Cerebrospinal fluid B lymphocyte identification for diagnosis and follow-up in human African trypanosomiasis in the field

Abstract

Summaryobjectives In human African trypanosomiasis (HAT, sleeping sickness), staging of disease and treatment follow-up relies on white cell count in the cerebrospinal fluid (CSF). As B lymphocytes (CD19 positive cells) are not found in the CSF of healthy individuals but occur in neurological disorders such as multiple sclerosis, B lymphocyte count may be useful for field diagnosis ⁄ staging and therapeutic followup in HAT.methods Seventy-one HAT patients were diagnosed and 50 were followed-up 6-24 months after treatment. White cell counts were used for conventional staging (stage 1, £5 cells ⁄ ll CSF, n = 42; stage 2, ‡20 cells ⁄ ll, n = 16) and intermediate stage (6-19 cells ⁄ ll, n = 13). Slides containing 1 ll of CSF mixed with Dynabeads Ò CD19 pan B were examined microscopically to detect B cell rosettes (bound to at least four beads).results Stage 1 patients exhibited zero (n = 37) or one CSF rosette ⁄ ll (n = 5), contrary to most stage 2 patients (14 ⁄ 16: ‡2 rosettes ⁄ ll). Intermediate stage patients expressed 0 (n = 9), 1 (n = 3) or 2 (n = 1) rosettes ⁄ ll of CSF. During follow-up, rosette counts correlated with white cell count staging but were much easier to read.conclusion B cell rosettes being easily detected in the CSF in field conditions may be proposed to replace white cell count for defining HAT stages 1 and 2 and limit uncertainty in treatment decision in patients with intermediate stage.

Polysomnography as a diagnosis and post-treatment follow-up tool in human African trypanosomiasis: A case study in an infant

“…These aspects clearly indicated the existence of a polysomnographic syndrome, demonstrating a disturbance of the circadian temporal regulation of sleep and wake states and an alteration in internal sleep structure [8,10,11]. The pathological character of the sleep-wake recording was confirmed by elevated CSF WBC and CD19 B cell counts recently applied in HAT (Table 1) [11,14].…”

Management of African Trypanosomiasis of the Cns: Polysomnography As A Noninvasive Staging Tool

“…A new technique based on the identification of B lymphocytes in the CSF by Dynabeads ® (Invitrogen, CA, USA) was also applied for staging [12], as the presence of such cells in the CSF of a patient infected by trypanosomes is indicative of an ongoing inflammatory or infectious process in the CNS. During the post-treatment follow-up sessions, staging criteria applied recent WHO recommendations based on CSF trypanosome detection and/or WBC counts [34].…”

“…Searching for CSF trypanosomes is often unsuccessful, even after simple or double centrifugation [9,10], and WBC counts remain an essential key to adapted therapeutics [11]. Recently, our team developed a test based on the detection of B lymphocytes in the CSF, using CD19 antibody beads [12]. The presence of B lymphocytes in the CSF indicates an inflammatory or infectious process in the CNS.…”

Serum Arginase, a Biomarker of Treatment Efficacy in Human African Trypanosomiasis

“…Screening tests on whole blood used the serological card agglutination trypanosomiasis test. Parasites were searched in aspirates from cervical lymph glands and/or blood after parasite concentration by capillary tube centrifugation and/or the mini-anion-exchange centrifugation technique (6). Inclusion criteria stipulated that patients were parasitologically confirmed.…”

“…Patients (n ϭ 32) were recruited from a previously described group (6). The field survey took place in the "Couloir" focus in the Republic of Congo (Brazzaville).…”