Mapping the geographical distribution of podoconiosis in Cameroon using parasitological, serological, and clinical evidence to exclude other causes of lymphedema

Podoconiosis is a non-filarial elephantiasis, which causes massive swelling of the lower legs. It was identified as a neglected tropical disease by WHO in 2011. Understanding of the geographical distribution of the disease is incomplete. As part of a global mapping of podoconiosis, this study was co...

Full description

Saved in:

Bibliographic Details
Published in:	PLoS neglected tropical diseases Vol. 12; no. 1; p. e0006126
Main Authors:	Deribe, Kebede, Beng, Amuam Andrew, Cano, Jorge, Njouendo, Abdel Jelil, Fru-Cho, Jerome, Awah, Abong Raphael, Eyong, Mathias Esum, Chounna Ndongmo, Patrick W, Giorgi, Emanuele, Pigott, David M, Golding, Nick, Pullan, Rachel L, Noor, Abdisalan M, Enquselassie, Fikre, Murray, Christopher J L, Brooker, Simon J, Hay, Simon I, Enyong, Peter, Newport, Melanie J, Wanji, Samuel, Davey, Gail
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 01-01-2018 Public Library of Science (PLoS)
Subjects:	Animals Antibodies, Protozoan - blood Antibodies, Protozoan - immunology Antigens Antigens, Helminth - immunology Biology Biology and Life Sciences Blood Cameroon - epidemiology Care and treatment Causes of Confidence intervals Density stratification Deoxyribonucleic acid Diagnosis Disease control Diseases DNA Elephantiasis Elephantiasis - diagnosis Elephantiasis - epidemiology Environmental risk Epidemiology Filariasis Funding Geographical distribution Geography Households Humans Hygiene Identification Immunoglobulin G Immunoglobulin G - blood Immunoglobulin G - immunology Legs Lymphatic system Lymphedema Lymphedema - diagnosis Lymphedema - epidemiology Lymphedema - parasitology Management services Mansonella - isolation & purification Mapping Mathematical models Medical research Medical schools Medicine Medicine and Health Sciences Morbidity Neglected Diseases - diagnosis Neglected Diseases - epidemiology Night Parasites Parasitology People and Places Public health Software Stratification Supervision Thick films Tropical climate Tropical diseases Vector-borne diseases Wuchereria bancrofti Wuchereria bancrofti - isolation & purification Cameroon United Kingdom > UK United States > US Africa Kenya Ethiopia Addis Ababa Ethiopia
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Podoconiosis is a non-filarial elephantiasis, which causes massive swelling of the lower legs. It was identified as a neglected tropical disease by WHO in 2011. Understanding of the geographical distribution of the disease is incomplete. As part of a global mapping of podoconiosis, this study was conducted in Cameroon to map the distribution of the disease. This mapping work will help to generate data on the geographical distribution of podoconiosis in Cameroon and contribute to the global atlas of podoconiosis. We used a multi-stage sampling design with stratification of the country by environmental risk of podoconiosis. We sampled 76 villages from 40 health districts from the ten Regions of Cameroon. All individuals of 15-years old or older in the village were surveyed house-to-house and screened for lymphedema. A clinical algorithm was used to reliably diagnose podoconiosis, excluding filarial-associated lymphedema. Individuals with lymphoedema were tested for circulating Wuchereria bancrofti antigen and specific IgG4 using the Alere Filariasis Test Strips (FTS) test and the Standard Diagnostics (SD) BIOLINE lymphatic filariasis IgG4 test (Wb123) respectively, in addition to thick blood films. Presence of DNA specific to W. bancrofti was checked on night blood using a qPCR technique. Overall, 10,178 individuals from 4,603 households participated in the study. In total, 83 individuals with lymphedema were identified. Of the 83 individuals with lymphedema, two were found to be FTS positive and all were negative using the Wb123 test. No microfilaria of W. bancrofti were found in the night blood of any individual with clinical lymphedema. None were found to be positive for W. bancrofti using qPCR. Of the two FTS positive cases, one was positive for Mansonella perstans DNA, while the other harbored Loa loa microfilaria. Overall, 52 people with podoconiosis were identified after applying the clinical algorithm. The overall prevalence of podoconiosis was found to be 0.5% (95% [confidence interval] CI; 0.4-0.7). At least one case of podoconiosis was found in every region of Cameroon except the two surveyed villages in Adamawa. Of the 40 health districts surveyed, 17 districts had no cases of podoconiosis; in 15 districts, mean prevalence was between 0.2% and 1.0%; and in the remaining eight, mean prevalence was between 1.2% and 2.7%. Our investigation has demonstrated low prevalence but almost nationwide distribution of podoconiosis in Cameroon. Designing a podoconiosis control program is a vital next step. A health system response to the burden of podoconiosis is important, through case surveillance and morbidity management services.
Bibliography:	The authors have declared that no competing interests exist.
ISSN:	1935-2735 1935-2727 1935-2735
DOI:	10.1371/journal.pntd.0006126