Ngoïla (2°37′ N, 14°1′ E, population 400) is in a rain-forest region of Cameroon. In November, 1997, there was an outbreak of red diarrhoea. After investigations by the District Health Authorities, metronidazole and cotrimoxazole were suggested to control the epidemic. By March, 1998, the Ministry of Health had reports of 237 cases and 44 deaths. The illness evolved slowly and deaths were not reported before day 7. Viral haemorrhagic fever was suspected and epidemiological investigations were started. We identified 22 patients, between March 25 and March 28 who presented with bloody diarrhoea or dysentery, duration of illness 3–58 days (median 7). Cramping abdominal pain, fever, and dehydration were noted in 96%, 43%, and 37%. Available antiparasitic and antibacterial agents were not effective against the illness. Stools and blood samples were collected from 22 patients either with dysentery or bloody diarrhoea, aged 2–60 years. Stool samples and serum samples were frozen in liquid nitrogen. Stool samples stored in merthiolate-iodineformaldehyde solution were screened for parasites. Stool cultures set up in the field were screened 2 days later for enteropathogenic bacteria. Serum samples were investigated at the Institut Pasteur de Bangui for Ebola Virus (sequence detection by RT PCR, ELISA IgM capture assay, ELISA antigen detection with IgM capture), Marburg virus (IgG and IgM), Rift Valley fever virus (ELISA antigen detection, FI ISA-IgM capture assay, viral isolation on Vero E6 cells), yellow fever virus (IgM), Rift Valley fever virus (IgG), CCHF virus (IgG) and hanta viruses (Hantaan, Seoul, Pumala). All were negative. Serum samples were negative for Ebola virus in the Institut Pasteur, Paris. Non-polio enterovirus was detected in 12 (54·5%) patients; parasites, including flagellates, amoebae, and helminths in 17 (77·3%); Entamoeba histolytica histolytica in seven. Stool cultures identified 11 (50%) patients infected with Escherichia coli 0157:H7; nine (41%) with Shigella dysenteriae type 1; and two (9%) with S boydii. Two patients were infected with both S dysenteriae type 1 and E coli 0157:H7, and one with both S dysenteriae type 1 and S boydii. PCR1Germani Y Bégaud E Le Bouguénec C Detection of Escherichia coli attaching and effacing gene (eaeA) in enteropathogenic strains by polymerase chain reaction.Res Microbiol. 1997; 148: 177-181Crossref PubMed Scopus (14) Google Scholar, 2Pollard DR Johnson WM Lior H Tyser SD Rozee R Rapid and specific detection of verotoxin genes in Escherichia coli by the polymerase reaction.J Clin Microbiol. 1990; 28: 540-545PubMed Google Scholar, 3Tyler SD Johnson WM Lior H Rozee R Identification of verotoxin type 2 variant B subunit genes in Escherichia coli by the polymerase chain reaction and restriction fragment length polymorphism analysis.J Clin Microbiol. 1991; 29: 1339-1343PubMed Google Scholar on E coli 0157:H7 showed DNA fragments of 130 and 494 nucleotides corresponding to amplified Shiga-like toxin 1 and to the attaching and effacing gene eaeA. Eight of nine S dysenteriae type 1 had similar patterns of resistance to amoxicillin and ticarcillin alone or in combination with clavulanic acid, tetracyclines, chromaphenicol, and cotrimoxazole. One was resistant to amoxicillin and ticarcillin only; they were all sensitive to nalidixic acid, ciprofloxacin, and other new quinolones. Both S boydii were resistant to tetracyclines only. All E coli 0157:H7 tested were resistant to amoxicillin and chloramphenicol. Before 1998, infections or outbreaks of enterohaemorrhagic E coli had not been reported in Cameroon as a cause of bloody diarrhoea. Similar observations were made in two central African Republic's at Bangui and at Zémio.4Germani Y Soro B Vohito M Morel O Morvan J Enterohaemorrhagic Escherichia coli in Central African Republic;.Lancet. 1997; 349: 1670Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Enterohaemorrhagic E coli emerged there in 1997 and the major contributing factor was consumption of pies (kanda) prepared with smoked zebu meat. In some cases of bloody diarrhoea at Ngoïla, food history pointed to the consumption of smoked game meat. Epidemic S dysenteriae type 1 infection has re-emerged in Central Africa.5Keush GT Bennish ML Shigellosis: recent progress, persisting problems and research issues.Pediatr Infect Dis J. 1989; 8: 713-719Crossref PubMed Scopus (51) Google Scholar At Ngoïla transmission was via person-to-person contact because of lack of personal and collective hygiene, and the high mortality rate during this outbreak was probably linked to the coexistence of three major enteropathogens, enterohaemorrhagic E coli, S dysenteriae type 1, and Entamoeba histolytica histolytica, and a lack of treatment at the begining of the epidemic, which is still in progress in villages along the road to Lomié (2°51′N, 13°52′E), the main city of the district.