Conflict and human African trypanosomiasis

Berrang‐Ford, Lea; Lundine, Jamie; Breau, Sébastien

doi:10.1016/j.socscimed.2010.06.006

Cited by 34 publications

(23 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…African trypanosomiasis and rabies (and some other NTDs) were also greatly diminished, the former possibly due to increased access to public health control in association with the resolution of some civil and international conflicts in sub-Saharan Africa [44]. In contrast, DALY estimates for schistosomiasis, lymphatic filariasis, and trachoma appear to have increased over the past 20 years.…”

Section: Trendsmentioning

confidence: 99%

The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases

et al. 2014

View full text Add to dashboard Cite

show abstract

Section: Trendsmentioning

confidence: 99%

The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases

et al. 2014

View full text Add to dashboard Cite

show abstract

“…It is estimated, however, that a significant number of new cases remain unreported or undiagnosed [3–5]. It is also important to consider that there is a lengthy lag in outbreaks of the disease after periods of conflict or socio-political instability [6]. Concern is currently raised by outbreaks in the Ivory Coast [7] and South Sudan [8], by the discovery of the presence of asymptomatic carriers [9, 10], and by the resurgence of an old focus in Zambia [11].…”

Section: Introductionmentioning

confidence: 99%

Trypanosoma brucei Invasion and T-Cell Infiltration of the Brain Parenchyma in Experimental Sleeping Sickness: Timing and Correlation with Functional Changes

et al. 2016

View full text Add to dashboard Cite

BackgroundThe timing of Trypanosoma brucei entry into the brain parenchyma to initiate the second, meningoencephalitic stage of human African trypanosomiasis or sleeping sickness is currently debated and even parasite invasion of the neuropil has been recently questioned. Furthermore, the relationship between neurological features and disease stage are unclear, despite the important diagnostic and therapeutic implications.MethodologyUsing a rat model of chronic Trypanosoma brucei brucei infection we determined the timing of parasite and T-cell neuropil infiltration and its correlation with functional changes. Parasite DNA was detected using trypanosome-specific PCR. Body weight and sleep structure alterations represented by sleep-onset rapid eye movement (SOREM) periods, reported in human and experimental African trypanosomiasis were monitored. The presence of parasites, as well as CD4+ and CD8+ T-cells in the neuropil was assessed over time in the brain of the same animals by immunocytochemistry and quantitative analyses.Principal findingsTrypanosome DNA was present in the brain at day 6 post-infection and increased more than 15-fold by day 21. Parasites and T-cells were observed in the parenchyma from day 9 onwards. Parasites traversing blood vessel walls were observed in the hypothalamus and other brain regions. Body weight gain was reduced from day 7 onwards. SOREM episodes started in most cases early after infection, with an increase in number and duration after parasite neuroinvasion.ConclusionThese findings demonstrate invasion of the neuropil over time, after an initial interval, by parasites and lymphocytes crossing the blood-brain barrier, and show that neurological features can precede this event. The data thus challenge the current clinical and cerebrospinal fluid criteria of disease staging.

show abstract

“…Results from recent research have shown that the peak incidence of HAT shows a lag time of 10 years from the start of conflict events. If this observation holds true in the case of the conflict in the DRC, we can expect more troubling prevalence rates before we see a decline [28]. …”

Section: Discussionmentioning

confidence: 99%

Challenges of controlling sleeping sickness in areas of violent conflict: experience in the Democratic Republic of Congo

et al. 2011

View full text Add to dashboard Cite

BackgroundHuman African trypanosomiasis (HAT), or sleeping sickness, is a fatal neglected tropical disease if left untreated. HAT primarily affects people living in rural sub-Saharan Africa, often in regions afflicted by violent conflict. Screening and treatment of HAT is complex and resource-intensive, and especially difficult in insecure, resource-constrained settings. The country with the highest endemicity of HAT is the Democratic Republic of Congo (DRC), which has a number of foci of high disease prevalence. We present here the challenges of carrying out HAT control programmes in general and in a conflict-affected region of DRC. We discuss the difficulties of measuring disease burden, medical care complexities, waning international support, and research and development barriers for HAT.DiscussionIn 2007, Médecins Sans Frontières (MSF) began screening for HAT in the Haut-Uélé and Bas-Uélé districts of Orientale Province in northeastern DRC, an area of high prevalence affected by armed conflict. Through early 2009, HAT prevalence rate of 3.4% was found, reaching 10% in some villages. More than 46,000 patients were screened and 1,570 treated for HAT during this time. In March 2009, two treatment centres were forced to close due to insecurity, disrupting patient treatment, follow-up, and transmission-control efforts. One project was reopened in December 2009 when the security situation improved, and another in late 2010 based on concerns that population displacement might reactivate historic foci. In all of 2010, 770 patients were treated at these sites, despite a limited geographical range of action for the mobile teams.SummaryIn conflict settings where HAT is prevalent, targeted medical interventions are needed to provide care to the patients caught in these areas. Strategies of integrating care into existing health systems may be unfeasible since such infrastructure is often absent in resource-poor contexts. HAT care in conflict areas must balance logistical and medical capacity with security considerations, and community networks and international-response coordination should be maintained. Research and development for less complicated, field-adapted tools for diagnosis and treatment, and international support for funding and program implementation, are urgently needed to facilitate HAT control in these remote and insecure areas.

show abstract

Conflict and human African trypanosomiasis

Cited by 34 publications

References 42 publications

The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases

The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases

Trypanosoma brucei Invasion and T-Cell Infiltration of the Brain Parenchyma in Experimental Sleeping Sickness: Timing and Correlation with Functional Changes

Challenges of controlling sleeping sickness in areas of violent conflict: experience in the Democratic Republic of Congo

Contact Info

Product

Resources

About