Abstract
Human African Trypanosomiasis may become manageable in the next decade with fexinidazole. However, currently stage diagnosis remains difficult to implement in the field and requires a lumbar puncture. Our study of an Angolan cohort of T. b. gambiense-infected patients used other staging criteria than those recommended by the WHO. We compared WHO criteria (cell count and parasite identification in the CSF) with two biomarkers (neopterin and CXCL-13) which have proven potential to diagnose disease stage or relapse. Biological, clinical, and neurological data were analysed from a cohort of 83 patients. A neopterin concentration below 15.5 nmol/L in the CSF denoted patients with stage 1 disease, and a concentration above 60.31 nmol/L characterized patients with advanced stage 2 (trypanosomes in CSF and/or cytorachia higher than 20 cells) disease. CXCL-13 levels below 91.208 pg/mL denoted patients with stage 1 disease, and levels of CXCL-13 above 395.45 pg/mL denoted patients with advanced stage 2 disease. Values between these cut-offs may represent patients with intermediate stage disease. Our work supports the existence of an intermediate stage in HAT, and CXCL-13 and neopterin levels may help to characterize it.
Highlights
It is hoped that sleeping sickness will become manageable within the decade, as suggested by the WHO [1, 2]
Patients with stage 1 disease had a mean cerebrospinal fluid (CSF) white blood cell (WBC) count of 1.83 cells/μL, and no trypanosomes were detected in the CSF
Patients with intermediate stage disease had a mean WBC count of 10.05, and three patients had trypanosomes in their CSF, the WBC counts of these patients were less than 5 cells/μL
Summary
It is hoped that sleeping sickness will become manageable within the decade, as suggested by the WHO [1, 2]. In 2016, the number of patients with sleeping sickness has been reported as fewer than 4,000 but there are still unreported cases, and the estimate of actual cases is around 20,000 infected people in the remaining endemic countries in Africa. E availability of easy-to-use molecules such as fexinidazole (oral intake) will help to reduce the remaining burden of the disease [3, 4]. Pentamidine (for gambiense-HAT) remains the molecule indicated for the treatment of stage 1 of the disease. The skin has been suggested as possible reservoir of latent infection, leading to relapse [7], and several authors have
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
