Konzo is a spastic paraparesis of sudden onset, linked to the exclusive consumption of insufficiently processed bitter cassava as staple food combined with low protein intake. Around 60,000 refugees from the Central African Republic sought refuge in villages in eastern Cameroon between 2005 and 2007. Médecins Sans Frontières was providing nutritional and medical assistance in the villages affected by displacement. We describe cases of konzo seen at the mobile clinics organized in these villages. Basic information including demographic data, history and clinical presentation was recorded for each konzo patient. All patients were given nutritional supplements, and selected cases were referred for physiotherapy to a rehabilitation center. A total of 469 patients were diagnosed with konzo. The majority (80%) were refugees. Children and women of reproductive age predominated. Most of the patients developed symptoms after 2007 in a seasonal pattern with most of the cases occurring during the dry winter season. Most of the patients complained about walking difficulties and weight loss and had exaggerated lower limb reflexes and muscle wasting on observation. Eastern Cameroon is an area with konzo. More effort needs to be put into preventive and educational measures. In addition, timely balanced food rations have to be provided to refugees.

IntroductionScaling up of antiretroviral therapy (ART) to HIV+ pregnant women is crucial for the elimination of HIV infection in children. The aim of this study was to evaluate the feasibility and effectiveness of triple ART for Prevention of Mother-to Child Transmission (PMTCT) in Cameroon.MethodsHIV-positive pregnant women attending the DREAM Centre of Dschang, Cameroon for prenatal care were enrolled in a prospective cohort study, and received ART until the end of breastfeeding or indefinitely if their CD4 count was <350mm3. Infants were evaluated for HIV infection at 1, 6 and 12 months of age.ResultsA total of 298 women were enrolled. Among them, 152 were already on established ART. Women were followed until 6 months after delivery with a retention rate of 92.6%. Eight women died. Those with a CD4 count <350 cells/mm3 during pregnancy had the highest mortality risk (RR 2.53; 95% CL= 1.86-3.44). The HIV transmission rate was 1.2% at 12 months with an HIV free survival of 91%. In the proportional Cox regression analysis, the following factors were positively associated with infant mortality: maternal CD4< 350 cells/mm3, no breastfeeding in the first 6 months of life, weight-for-age z score<-2.ConclusionResults confirm the feasibility and effectiveness of the implementation of Option B, with very low rates of HIV MTC transmission, and potential benefits to the health of mothers and infants with earlier initiation of ART. Breastfeeding again demonstrates to be highly beneficial for the growth and survival of HIV exposed children.

Background: Fever is the most frequent symptom for Malaria and HIV/AIDS, but it is non-specific; therefore it can’t be used efficiently in clinical diagnosis of malaria in hyperendemic zones. In hypoendemic areas of malaria, this assertion is not obvious, since people lack naturally acquired immunity. The present study aims at determining the Malaria-attributable fraction of fever episodes (MAFE) among HIV-positive patients in a hypoendemic highland area. Methods: During two-years prospective cross-sectional study, blood samples were collected from outpatients of an HIV/AIDS clinic and examined for the presence and density of malaria parasites. In addition to malaria related symptoms, some other patients’ data were recorded: sexe, age, body mass index (BMI), T-lymphocyte CD4 counts, viral loads, haemograms and transaminases measurements. Results: A total of 729 HIV-seropositive patients were enrolled into the study. Their mean Plasmodial infection rate and parasitaemia were: 0.823% and 1.050 parasites/µl of blood respectively; and were both significantly lower, compared to the control seronegative group, in contrast to our hypothesis. No significant difference was observed when the mean values of transaminases were compared between those with and without plasmodial infection. For the 119 (16.32%) febrile individuals found, the calculated MAFE was almost null (0.15%). Their mean CD4 count, red blood cells (RBC) count and haemoglobin rate were: 226 cell/µl, 3.83x10 6 RBC/µl and 10.4 g/dl respectively; and were all significantly lower than in the non-febrile group. However, malaria parasite infection rates and mean densities were similar in both groups. Likewise, there was no difference between: sex ratios, mean ages, BMI, total white blood cells counts and viral loads between the two groups. Conclusion: HIV infection in spite of the immunodeficiency induced does not enhance the risk of Plasmodium infection in hypoendemic highland settings. Even in the scarce cases of co-infection occurring here, malaria is rarely responsible for fever episodes. These fevers are indeed associated with higher anaemia and immunodeficiency, and likely due instead to opportunistic infectious diseases.

Cet article décrit un contexte de soins qui différait des simples tableaux que nous avons souvent pris en charge ; exigeant des compétences spécialisées et une approche multidisciplinaire. Il s’agit en effet d’une femme séropositive au VIH (Mirabelle) qui a assisté à la mort de ses deux enfants adolescents ; Sandra 15 ans et Ivan 12 ans. Le contexte a requis les soins palliatifs familiaux, différents de ceux du groupe. Ce vécu stressant de Mirabelle lui a imposé la présence de différents soignants au cours de la logique des soins. Des pseudonymes sont employés par la rédaction.