Abstract
BackgroundThe acute form of Human African Trypanosomiasis (HAT, also known as Sleeping sickness) caused by Trypanosoma brucei rhodesiense has been shown to have a wide spectrum of focus specific clinical presentation and severity in East and Southern Africa. Indeed HAT occurs in regions endemic for other tropical diseases, however data on how these co-morbidities might complicate the clinical picture and affect disease outcome remains largely scanty. We here describe the clinical presentation, presence of co-infections, and how the latter impact on HAT prognosis.Methods and FindingsWe carried out a retrospective analysis of clinical data from 258 sleeping sickness patients reporting to Lwala hospital between 2005 and 2012. The mean patient age was 28.6 years with a significant number of cases below 18 years (p< 0.0001). About 93.4% of the cases were diagnosed as late stage (p< 0.0001). The case fatality rate was 10.5% with post treatment reactive encephalopathys reported in 7.9% of the cases, of whom 36.8% eventually died. Fever was significantly (p = 0.045) higher in patients under 18 years. Of the early stage patients, 26.7% and 6.7% presented with late stage signs of sleep disorder and mental confusion respectively. Among the co-infections, malaria was significantly more prevalent (28.9%; p< 0.0001) followed by urinary tract infections (4.2%). Co-infections were present in 14.3% of in-hospital deaths, 38.5% of which were recorded as Malaria. Malaria was significantly more common in patients under 18 years (45.5%; p< 0.02), and was reported in 60% of the fatal cases in this age group.ConclusionsWe show a wide spectrum of sleeping sickness clinical presentation and disease outcome that was apparently not significantly influenced by concurrent infections. It would thus be interesting to determine the host and/or parasite factors that might be responsible for the observed diverse clinical presentation.
Highlights
Human African Trypanosomiasis (HAT) or sleeping sickness is caused by extra-cellular protozoan parasites T. b. rhodesiense (East and Southern Africa) and T. b. gambiense (West and central Africa)
The acute form of Human African Trypanosomiasis (HAT, known as Sleeping sickness) caused by Trypanosoma brucei rhodesiense has been shown to have a wide spectrum of focus specific clinical presentation and severity in East and Southern Africa
We show a wide spectrum of sleeping sickness clinical presentation and disease outcome that was apparently not significantly influenced by concurrent infections
Summary
Human African Trypanosomiasis (HAT) or sleeping sickness is caused by extra-cellular protozoan parasites T. b. rhodesiense (East and Southern Africa) and T. b. gambiense (West and central Africa). Rhodesiense (East and Southern Africa) and T. b. Trypanosoma brucei rhodesiense HAT has been described as acute while T. b. A wide spectrum of clinical presentation of T. b. Rhodesiense HAT in East Africa was previously reported [4,5]. A study by MacLean et al [5] in Uganda while comparing patients in geographically similar areas (Tororo and Soroti) reported differences in disease presentation and progression. The acute form of Human African Trypanosomiasis (HAT, known as Sleeping sickness) caused by Trypanosoma brucei rhodesiense has been shown to have a wide spectrum of focus specific clinical presentation and severity in East and Southern Africa. We here describe the clinical presentation, presence of co-infections, and how the latter impact on HAT prognosis
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