Human African trypanosomiasis in non-endemic countries.

Human African trypanosomiasis (HAT) or sleeping sickness is a parasitic disease, acquired by the bite of an infected tsetse fly. In non-endemic countries HAT is rare, and therefore the diagnosis may be delayed leading to potentially fatal consequences. In this article the clinical presentation, diagnosis and treatment of the two forms of HAT are outlined. Rhodesiense HAT is an acute illness that presents in tourists who have recently visited game parks in Eastern or Southern Africa, whereas Gambiense HAT has a more chronic clinical course, in individuals from West or Central Africa

Human African trypanosomiasis presenting at least 29 years after infection--what can this teach us about the pathogenesis and control of this neglected tropical disease?

No abstract available

Determinants of HIV-1 transmission in men who have sex with men: a combined clinical, epidemiological and phylogenetic approach

OBJECTIVES To identify biological factors associated with HIV transmission in men who have sex with men (MSM). DESIGN A longitudinal phylogenetic analysis of HIV-1 from an MSM cohort, incorporating clinical and epidemiological data. METHODS Potential individuals were HIV-infected MSM attending a sexual health clinic between 2000 and 2006. Individuals were classified such that they could move from recent to chronic infection categories. HIV-1pol gene sequences were obtained from plasma virus or proviral DNA and clusters estimated by maximum likelihood and conservative genetic distance differences. The single most likely transmitter generating each recent infection was ascertained and risk factors around time of likely transmission explored using Poisson regression modelling. RESULTS Out of 1144 HIV-infected MSM, pol sequence data were obtained for 859 (75%); 159 out of 859 (19%) were recently HIV infected at diagnosis. A single most likely transmitter was identified for 41 out of 159 (26%), of which 11 were recently infected (27%) and 30 chronically infected. Factors associated with transmission in multivariable analysis were: younger age {rate ratio per 5 years older 0.68 [95% confidence interval (CI) 0.54-0.86], P=0.0009}, higher viral load [rate ratio per log higher 1.61 (95% CI 1.15-2.25), P=0.005], recent infection [rate ratio 3.88 (95% CI 1.76-8.55), P=0.0008] and recent sexually transmitted disease [rate ratio 5.32 (95% CI 2.51-11.29), P=0.0001]. HAART was highly protective in a univariable model, RR 0.14 (95% CI 0.07-0.27, P=0.0001). CONCLUSION Onward transmission of HIV among MSM is significantly associated with recent infection, sexually transmitted diseases and higher viral load, and reduced by effective HAART. The majority of new infections appear to occur from individuals whose infection was undiagnosed at the time of transmission

Phylogenetic tree depicting the relationship between our patient's parasite and field isolates taken between 1978–1983.

<p>Neighbour joining tree of <i>T. b. brucei</i>, <i>T. b. gambiense</i> group 1 and <i>T. b. gambiense</i> group 2 isolates from Cote d'Ivoire and <i>T. b. gambiense</i> group 1 isolates from Cameroon and the Democratic Republic of Congo. Our patient's isolate clustered most closely with other Type 1 isolates from Cote d'Ivoire.</p

Timeline of the patient's clinical course.

<p>Timeline is not to scale. Abbreviations: Ab: Antibody ANA: anti-nuclear antibody, ANCA: anti-neutrophil cytoplasmic antibody, BM Bx: bone marrow biopsy, CSF: cerebrospinal fluid, ED: Emergency department, ENA: extractable nuclear antigens, ESR: erythrocyte sedimentation rate, Hb: haemoglobin, LP: lumbar puncture, MRI: magnetic resonance imaging, NECT: nifurtimox-eflornithine combination therapy, NMDA: N-methyl-D-aspartate receptor, PEX: Plasma exchange, PCR: polymerase chain reaction, Plts: platelets, Rx: treated with, VGKC: complex voltage gated potassium channel-complex, WCC: white cell count.</p

Map showing reports of spontaneous clearance of infection (blue squares), or extended duration of infection (red squares).

<p>Abbreviations: sc: spontaneous clearance of infection, y: years. References: <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003349#pntd.0003349-Todd1" target="_blank">[4]</a>–<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003349#pntd.0003349-Barlovatz1" target="_blank">[11]</a>. Adapted from <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003349#pntd.0003349-Checchi1" target="_blank">[3]</a>.</p