No evidence for association with APOL1 kidney disease risk alleles and Human African Trypanosomiasis in two Ugandan populations:

Human African trypanosomiasis (HAT) manifests as an acute form caused by Trypanosoma brucei rhodesiense (Tbr) and a chronic form caused by Trypanosoma brucei gambiense (Tbg). Previous studies have suggested a host genetic role in infection outcomes, particularly for APOL1. We have undertaken a candidate gene association studies (CGAS) in a Ugandan Tbr and a Tbg HAT endemic area, to determine whether polymorphisms in IL10, IL8, IL4, HLAG, TNFA, TNX4LB, IL6, IFNG, MIF, APOL1, HLAA, IL1B, IL4R, IL12B, IL12R, HP, HPR, and CFH have a role in HAT

Prevalence de l’alloimmunisation anti-erythrocytaire chez des patients adresses au laboratoire du Centre National de Transfusion Sanguine (CNTS) d’Abidjan (Côte d’Ivoire)

Introduction: La présente étude avait pour objectif général d’évaluer l’allo-immunisation anti-érythrocytaire dans une population de patients reçus au laboratoire d’analyses externes du Centre National de Transfusion Sanguine d’Abidjan.Méthodologie: Nous avons réalisé une étude rétrospective à partir de la base de données du logiciel médico-technique Progesa et des dossiers d’archive des patients référés au CNTS pour une Recherche d’agglutinines irrégulières (RAI) entre le 1er janvier 2014 et le 31 décembre 2016, sans distinction de sexe ou d’âge.Résultats: Sur les 288 patients inclus, nous avons noté une prédominance féminine (60%). Les sujets de moins de 36 ans prédominaient aussi bien chez les hommes que chez les femmes. La majorité des patients de notre étude provenait des CHU. La prévalence globale de l’allo-immunisation était de 14,2%. Les anticorps du système Rhésus étaient les plus fréquemment en cause (61,1%). L’anticorps anti-E du système Rhésus était le plus retrouvé aussi bien dans les incompatibilités foeto-maternelles (54,5%) que dans le contexte transfusionnel (25%). L’analyse des facteurs de risque de survenue de l’allo-immunisation anti-érythrocytaire n’a montré aucune association statistiquement significative avec le sexe (p=0,64), l’âge (p=0,47), la structure de provenance (p=0,53) et le motif de demande de l’examen (p=0,86).Conclusion: Cette étude confirme une fois de plus l’intérêt de réaliser la RAI chez les sujets polytransfusés ainsi que chez les femmes enceintes Rhésus négatif afin de prévenir les accidents hémolytiques transfusionnels et les anémies hémolytiques néonatales.Mots clés: Allo-immunisation, Anti-érythrocytaire, Recherche d’agglutinines irrégulières, RAIEnglish Title: Prevalence of alloimmunization among patients addressed to the laboratory of the National Blood Transfusion Center (NBTC) of Abidjan (Côte d'Ivoire)English AbstractIntroduction: The aim of this study was to evaluate anti-erythrocyte alloimmunization among a population of patients received at the external analysis laboratory of the National Blood Transfusion Center (NBTC) in Abidjan.Methodology: We carried out a retrospective study from the Progesa medical-technical software database and the files of patients referred to the NBTC for an irregular agglutinin (RAI) search between January 1st, 2014 and December 31st. December 2016, regardless of sex or age.Results: Of the 288 patients included, we noted a female predominance (60%). Subjects younger than 36 years predominated in both men and women. The majority of patients  in our study came from CHUs. The overall prevalence of alloimmunization was 14.2%. Rhesus antibodies were more frequently involved (61.1%). The anti-E antibody of the Rhesus system was found even more in foeto-maternal incompatibility (54.5%) and in the transfusion context (25%). The analysis of the risk factors for the occurrence of antierythrocyte allo-immunization revealed no statistically significant association with sex (p = 0.64), age (p = 0.47), structure of origin (p = 0.53) and the reason for the exam request (p = 0.86).Conclusion: This study is one of most of the results of RAI in polytransfused subjects as well as in Rh-negative pregnant women to prevent hemolytic transfusion events and neonatal haemolytic anemias.Keywords: Alloimmunization, Anti-erythrocyte, Irregular agglutinins, Screenin

The complex health seeking pathway of a human African trypanosomiasis patient in Cote d'Ivoire underlines the need of setting up passive surveillance systems

Background Significant efforts to control human African trypanosomiasis (HAT) over the two past decades have resulted in drastic decrease of its prevalence in Cote d'Ivoire. In this context, passive surveillance, integrated in the national health system and based on clinical suspicion, was reinforced. We describe here the health-seeking pathway of a girl who was the first HAT patient diagnosed through this strategy in August 2017. Methods After definitive diagnosis of this patient, epidemiological investigations were carried out into the clinical evolution and the health and therapeutic itinerary of the patient before diagnosis. Results At the time of diagnosis, the patient was positive in both serological and molecular tests and trypanosomes were detected in blood and cerebrospinal fluid. She suffered from important neurological disorders. The first disease symptoms had appeared three years earlier, and the patient had visited several public and private peripheral health care centres and hospitals in different cities. The failure to diagnose HAT for such a long time caused significant health deterioration and was an important financial burden for the family. Conclusion This description illustrates the complexity of detecting the last HAT cases due to complex diagnosis and the progressive disinterest and unawareness by both health professionals and the population. It confirms the need of implementing passive surveillance in combination with continued sensitization and health staff training. Author summary Human African trypanosomiasis (HAT) or sleeping sickness is a parasitic disease caused byTrypanosoma bruceithat is transmitted by tsetse flies. In 2012, HAT was included in the World Health Organization roadmap for the control of neglected tropical diseases with the objective of elimination as a public health problem by 2020. In Cote d'Ivoire, HAT prevalence has dropped sharply the last decade. A passive HAT surveillance was therefore integrated in the national health system, which allowed to detect a first patient in 2017. This article describes the complex health seeking pathway and suffering before diagnosis of this patient, an 11 years old girl, and illustrates the challenge when health agents and population no longer consider HAT as a threat in an elimination context. Our results show the need to install a solid surveillance system, in combination with continued sensitization and repeated health staff training

Passive surveillance of human African trypanosomiasis in Côte d'Ivoire: Understanding prevalence, clinical symptoms and signs, and diagnostic test characteristics

Background: Little is known about the diagnostic performance of rapid diagnostic tests (RDTs) for passive screening of human African trypanosomiasis (HAT) in Côte d'Ivoire. We determined HAT prevalence among clinical suspects, identified clinical symptoms and signs associated with HAT RDT positivity, and assessed the diagnostic tests' specificity, positive predictive value and agreement. Methods: Clinical suspects were screened with SD Bioline HAT, HAT Sero-K-Set and rHAT Sero-Strip. Seropositives were parasitologically examined, and their dried blood spots tested in trypanolysis, ELISA/Tbg, m18S-qPCR and LAMP. The HAT prevalence in the study population was calculated based on RDT positivity followed by parasitological confirmation. The association between clinical symptoms and signs and RDT positivity was determined using multivariable logistic regression. The tests' Positive Predictive Value (PPV), specificity and agreement were determined. Results: Over 29 months, 3433 clinical suspects were tested. The RDT positivity rate was 2.83%, HAT prevalence 0.06%. Individuals with sleep disturbances (p<0.001), motor disorders (p = 0.002), convulsions (p = 0.02), severe weight loss (p = 0.02) or psychiatric problems (p = 0.04) had an increased odds (odds ratios 1.7-4.6) of being HAT RDT seropositive. Specificities ranged between 97.8%-99.6% for individual RDTs, and 93.3-98.9% for subsequent tests on dried blood spots. The PPV of the individual RDTs was below 14.3% (CI 2-43), increased to 33.3% (CI 4-78) for serial RDT combinations, and reached 67% for LAMP and ELISA/Tbg on RDT positives. Agreement between diagnostic tests was poor to moderate (Kappa ≤ 0.60), except for LAMP and ELISA/Tbg (Kappa = 0.66). Conclusion: Identification of five key clinical symptoms and signs may simplify referral for HAT RDT screening. The results confirm the appropriateness of the diagnostic algorithm presently applied, with screening by SD Bioline HAT or HAT Sero-K-Set, supplemented with trypanolysis. ELISA/Tbg could replace trypanolysis and is simpler to perform