic zone of S. mansoni in southern Cameroon.