Etude épidémiologique de la paragonimose chez les écoliers dans la zone péri-urbaine de Kumba après 5 années de distribution de Praziquantel

Haematology, microbiology, parasitology and infectious diseases, University of Yaoundé I
September, 2014


Paragonimiasis is a parasitic disease of human and other mammals due to infestation with lung flukes of the Paragonimus genus. Nearly twenty one million people are currently affected in South-Eastern Asia, Southern America and Africa and almost 290 million people are at risk. Paragonimus africanus and Paragonimus uterobilateralis are the main species affecting human in Africa. In Cameroon, the widespread species is Paragonimus africanus.
Lungs are the primary site of infection, where it is characterized by chronic cough with rusty brown sputum or hemoptysis. The extrapulmonary localization of the adult fluke results in more severe infection. Diagnosis is by isolation of the Paragonimus ova in stool or sputum samples and by immunological tests.
Geographically, it is limited to areas where conditions are favourable to the growth of parasite. Consumption of raw or undercooked freshwater crustaceans constitutes the major risk factor.
Six paragonimiasis foci exist in Cameroon. The South-West region being the most endemic. Since ten years, no study has been carried out on this disease and the most recent data on the prevalence in this focus date back 2004.
The peri-urban zone of Kumba is coendemic for paragonimiasis and schistosomosis. The National Program against Schistosomosis and Intestinal Helminthiasis annually distributes Praziquantel for the control of schistosomosis.
The main objective of this study was to determine the impact of these Praziquantel distribution campaigns on the level of paragonimiasis in this region.

We carried out a cross-sectional descriptive study from November 2013 to March 2014. Subjects were seen in their respective schools. All those who fulfilled our inclusion criteria and presented with an informed consent from parent or legal guardians were enrolled in the study. Data were collected using standard data forms. The stool and sputum samples collected were preserved using 10% formalin solution and transported to the IMPM Laboratory in Yaounde for parasitological analysis.
Data collected were analyzed using EPI INFO version 3.5.1, MICROSOFT OFFICE EXCELL version 2010 and OPEN EPI version 2.3 softwares. Comparisons between different groups were done using the Chi-square and the Fisher exact test for proportions and Student t test for means. The Confidence intervals were estimated at 95% and p values < 0.05 were considered statistically significant.
We recruited 175 children, 96 females and 79 males with sex ratio of 0.82. It was essentially a school population and their ages ranged from 05 to 15 years giving a mean age of 10 ± 3.74 ans. The 6 to 10 age group was the most represented. The entire subject recruited consumed crabs. The paragonimiasis specific prevalence was 0.57% CI= [0.0143%; 3.143%]. This result was statistically inferior to the one of the last study carried out ten years ago with same diagnostic method in that area.
58.9% of children declared, they prepared their crabs by boiling and 69.1% estimated their cooking period at more than 30 minutes. 77.7% of entrants who estimated the crabs cooking period at more than 30 minutes, consumed them in family, a proportion statistically significant (p value <0.001). Besides, 74.9% of entrants consumed crabs in family.
Pulmonary symptoms were the most frequent. Cough being the most predominant. In addition, we did not register any case of hemoptysis.
Cases of coinfection were moreover found in the studied population.
The prevalence of paragonimiasis has reduced in this focus known to be the most endemic for this disease in Cameroon. This is due to the large Praziquantel distribution in that area and likely to modifications from unhealthy cooking behavior to healthier habi