1921
Volume 71, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

The diagnosis of human African trypanosomiasis (HAT) due to relies on an initial serologic screening with the card agglutination test for trypanosomiasis (CATT) for , followed by parasitologic confirmation in most endemic areas. Unfortunately, field parasitologic methods lack sensitivity and the management of serologically suspected individuals (i.e., individuals with a positive CATT result but negative parasitology) remains controversial. In Kajo-Keji County in southern Sudan, we prospectively collected sociodemographic and laboratory data of a cohort of 2,274 serologically suspected individuals. Thirty-three percent (n = 749) attended at least one follow-up visit and HAT was confirmed in 64 (9%) cases. Individuals with lower initial CATT-plasma (CATT-P) end-dilution titers had lowest risks (10.4 and 13.8/100 person-years for 1:4 and 1:8 titers, respectively) that significantly increased for higher dilutions: relative risks = 5.1 (95% confidence interval [CI] = 2.6–9.5) and 4.6 (95% CI = 2.8–9.8) for 1:16 and 1:32 titers, respectively. The cumulative yearly risk was also high (76%) in individuals found with 11–20 cells in the cerebrospinal fluid, but this involved only eight patients. Adjustment for potential confounders did not affect the results. In conclusion, treatment with pentamidine should be considered for all serologically suspected individuals with a CATT-P end-dilution titer ≥ 1:16 in areas of a moderate to high prevalence of HAT.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2004.71.313
2004-09-01
2017-11-23
Loading full text...

Full text loading...

/deliver/fulltext/14761645/71/3/0700313.html?itemId=/content/journals/10.4269/ajtmh.2004.71.313&mimeType=html&fmt=ahah

References

  1. Magnus E, Vervoort T, van Meirvenne N, 1978. A card-agglutination test with stained trypanosomes (C.A.T.T.) for the serological diagnosis of T. b. gambiense trypanosomiasis. Ann Soc Belg Med Trop 58 : 169–176.
  2. Truc P, Lejon V, Magnus E, Jamonneau V, Nangouma A, Verloo D, Penchenier L, Büscher P, 2002. Evaluation of the micro-CATT, CATT/Trypanosoma brucei gambiense, and LATEX/T. b. gambiense methods for serodiagnosis and surveillance of human African trypanosomiasis in west and central Africa. Bull World Health Organ 80 : 882–886.
  3. Jamonneau V, Truc P, Garcia A, Magnus E, Büscher P, 2000. Preliminary evaluation of latex/T. b. gambiense and alternative versions of CATT/T. b. gambiense for the serodiagnosis of human African trypanosomiasis of a population at risk in Côte d’Ivoire: considerations for mass-screening. Acta Trop 76 : 175–183.
  4. van Meirvenne N, 1999. Biological diagnosis of human African trypanosomiasis. Dumas M, Bouteille B, Buguet A, eds. Progress in Human African Trypanosomiasis, Sleeping Sickness. Paris: Springer Verlag, 235–252.
  5. World Health Organization, 1998. Control and surveillance of African trypanosomiasis. Report of a WHO Expert Committee. World Health Organ Tech Report Series 881 : 1–113.
  6. Ancelle T, Paugam A, Bourlioux F, Merad A, Vigier JP, 1997. Détection des trypanosomes dans le sang par la technique du quantitative buffy coat (QBC): évaluation expérimentale. Med Trop (Mars) 57 : 245–248.
  7. Simarro PP, Ruiz JA, Franco JR, Josenando T, 1999. Attitude towards CATT-positive individuals without confirmation in the African trypanosomiasis (T.b.gambiense) focus of Quiçama (Angola). Trop Med Int Health 4 : 858–861.
  8. Garcia A, Jamonneau V, Magnus E, Laveissière C, Lejon V, Nguessan P, Ndri L, Vanmeirvenne N, Büscher P, 2000. Follow-up of card agglutination trypanosomiasis test (CATT) positive but apparently aparasitaemic individuals in Côte d’Ivoire: evidence for a complex and heterogeneous population. Trop Med Int Health 5 : 786–793.
  9. Chappuis F, Pittet A, Bovier PA, Adams K, Godineau V, Hwang SY, Magnus E, Büscher P, 2002. Field Evaluation of the CATT/Trypanosoma brucei gambiense on blood-impregnated filter papers for diagnosis of human African trypanosomiasis in southern Sudan. Trop Med Int Health 11 : 942–948.
  10. Doua F, Miezan TW, Sanon Singaro JR, Boa Yapo F, Baltz T, 1996. The efficacy of pentamidine in the treatment of early-late stage Trypanosoma brucei gambiense trypanosomiasis. Am J Trop Med Hyg 55 : 586–588.
  11. Lejon V, Legros D, Savignoni A, Etchegorry MG, Mbulamberi D, Büscher P, 2003. Neuro-inflammatory risk factors for treatment failure in “early second stage” sleeping sickness patients treated with pentamidine. J Neuroimmunol 144 : 132–138.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2004.71.313
Loading
/content/journals/10.4269/ajtmh.2004.71.313
Loading

Data & Media loading...

  • Received : 10 Feb 2004
  • Accepted : 05 Apr 2004

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error