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Cameroon: 54 cases, 16 deaths due to undiagnosed illness - probable leishmaniasis

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  • Cameroon: 54 cases, 16 deaths due to undiagnosed illness - probable leishmaniasis

    Measles?

    Published Date: 2017-03-19 06:44:02
    Subject: PRO / EN> Infectious disease of unknown, fatal origin - Cameroon (Far North): ICR
    Archive Number: 20170319.4910238
    INFECTIOUS DISEASE OF UNKNOWN ORIGIN, FATAL - CAMEROON (EXTREME NORTH): ADDITIONAL INFORMATION REQUIRED
    ************************************************** ************************************************** ***************
    A communication from ProMED-mail
    Http://www.promedmail.org
    ProMED-mail is a program of the
    International Society for Infectious Diseases
    Http://www.isid.org

    Date: Fri 17 March 2017
    Source: APA-News (African News Agency) [edited]
    Http://apanews.net/index.php/en/news...ve-au-cameroun


    Already 16 dead as a result of "eruptive fever" in Cameroon
    ---------------------
    At least 16 people out of 54 patients have died in the Far North of Cameroon as a result of a "mysterious disease" that would be atypical eruptive fever (FEA), hospital sources said Friday.
    According to the Director of the Fight against Disease and Epidemics (DLMEP) in the Ministry of Public Health, Dr. Etoundi Mballa, it is a "curious disease" whose symptoms suggest that it is a FEA , Adding that "the investigations are continuing".
    According to the Ministry of Public Health, "the most important thing is to know if it is an infectious disease and so far we know that it is not something that is contaminating itself," he said. indicated.
    Atypical eruptive fever (FEA), which appeared in 6 health districts (DS) of the MayoTsanaga in the Far North, continues to cause fatalities.
    Its frequent clinical manifestations are persistent fever, rash, anemia, hepatosplenomegaly, and lymphadenopathy.
    According to medical sources, the victims of this new disease are only children under 5 years of age.

    [By MBOG / od / APA]

    -
    Press Release:
    ProMED-ENG



    [Clinical signs of this atypical eruptive fever (FEA) are not pathognomonic of a single infectious disease. Indeed, many viral and bacterial infections can have this clinical picture. What seems obvious is that the disease affects mostly children under 5 years of age. In any case, ProMED-FRA would be grateful to anyone who can provide additional information on this FEA and to know the nature and the etiology of this disease.


  • #2
    Report from the Ministry of Health in February:

    Translation Google

    SITUATION REPORT NO. 2
    ATYPICAL FEBRILE ERUPTION IN THE EXTREME NORTHERN REGION
    February 2017

    Photo: lesions found in some affected children and their location

    1. SUMMARY OF THE SITUATION
    • 16/02/2016, notification of six cases of atypical eruptive fever
    and resistant to usual antibiotics including 4 deaths in the HD of Mokolo;
    ,
    • 21 cases found during the active search, 12 of which were deceased (10
    Records of HD Mokolo and 2 in community) since January 2016;
    • Area of ​​origin of the cases: DS Mogode, DS Bourrha, DS Mokolo, DS Roua;
    Clinical Manifestations: persistent fever, localized rash
    Plantar and cephalic, hepato splenomegaly, anemia;

    • The Rapid Investigation and Response Team (EI2R) goes down on 19/02/2017
    ...
    https://www.humanitarianresponse.inf...ep20nc2b02.pdf

    --------------------------------------------------- ----------------------

    Translation Google

    Epidemiological Bulletin of the Far North
    Case of Atypical Eruptive Fever (FEA) in the Region
    Evaluation of the management of the event
    SITREP N ° 06 of March 12, 2017


    I. SUMMARY OF THE SITUATION
     16/02/2016, notification of two cases of persistent eruptive fever at the Mokolo HD
    43 cases already notified since January 2016
     16 deaths (37.21%)
     Area of ​​origin of cases: 6 DS

    - Extreme North: DS Bourha, Mokolo, Mogode, Hina, Roua
    - North: DS Mayo-Oulo
    Frequent clinical manifestations: Persistent fever, rash, anemia, hepatosplenomegaly,
    Adenopathies

    ...

    Https://www.humanitarianresponse.inf...mars202017.pdf
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

    Comment


    • #3
      This would be remarkable if confirmed and is not consistent with the age reported above:


      Published Date: 2017-03-25 16:27:48
      Subject: PRO/AH/EDR> Undiagnosed rash - Cameroon (03): (EN) fatalities, commentary
      Archive Number: 20170325.4925761
      UNDIAGNOSED RASH - CAMEROON (03): (EXTREME NORTH) FATALITIES, COMMENTARY
      ************************************************** **********************
      A ProMED-mail post
      http://www.promedmail.org
      ProMED-mail is a program of the
      International Society for Infectious Diseases
      http://www.isid.org

      Date: Fri 24 Mar 2017
      Source: EpiCore Global Surveillance Project [edited]


      Concerning this outbreak, the analysis' results are still waiting. We think that this outbreak can be due to migration observed in the Far North of Cameroon. In central Africa (Central African Republic), we have also observed these same cases due to Monkey pox. Only the analysis' results of "Centre Pasteur du Cameroun" will help us know more about this outbreak.

      --
      Communicated by:
      EpiCore Surveillance Project member
      Romaric Ateugieu
      University of Douala,
      Douala, Cameroon

      [Douala, Cameroon ProMED thanks this EpiCore Surveillace Project member for his contribution. Indeed monkey pox has been described in chimpanzees in Cameroon but it is unclear if human have or are occurring. We await further information. - Mod.LL
      Last edited by sharon sanders; April 6th, 2017, 09:12 AM.

      Comment


      • #4
        Published Date: 2017-04-05 17:13:43
        Subject: PRO/AH/EDR> Leishmaniasis, visceral - Cameroun: (EN, NO)
        Archive Number: 20170405.4950304
        LEISHMANIASIS, VISCERAL - CAMEROUN: (EXTREME NORTH, NORTH)
        ************************************************** ********
        A ProMED-mail post
        http://www.promedmail.org
        ProMED-mail is a program of the
        International Society for Infectious Diseases
        http://www.isid.org

        Date: Tue 4 Apr 2017

        edited: please see WHO link as source for context and link in next post below (S.S.)

        --
        Communicated by:
        ProMED-mail


        [There have been reports of an illness associated with an unspecified rash in Northern Cameroon 1st reported by ProMED on [21 Mar 2017] (see below). It is possible that these cases may be Leishmaniasis. However, the diagnostic procedures in this article are not described in detail, but we presume that either serology or PCR have been performed.

        Very little is known about Visceral Leishmaniasis (VL) in Cameroon and only _Leishmania major_ has been found (Alvar J, Vélez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7(5):e35671. doi: 10.1371/journal.pone.0035671. Annex 15, available at: http://journals.plos.org/plosone/art...l.pone.0035671).

        VL may be endemic in Kousseri region in the north of Cameroon. Between 1987 and 1988, in a survey among 120 people in Kousseri, 46 had clinical symptoms of VL and 9 of them were confirmed parasitologically and/or serologically (Kaptue L, Zekeng L, Fomekong E, Nsangou A, Tagu JP and Tchuela J. La leishmaniose viscérale au Cameroun. A propos de quelques observations et d'une prospection clinique dans la région de Kousseri, extrême-nord Camerounais. Bull. Soc. Pathol. Exot 1992;85:156-8 [in French]).

        An interesting possibility is that gorillas may act as host for Leishmania major in Cameroon (Hamad I, Forestier CL, Peeters M, Delaporte E, Raoult D and Bittar F. Wild gorillas as a potential reservoir of Leishmania major. J Infect Dis. 2015;15;211(2):267-73. doi: 10.1093/infdis/jiu380, available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342692/).

        Leishmaniasis is an HIV-related infection also in Cameroon (Ngouateu OB, Kollo P, Ravel C, et al. Clinical features and epidemiology of cutaneous leishmaniasis and Leishmania major/HIV co-infection in Cameroon: results of a large cross-sectional study. Trans R Soc Trop Med Hyg. 2012;106(3):137-42. doi: 10.1016/j.trstmh.2011.10.012, abstract available at: https://academic.oup.com/trstmh/arti...dFrom=fulltext). - Mod.EP
        Last edited by sharon sanders; April 9th, 2017, 09:57 AM.

        Comment


        • #5
          Source: ...
          Leishmaniasis Cameroon

          On 19 February 2017, the Ministry of Public Health (MOPH) of Cameroon
          notified WHO of cases of acute fever and rash syndrome of
          unknown aetiology being reported from the Far North and North regions
          of the country. The major clinical manifestations of the illness
          included skin rash, persistent fever, malnutrition, anaemia, hepato-splenomegaly
          and adenopathy. Laboratory results released on
          17 March 2017 by the Centre Pasteur of Cameroon in Yaoundé revealed
          that two out of five samples obtained between 21 and 24 February
          2017 from acute incidence cases tested positive for cutaneous
          leishmaniasis.

          Retrospective investigation indicated that 48 cases with similar clinical
          features including 17 deaths (case fatality rate of 35.4%) had
          been registered between January 2016 and 24 March 2017. These
          cases originated from six health districts (Bourha, Mokolo, Mogode,
          Hina, Maroua 3 and Soulede Roua) in the Far North region of Cameroon,
          and Mayo-Oulo district in the North region, the same areas
          where humanitarian crisis is occurring. Thirty six of the 48 cases investigated
          had no established epidemiological links, negating contact
          contagion as a mode of transmission. Six cases are currently
          hospitalized in Mokolo district hospital.

          Public health actions

          The Ministry of Public Health is leading the response to the
          outbreak, supported by Partners including IMC, ALIMA, CDC,
          CAFETP, UNICEF, MSF, CRF, CRC, and Epicenter.

          The outbreak management committee has developed a response
          plan that is being used to mobilize additional resources.

          The surveillance case definition for this outbreak and standard
          operating procedures for surveillance and case management
          have been adopted and being implemented since 20 March 2017.

          Situation interpretation

          Leishmaniasis is caused by the protozoan Leishmania parasites that are transmitted through the bites of infected female sandflies. The disease is associated with malnutrition, population displacement, poor housing, a weak immune system, and poverty. These factors are prevalent in the Far North and North regions of the country, in addition to availability of the vectors.

          Cutaneous leishmaniasis was first described in Cameroon in 1930, with the first case reported from Mokolo in 1972. Between January 2007 and June 2009, 147 cases were reported from Mokolo, 60% of the affected people were under 15 years of age. Visceral leishmaniasis has also been reported in the north of the country, with the first case confirmed in 1986. Under reporting of the disease is thought to be substantial in the country.

          The outbreak of leishmaniasis in the far north and north of Cameroon has been going on insidiously since January 2017 or beyond. Detection and confirmation of the outbreak took several weeks due to a number of factors, including weak surveillance system especially for a neglected tropical diseases like leishmaniasis, inadequate laboratory diagnostic capacity and functional specimen transportation system, shortage of essential medicines and supplies for case management, limited numbers of trained health workers, etc. Some parts of the affected areas are also experiencing insecurity, with poor communication network to the rest of the country and limited coverage and accessibility to health services.

          The Ministry of Public Health has rallied several partners to mount an effective response to this outbreak. In the bid to address some of the existing challenges, WHO is shipping pentavalent antimonials, paromomycin, rapid diagnostic tests and supplies for leishmaniasis testing and case management from its emergency stocks to Cameroon. A neglected tropical diseases (NTD) case management expert will be deployed from WHO headquarters to work closely with the Ministry of Public Health.

          There is an urgent need to accelerate implementation of response activities including building local capacity. The support from partners will be pivotal in attaining this. In the medium to long term, enhancing the operational capacity of the national leishmaniasis control programme to run effectively is critical.
          ...
          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

          Comment

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