[Leish-l] Fwd: Fw: PRO/AH/EDR> Leishmaniasis, visceral - Cameroun: (EN, NO)

Thu Apr 6 11:51:20 BRT 2017

From: <promed at promedmail.org>
Date: 2017-04-05 18:13 GMT-03:00
Subject: PRO/AH/EDR> Leishmaniasis, visceral - Cameroun: (EN, NO)
To: promed-post at promedmail.org, promed-edr-post at promedmail.org,
promed-ahead-post at promedmail.org

LEISHMANIASIS, VISCERAL - CAMEROUN: (EXTREME NORTH, NORTH)
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Date: Tue 4 Apr 2017
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/leishmaniasis-outbreak-reporte
d-cameroon-58045/>

The Ministry of Public Health (MOPH) of Cameroon reported in
mid-February [2017] cases of acute fever and rash syndrome of unknown
etiology being reported from the Far North [Extreme North] and North
regions of the country.

The major clinical manifestations of the illness included skin rash,
persistent fever, malnutrition, anemia, hepatosplenomegaly and
adenopathy. Laboratory results by the Centre Pasteur of Cameroon in
Yaoundé have since shown this illnesses were due to cutaneous
leishmaniasis.

Retrospective investigation indicated that 48 cases with similar
clinical features including 17 deaths (case fatality rate of 35.4
percent) had been registered between January 2016 and [24 Mar 2017].
These cases originated from 6 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.

A total of 36 of the 48 cases investigated had no established
epidemiological links, negating contact contagion as a mode of
transmission. Currently 6 cases are hospitalized in Mokolo district
hospital.

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.

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 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, the 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 the WHO headquarters to work closely with the Ministry
of Public Health.

Cutaneous leishmaniasis was 1st described in Cameroon in 1930, with
the 1st case reported from Mokolo in 1972. Between January 2007 and
June 2009, 147 cases were reported from Mokolo; 60 percent of the
affected people were under 15 years of age. Visceral leishmaniasis has
also been reported in the north of the country, with the 1st case
confirmed in 1986. Underreporting of the disease is thought to be
substantial in the country.

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed at promedmail.org>

[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/article?id=10.1371/journal.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/article-abstract/106/3/137/
1893169/Clinical-features-and-epidemiology-of-cutaneous?redi
rectedFrom=fulltext>).
- Mod.EP

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/58518>.]

[See Also:
Undiagnosed rash - Cameroon (03): (EN) fatalities, commentary
http://promedmail.org/post/20170325.4925761
Undiagnosed rash - Cameroon (02): (EN) fatalities, commentary
http://promedmail.org/post/20170323.4920216
Undiagnosed rash - Cameroon: (EN) fatalities, RFI
http://promedmail.org/post/20170321.4915569
Monkeypox - Republic of Congo
http://promedmail.org/post/20170315.4903754
2016
----
Monkeypox - Central African Republic (04): (HK) WHO
http://promedmail.org/post/20161014.4560870
Monkeypox - Central African Republic (03): (BK,HK) fatal
http://promedmail.org/post/20160929.4525807
Monkeypox - Central African Republic (02): (BK) fatal
http://promedmail.org/post/20160924.4512897
Monkeypox, chimpanzee - Cameroon: (CE) emerging, OIE
http://promedmail.org/post/20160827.4445967
Monkeypox - Congo DR (02): (BU)
http://promedmail.org/post/20160212.4014697
Monkeypox - Central African Republic: (MB) RFI
http://promedmail.org/post/20160119.3947756
2015
----
Monkeypox, human - Congo DR: susp. RFI
http://promedmail.org/post/20150914.3643887
2014
----
Monkeypox, chimpanzee - Cameroon: (CE) emerging, OIE
http://promedmail.org/post/20140721.2622536]
.................................................sb/ep/ao/lm
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