Background The public health response to the global COVID-19 pandemic has varied widely by region. In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy. The aim of this study was to compare perceptions of COVID-19 infection and vaccination between pregnant women and non-pregnant adults in four regions of Cameroon, located in Central Africa. Methods A cross-sectional survey study was conducted at urban and suburban hospital facilities in Cameroon. Participants were randomly selected from a convenience sample of adult pregnant and non-pregnant adults in outpatient clinical settings between June 1st and July 14th, 2021. A confidential survey was administered in person by trained research nurses after obtaining written informed consent. Participants were asked about self-reported sociodemographics, medical comorbidities, perceptions of COVID-19 infection, and vaccination. Descriptive statistics were used for survey responses and univariate and multivariable logistic regression models were created to explore factors associated with COVID-19 vaccine acceptability. Results Fewer than one-third of participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by pregnancy status. Overall, 43% of participants doubted vaccine efficacy, and 85% stated that the vaccine available in Africa was less effective than vaccine available in Europe. Factors independently associated with vaccine acceptability included having children (aOR = 1.5; p = 0.04) and higher education (aOR = 1.6 for secondary school vs primary/none; p = 0.03). Perceived risks of vaccination ranged from death (33%) to fetal harm (31%) to genetic changes (1%). Health care professionals were cited as the most trusted source for health information (82%, n = 681). Conclusion COVID-19 vaccine hesitancy and misinformation in Cameroon was highly prevalent among pregnant and non-pregnant adults in 2021 while vaccine was available but not recommended for use in pregnancy. Based on study findings, consistent public health messaging from medical professionals about vaccine safety and efficacy and local production of vaccine are likely to improve acceptability.

Pembrolizumab is a humanized monoclonal antibody that targets the programmed cell death 1 protein (PD-1) receptor and blocks the inhibitory checkpoint interaction between PD-1 and its ligands. This interaction leads to the upregulation of effector T-cells and downregulating regulatory T-cell production. Although this mechanism is essential for the management of cancer, it may lead to decreased self-tolerance with an autoimmune reaction toward healthy functioning tissue. One of the less commonly reported and less understood immune-related adverse events includes neuromuscular complications. We present a rare case of autoimmune demyelinating polyneuropathy and hydrocephalus secondary to pembrolizumab use for cutaneous squamous cell carcinoma of the cheek.

IntroductionIn the United States, cocaine is a commonly used drug of abuse. It is also a recognized contributing factor for both hemorrhagic and ischemic strokes. However, cocaine-induced basilar artery thrombosis has rarely been reported in the literature.Case presentationOur patient was a 51-year-old African American woman with a history of polysubstance abuse who presented to the emergency department for acute behavior changes. Later, during admission, she had a dramatic decrease in motor strength in all extremities and a positive Babinski reflex bilaterally. The results of her toxicology reports were positive for cocaine; in addition, results of magnetic resonance angiography and magnetic resonance imaging were consistent with acute thrombosis and subsequent infarction of the basilar artery. Her mental status improved, but she was only able to communicate via movements of her eyes.ConclusionOur patient developed locked-in syndrome after use of cocaine. Given the prevalence of its use in the United States, cocaine use should be included among the potential causes of locked-in syndrome.

INTRODUCTION: Cryptococcus neoformans and Coccidioides immitis are important opportunistic mycoses. C. neoformans is widely found in soil and bird droppings while C. immitis is endemic to the southwestern US. These infections behave more aggressively in immunocompromised hosts and may present as pulmonary nodules mimicking malignancy. We present a case of a pulmonary nodule revealing coinfection with both mycoses. CASE PRESENTATION:A 47-year-old male was brought to the ED due to erratic behavior. He was hemodynamically stable, but had choreoathetoid movements, lip smacking and garbled speech. He had a history of polysubstance abuse, baseline chorea of unknown etiology, and HIV not on ART. He was on vacation from California. Initial chemistries were normal. UDS was positive for amphetamines and methamphetamines. CT brain showed global cerebral atrophy. RPR was positive. Due to concern for CNS infection, LP was performed. Opening pressure and CSF studies were normal. MRI revealed global and caudate atrophy concerning for neurodegenerative disease. On hospital day 2, the patient was febrile to 102.7 degrees F with associated nonproductive cough. CXR revealed pneumonic consolidation in the LLL and a well-defined RLL nodule. Broad spectrum antibiotics were initiated. Chest CT confirmed a pleural based mass measuring 2.4x2.2 cm concerning for malignancy. CT guided lung biopsy revealed benign pulmonary parenchyma with extensive necrosis. GMS stain was positive for two morphologically distinct fungal species consistent with C. immitis and C. neoformans coinfection. Oral fluconazole was initiated with improvement in his clinical condition. His chorea and speech improved throughout his hospitalization. Underlying Huntington's disease exacerbated by amphetamine use was suspected.DISCUSSION: Pulmonary cryptococcosis is rare, representing 20% of pulmonary fungal infections. In immunocompetent hosts, it may present as a consolidation, reticulonodular process, or lung mass that mimics cancer. In those with altered immune function, it may establish latent infection through persistence within granulomas or may cause disseminated disease, such as meningitis. Similarly, C. immitis usually causes a severe pneumonia and may cause disseminated disease in immunocompromised patients. In non-immunocompromised patients, coccidiomycosis presents similarly to bacterial CAP with cough, fever and a consolidation on CXR (75%). However, thoracic manifestations are variable and include nodules, cavities, and peribronchial thickening. Pulmonary nodules caused by both fungal species may be positive on FDG-PET imaging, further mimicking malignancy. CONCLUSIONS: Our literature review returned no prior reports of pulmonary coinfection C. neoformans and C. immitis. We postulate that such a coinfection occurred due impaired host immune function and geographic prevalence of both organisms.

Background In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy (VH). VH is multifactorial but influences include disinformation through social media with Whats App being the most popular form in Cameroon. The aim of this study was to test our hypothesis that frequent users of social media would have higher vaccine hesitancy due to exposure to disinformation in Cameroon in Central Africa. Methods A survey study was conducted at urban and suburban hospital facilities in four of the ten regions of Cameroon. Participants were asked to self-report socio-demographics, perceptions of COVID-19 infection, and interest in vaccination. They were also asked to rank their top two sources of health care information, including social media. Bivariate analysis was used to explore the perceptions of infection and vaccination stratified by social media preference with statistical significance set at p< 0.05. Results We found that 18% (151/835) of participants cited social media (SM) as a top source of health care information. Health care professionals were cited by 82% as the most trusted source for health information (n=681). Fewer than one-third of survey participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by SM preferences. More people in the social media group, 53% vs 38% (p=0.046) stated that more information about vaccine safety may help reduce hesitancy. Perceived risks of COVID-19 vaccination ranged from death (33%) to fetal harm (31%) to supernatural reactions (1.4%). The SM group was not more likely to site perceived risks of the vaccine (p=0.244). Participant Characteristics. Conclusion Although vaccine hesitancy in Cameroon was high at the time of the survey, adults who prefer to get health information from social media were not more likely to express vaccine hesitancy. Public education campaigns led by healthcare professionals may have the greatest impact on vaccine acceptability based on trusted information sources cited by participants. Disclosures All Authors: No reported disclosures.