The Natural Progression of Gambiense Sleeping Sickness: What Is the Evidence?

Checchi, Francesco; Filipe, J. A. N.; Barrett, Michael P.; Chandramohan, Daniel

doi:10.1371/journal.pntd.0000303

Cited by 80 publications

(74 citation statements)

References 70 publications

(62 reference statements)

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“…These individuals can become aparasitemic by microscopy, while keeping a polymerase chain reaction intermittently positive and a trypanolysis test positive 60. They could be asymptomatic chronic carriers of the infection, and a source of vector infection that maintains the transmission of gambiense HAT in some cases 61. This could be similar to the phenomena of trypanotolerance, which is well described in animals 62,63…”

Section: Transmission Cyclementioning

confidence: 88%

Epidemiology of human African trypanosomiasis

Franco¹,

Simarro²,

Diarra³

et al. 2014

CLEP

259

230

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Human African trypanosomiasis (HAT), or sleeping sickness, is caused by Trypanosoma brucei gambiense, which is a chronic form of the disease present in western and central Africa, and by Trypanosoma brucei rhodesiense, which is an acute disease located in eastern and southern Africa. The rhodesiense form is a zoonosis, with the occasional infection of humans, but in the gambiense form, the human being is regarded as the main reservoir that plays a key role in the transmission cycle of the disease. The gambiense form currently assumes that 98% of the cases are declared; the Democratic Republic of the Congo is the most affected country, with more than 75% of the gambiense cases declared. The epidemiology of the disease is mediated by the interaction of the parasite (trypanosome) with the vectors (tsetse flies), as well as with the human and animal hosts within a particular environment. Related to these interactions, the disease is confined in spatially limited areas called “foci”, which are located in Sub-Saharan Africa, mainly in remote rural areas. The risk of contracting HAT is, therefore, determined by the possibility of contact of a human being with an infected tsetse fly. Epidemics of HAT were described at the beginning of the 20th century; intensive activities have been set up to confront the disease, and it was under control in the 1960s, with fewer than 5,000 cases reported in the whole continent. The disease resurged at the end of the 1990s, but renewed efforts from endemic countries, cooperation agencies, and nongovernmental organizations led by the World Health Organization succeeded to raise awareness and resources, while reinforcing national programs, reversing the trend of the cases reported, and bringing the disease under control again. In this context, sustainable elimination of the gambiense HAT, defined as the interruption of the transmission of the disease, was considered as a feasible target for 2030. Since rhodesiense HAT is a zoonosis, where the animal reservoir plays a key role, the interruption of the disease’s transmission is not deemed feasible.

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Section: Transmission Cyclementioning

confidence: 88%

Epidemiology of human African trypanosomiasis

Franco¹,

Simarro²,

Diarra³

et al. 2014

CLEP

259

230

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“…African sleeping sickness and Chagas' disease are both potentially fatal in the absence of treatment (32,103) regardless of the presence of HIV.…”

Section: Trypanosomamentioning

confidence: 99%

Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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SUMMARY There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.

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“…When its treatment is delayed, the chances of recovery without neurologic sequels are minimal. In the absence of adequate treatment, the patient evolves toward apathy, terminal sleeping cachexia, coma and death [31,32,33,34].…”

Section: Justification Of the Investigationmentioning

confidence: 99%

Risk Factors of Human African Trypanosomiasis in Mbuji Mayi, Eastern Kasai Province, Democratic Republic of the Congo

Mpiana¹,

Mpinga²,

Tshilonda³

et al. 2015

IJTDH

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Aims: Our study is aimed at determining the risk factors of Human African Trypanosomiasis (HAT) in Mbuji Mayi, Eastern Kasai Province, Democratic Republic of the Congo. Study Design: We used a case-control design with a ratio of 2 controls for every HAT case. Place and Duration of Study: Our multidisciplinary research team collected primary data on cases of HAT patients treated at the Referral and Treatment Center of Dipumba in Mbuji Mayi in 2012 and on their controls of similar gender and age, living in Mbuji Mayi, but free of HAT infection. Methodology: We analyzed data, using both descriptive and analytical statistical procedures such univariate and multivariate methods of logistic regression. The association between the different factors studied and HAT infection has been determined by estimating the odds-ratio (OR) with a confidence interval (CI) of 95% and a P-value of less than 0.05. We interviewed 180 subjects (60 cases and 120 controls). Results: The 60 cases were predominantly male (male-female ratio of 2.2:1) with the majority (53%) in the age group of 20-40 years. Subjects in the age group of over 40 represented 28.3% of the patients. The same patterns were seen in the control group. The age of interviewees varies from 11 to 65 years. HAT cases reported drawing water from wells (16.7% vs 6.7%; P > .05), walking along the river bed and in the peat lands (11.7% vs 9.2%; P > .05) at a higher rate than controls. The HAT cases reported involvement in various activities that put them in much closer proximity with water sources: bathing (8.3% vs 6.6%; P >.05), dishwashing and laundry (20% vs 37.5%), fetching household water (50% vs 24.2%; P<.0001), cassava retting roots (1,7% vs 7.5%), diamond digging in the mines (51.7% vs 21.6%; P < .0001), trafficking or buying diamond from diggers (13,3% vs 8.3% ; P > .05). Conclusion: Involvement in activities that connect with water sources increases the risk of acquiring HAT infection in Mbuji Mayi.

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The Natural Progression of Gambiense Sleeping Sickness: What Is the Evidence?

Cited by 80 publications

References 70 publications

Epidemiology of human African trypanosomiasis

Epidemiology of human African trypanosomiasis

Importance of Nonenteric Protozoan Infections in Immunocompromised People

Risk Factors of Human African Trypanosomiasis in Mbuji Mayi, Eastern Kasai Province, Democratic Republic of the Congo

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