Confirmation of the use of Latex IgM on cerebrospinal fluid for improving stage determination of Human African Trypanosomiasis

The clinical evolution of the chronic form of Human African Trypanosomiasis starts with the haematolymphatic or first stage (P1). The meningoencephalitic or second stage (P2) begins when trypanosomes reach the cerebrospinal fluid (CSF). The classical stage determination method is based on CSF cell count, CSF protein concentration and/or the presence of trypanosomes detected in CSF. However their cutoff values and the sensitivity of detection of trypanosomes in CSF remains doubtful while the appropriate treatment depends on this determination of disease stage. Thus, the classical stage determination is reconsidered using new serological tests, and results were compared to the clinical data. Thirty-eight patients were classified into 4 clinical groups according to the observed degree of severity of neuropsychiatric signs. Based on multivariate analysis to evaluate the relevance of the new serological tests as compared with clinical groups, we confirm that Latex IgM CSF, cheap and easy to perform under field conditions, may improve stage determination of the disease

Characterization of Trypanosoma brucei gambiense stocks isolated from humans by RAPD fingerprinting in Côte d'Ivoire: another evidence for multiple infections

Trypanosoma brucei gambiense was isolated twice from each of 23 patients in Côte d'Ivoire. Genetic characterization using RAPD (Random Primed Amplified Polymorphic DNA) showed additional variability within a given isoenzyme profile (zymodeme), confirming that this fingerprinting method has a higher discriminative power (faster molecular clock) than isoenzymes. RAPD confirmed also the evidence of multiple infections by different genotypes in the same patient despite a low genetic variability among Trypanosoma brucei gambiense stocks. The involvement of this phenomenon in treatment failure is discussed. Key Words: Human African Trypanosomiasis, Trypanosoma brucei gambiense, RAPD, multiple infections. African Journal of Biotechnology Vol.3(1) 2004: 94-9

Impact de la dynamique de peuplement sur la distribution des glossines et des trypanosomoses dans la boucle du Mouhoun (Burkina Faso)

In Burkina Faso, the Mouhoun river basin (formerly 'Black Volta") constitutes a historical focus of Human (HAT) and Animal (AAT) African Tryponosomoses, both transmitted by tsetse flies. Nowadays, HAT seems to have disappeared from this area, while AAT still causes severe economic losses. In order to explain these different epidemiological situations, we undertook a geographical study based on the analysis of aerial pictures between 1952 and 2007, and field surveys to collect medical, entomological, and veterinary data on trypanosomoses. Our results suggest that in this area, landscapes have been dramatically modified as a consequence of population growth, and in turn have had an impact on the number and distribution of tsetse flies. Combined with the historical medical action on HAT which probably led to the disappearance of T. b. gambiense, this environmental degradation and the development of hydrological structures provide explanations for the local disappearance of HAT, and for the maintenance of AAT. It appears necessary to extrapolate these studies to other areas in order to identify the factors explaining the presence/absence of trypanosomoses in the context of human population growth and climatic changes, in orde

: The impact of war on the evolution of sleeping sickness in west-central Cote d'Ivoire

International audienceTo evaluate the situation of sleeping sickness in west-central Cote d'Ivoire from 2000 to 2003, in view of the war which broke out in September 2002. Active surveys by medical teams and passive case detection. Between 2000 and 2003, 250 patients were diagnosed with sleeping sickness. At first it appeared that sleeping sickness prevalence had fallen since the beginning of political troubles. But this apparent drop was due to poor population coverage. Participation in medical surveys differed according to ethnic group, reflecting land use conflicts between ethnic communities. Such conflicts are common in this area, but have been exacerbated by the war. In war, assessing the importance of sleeping sickness by medical surveys only is very difficult. But detection of sleeping sickness cases by passive surveillance increased.Evaluer la situation de la maladie du sommeil dans le centre-ouest de la Cote d'Ivoire de 2000 a 2003, en tenant compte des evenements survenus depuis en septembre 2002. Enquete active realisee par des equipes medicales et detection passive des cas. Entre 2000 et 2003, 250 patients ont ete diagnostiques pour la maladie du sommeil. De prime abord la prevalence de la maladie du sommeil semblait avoir baisse depuis le debut de la guerre. Mais cette baisse apparente etait due a une faible couverture de la population. La participation dans l'enquete medicale etait differente selon le groupe ethnique, refletant les conflits entre les differentes communautes pour les terres. De tels conflits sont courants dans la zone mais ont ete exacerbes par la guerre. L'evaluation de l'importance de la maladie du sommeil durant la guerre par enquete medicale seule est tres difficile. Mais la detection de la maladie du sommeil par surveillance passive a augmente

Towards understanding the presence/absence of Human African Trypanosomosis in a focus of Côte d'Ivoire: a spatial analysis of the pathogenic system

BACKGROUND: This study aimed at identifying factors influencing the development of Human African Trypanosomosis (HAT, or sleeping sickness) in the focus of Bonon, located in the mesophile forest of Côte d'Ivoire. A previous study mapping the main daytime activity sites of 96 patients revealed an important disparity between the area south of the town- where all the patients lived- and the area north of the town, apparently free of disease. In order to explain this disparity, we carried out a spatial analysis of the key components of the pathogenic system, i.e. the human host, the tsetse vector and the trypanosomes in their environment using a geographic information system (GIS). RESULTS: This approach at the scale of a HAT focus enabled us to identify spatial patterns which linked to the transmission and the dissemination of this disease. The history of human settlement (with the rural northern area exploited much earlier than the southern one) appears to be a major factor which determines the land use pattern, which itself may account for differences found in vector densities (tsetse were found six times more abundant in the southern rural area than in the northern). Vector density, according to the human and environmental context in which it is found (here an intense mobility between the town of Bonon and the rural areas), may explain the observed spatial differences in HAT prevalence. CONCLUSION: This work demonstrates the role of GIS analyses of key components of the pathogenic system in providing a better understanding of transmission and dissemination of HAT. Moreover, following the identification of the most active transmission areas, and of an area unfavourable to HAT transmission, this study more precisely delineates the boundaries of the Bonon focus. As a follow-up, targeted tsetse control activities starting north of Bonon (with few chances of reinvasion due to very low densities) going south, and additional medical surveys in the south will be proposed to the Ivoirian HAT control program to enhance the control of the disease in this focus. This work also shows the evolution of HAT regarding time and environment, and the methodology used may be able to predict possible sleeping sickness development/extinction in areas with similar history and space organization

DIAGNOSTIC TOOLS FOR HUMAN AFRICAN TRYPANOSOMIASIS ELIMINATION AND CLINICAL TRIALS: THE DITECT-HAT PROJECT

Background Trypanosoma brucei gambiense (Tbg) causes human African trypanosomiasis (HAT), one of the neglected tropical diseases targeted for elimination. Integration of diagnosis and case management into the general health system, sustainable monitoring of eliminated foci and development of safe and efficacious drugs, remain important challenges. Methods The DiTECT-HAT project tackles these challenges. For passive case detection, we will determine the diagnostic performance and cost of rapid diagnostic tests (RDTs) performed on clinical suspects in peripheral health centres, whether or not combined with serological and/or molecular tests on filter paper done at regional reference centres. Cost-effective diagnostic algorithms with high positive predictive values might allow test-and-treat scenarios without the need for complicated parasitological confirmations. Secondly, health workers performing house to house visits in foci with very low HAT prevalence can easily collect blood on filter paper and send it to regional HAT reference centres for analysis. The feasibility and cost of diagnostic algorithms with RDTs, serological and molecular high-throughput tests for post-elimination monitoring will be determined. An appropriate threshold will be established to trigger active case finding to avoid re-emergence of HAT, without unnecessarily raising the alarm. Finally, the accuracy of neopterin and RNA detection as early test-of-cure will be determined in therapeutic trials. Earlier treatment outcome assessment will speed up the development of new drugs for HAT, and improve management of relapses in routine care. Results An update of ongoing and planned activities is given. The passive case detection sub-project is being set up in DR Congo, Côte d'Ivoire and Guinea. The inclusions for the early test-of-cure sub-project are ongoing in DR Congo. Conclusions The proposed research will provide evidence to support policies for improved HAT diagnosis and patient management within a context of disease elimination, and will contribute to successful and sustainable HAT elimination

Tsetse elimination : its interest and feasibility in the historical sleeping sickness focus of Loos Islands, Guinea

Guinea is the West African country which is currently the most prevalent for sleeping sickness. The littoral area is the region where most of the recent sleeping sickness cases have been described, especially the mangrove sleeping sickness foci of Dubreka and Boffa where Glossina palpalis gambiensis is the vector. Loos islands constitute a small archipelago 5 km apart from the capital, Conakry. Medical, animal, and entomological surveys were implemented in these islands in Oct-Nov 2006. No pathogenic tryponosomes were found in these surveys. The locally very high tsetse densities (up to more than 100 tsetse/trap/day) linked to pig rearing, constitute a high potential risk for humans (taking into account populations movements with neighboring active sleeping sickness foci,of the Guinea littoral, and the history of sleeping sickness on these islands), and for the economically important pig rearing, as well as a danger for tourism. This situation, associated to the possibility of elimination of these tsetse populations due to low possibility of reinvasion, led the National Control Program to launch a tsetse elimination project following an "area wide" strategy for the first time in West Africa, which participates in the global objective of the PATTEC (Pan African Tsetse and Trypanosomosis Eradication Campaign)