Materno-Fetal Outcomes of COVID-19 Infected Pregnant Women Managed at the Douala Gyneco-Obstetric and Pediatric Hospital—Cameroon

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%, and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30 - 39 years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were: fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%. Conclusion: The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.

Antibiotics Susceptibility Profile of Staphylococcus aureus Clinical Isolates Collected in Hospitals in the City of Douala (Cameroon)

Introduction: Staphylococcus aureus is one of the most important agents involved in community and hospital-acquired infections. Due to the multi-drug resistance of strains to antibiotics, treatment to eradicate it is becoming more difficult and poses a global public health problem. Methodology: This was a cross-sectional study conducted from March to August 2020 in hospitals in the city of Douala, including all S. aureus isolates from diagnostic samples. Strain identification and antibiotic susceptibility testing were performed using the Vitek2 CompactTM (BioMerieux). Results: During the study period, 136 non-repetitive S. aureus strains were identified with a high frequency of methicillin-resistant S. aureus of 78.7%. The majority of the strains originated from the Douala General Hospital (66.9%) and was most frequently isolated from blood culture samples (55.1%). The study of biochemical characteristics showed that most of the strains identified had between 87% and 99% homology with the reference strain. The most active antibiotics were Quinupristin/Dalfopristin (94.2%), Linezolid (87.8%) and Vancomycin (84.2%). Methicillin resistance was associated with decreased susceptibility of S. aureus to other antibiotics such as Gentamycin (44.9%), Erythromycin (38.2%), Tetracycline (38.3%), Trimethoprim (21.4%), Ciprofloxacin (19.1%) and Levofloxacin (24.0%). Inducible MLSb and constitutive resistance phenotypes were identified with 26.7% and 22.8% respectively. Conclusion: The sensitivity of S. aureus strains differs from one antibiotic family to another, and remains good for molecules that are not available in our context. The high frequency of Methicillin-Resistant S. aureus shows the continuous progression of multi-resistant strains of S. aureus and their decreased sensitivity to usual antibiotics becomes more and more alarming.

Hypercoagulability in the Context of Pre-Eclampsia: Case-Control Study at the Laquintinie Douala Hospital (Cameroon)

Introduction: Preeclampsia is one of the major causes of maternal and neonatal morbidity and mortality in the world. The complexity of its etio-pathogenesis involves, among other things, hypercoagulability, which alone accounts for about 15% of his deaths. Our objective was to study the parameters of coagulation (prothrombin level, activated cephalin time) in pregnant women with preeclampsia and non-preeclampsia at Laquintinie Hospital in Douala. Methodology: We carried out an analytical cross-sectional case-control study from November 01st, 2018 to May 31st, 2019, in the gynecology and obstetrics department of Laquintinie Hospital in Douala. We included preeclampsia and non-preeclampsia pregnant women with a gestational age greater than or equal to 20 weeks amenorrhea. The variables of interest were age, pregnancy, parity, gestational age, marital status and body mass index, prothrombin level (PL) and activated cephalin time (ACT). Hypercoagulability was defined by the presence of at least one of the following abnormalities: PL > 100%, ACT < 25 seconds. Statistical tests were considered significant for a p-value < 0.05. Results: We recruited 150 pregnant women including 50 preeclampsia matched with 100 non-preeclampsia. The majority age group in both groups was 25 - 30 years (32% versus 37%). We found a high PL in 58% of preeclampsia versus 22% of non-preeclampsia patients (p = <0.001), a low PL in 8% of preeclampsia versus 0% in non-preeclampsia patients (p = 0.004). The ACT was prolonged in 12% of the preeclampsia versus 0% in the non-preeclampsia patients (p = <0.001). Pregnant women with preeclampsia were 4.89 times more likely to develop hypercoagulability than pregnant women without preeclampsia (OR 4.89;CI 2.34 - 10.20;p = <0.001). In linear regression, preeclampsia was significantly associated with PL (correlation coefficient 0.07;p = 0.008). We did not find risk factors associated with hypercoagulability in preeclampsia. Conclusion: Our study confirms the existence of hypercoagulability associated with preeclampsia, in particular in relation to an increase in the level of prothrombin.

Detection of the Production of Klebsiella Pneumoniae Carbapenemase, New Delhi Metallo-Beta-Lactamase and Oxacillinase-48-Type Carbapenemases by Gram-Negative Bacilli in Resource-Limited Setting

Background: The increasing resistance of bacteria to various antibiotics is a worldwide public health issue. Carbapenems that have elicited great hope in treating infections caused by multidrug-resistant germs have seen their efficacy narrowed over time with the emergence of other novel resistance mechanisms, notably the production of Carbapenemases. Methods: A prospective cross-sectional study was conducted from May 2017 to May 2018 in Douala (Cameroon) to detect carbapenemase-producing Gram-negative bacilli. Isolated strains were identified using the Vitek2TM system. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on agar plates with 20 selected commercially available antibiotic discs. The bacterial strains were tested for the production of three Carbapenemases (OXA-48, NDM, KPC), using an immuno-chromatographic technique, with the “RESIST-3 O.K.N. K-SeT” rapid detection kit. Results: During the study period, 1687 strains of Gram-negative bacilli were isolated in selected laboratories with a total of 200 multi-resistant strains identified (11.9%). Among the multi-resistant strains, E. coli was the species most represented in Enterobacteriaceae (27.5%) followed by K. pneumoniae (15.5%) and the non-fermenting Gram-negative bacilli were predominantly P. aeruginosa (20.5%). These strains mainly came from urine and pus, i.e. 41% and 32% respectively. Thirty-two (16%) strains produced one of the Carbapenemases with a higher frequency at the General Hospital (84%). NDM-type carbapenemase was the most frequently identified (8.5%), OXA-48 type 7.5%, and no KPC production was observed. Among the Enterobacteriaceae 22.9% produced Carbapenemases and only 5.1% of the non-fermenting bacilli produced these enzymes. The isolates strains were completely resistant to all antibiotics except Amikacin and Fosfomycin. The strains producing the NDM-type carbapenemase showed higher rates of resistance to almost all of the antibiotics tested. Conclusion: Multidrug-resistant strains are experiencing an increase in evolution. The apparition of strains producing Carbapenemases prominently, the NDM and OXA-48 favor this increase. The activities of antibiotics with high efficacies on these strains are low.

Assessing GastroPanel serum markers as a non-invasive method for the diagnosis of atrophic gastritis and <i>Helicobacter pylori</i>infection

Gastric colonization by Helicobacter pylori increases the risk of gastric disorders, including atrophic gastritis which can be diagnosed based on levels of serum biomarkers like Gastrin and Pepsinogen. We therefore examined the efficacy of a serological-based method namely GastroPanel Blood kit, in diagnosing and scoring gastritis associated to Helicobacter pylori infection. Patients with dyspeptic symptoms were prospectively recruited on voluntary basis at the Yaounde Central Hospital and University Teaching Hospital, from March to July 2011. The degree of atrophy was classified according to levels in patient serum of pepsinogens I and II (PGI and PGII) and Gastrin 17 (G17) and compared with histological profiles as reference method. A specific ELISA test was used for the detection of H. pylori IgG antibodies. In total, 86 volunteers from 21 to 83 years old (mean = 46.4 ± 3.3) were enrolled, including 74.4% of women and 25.6% of men. The prevalence of gastritis was statistically similar between Gastro Blood Panel test and histology used as reference method (89.5% versus 83.7%: p > 0.20). Diagnosis based on serum makers showed high sensitivity (93.1%) in comparison with the reference method. However, the serological based method has diagnosed more atrophic gastritis than the reference (17.4% versus 7.0%: p 0.05). Furthermore, the prevalence of H. pylori infection did not differ significantly between serological method (84.9%) and reference method (81.4%). These results suggest that diagnosis of atrophic gastritis and H. pylori infection obtained with an optional serological method (GastroPanel) is in a strong agreement with the biopsy findings, and thus can be a useful non endoscopic assessment of stomach mucosal atrophy in patients with dyspepsia.