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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Diagnostic accuracy of pcr in gambiense sleeping sickness diagnosis, staging and post-treatment follow-up: A 2-year longitudinal study
PLoS Neglected Tropical Diseases, Volume 5, No. 2, Article e972, Year 2011
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Description
Background:The polymerase chain reaction (PCR) has been proposed for diagnosis, staging and post-treatment follow-up of sleeping sickness but no large-scale clinical evaluations of its diagnostic accuracy have taken place yet.Methodology/Principal Findings:An 18S ribosomal RNA gene targeting PCR was performed on blood and cerebrospinal fluid (CSF) of 360 T. brucei gambiense sleeping sickness patients and on blood of 129 endemic controls from the Democratic Republic of Congo. Sensitivity and specificity (with 95% confidence intervals) of PCR for diagnosis, disease staging and treatment failure over 2 years follow-up post-treatment were determined. Reference standard tests were trypanosome detection for diagnosis and trypanosome detection and/or increased white blood cell concentration in CSF for staging and detection of treatment failure. PCR on blood showed a sensitivity of 88.4% (84.4-92.5%) and a specificity of 99.2% (97.7-100%) for diagnosis, while for disease staging the sensitivity and specificity of PCR on cerebrospinal fluid were 88.4% (84.8-91.9%) and 82.9% (71.2-94.6%), respectively. During follow-up after treatment, PCR on blood had low sensitivity to detect treatment failure. In cerebrospinal fluid, PCR positivity vanished slowly and was observed until the end of the 2 year follow-up in around 20% of successfully treated patients.Conclusions/Significance:For T.b. gambiense sleeping sickness diagnosis and staging, PCR performed better than, or similar to, the current parasite detection techniques but it cannot be used for post-treatment follow-up. Continued PCR positivity in one out of five cured patients points to persistence of living or dead parasites or their DNA after successful treatment and may necessitate the revision of some paradigms about the pathophysiology of sleeping sickness. © 2011 Deborggraeve et al.
Authors & Co-Authors
Deborggraeve, Stijn
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Leuven
Rega Institute for Medical Research
Lejon, Veerle
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Ekangu, Rosine A.
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Democratic Republic Congo, Kinshasa
Institut National de Recherche Biomédicale
Mumba Ngoyi, Dieudonné
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Democratic Republic Congo, Kinshasa
Institut National de Recherche Biomédicale
Pyana, Pati Patient
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Democratic Republic Congo, Kinshasa
Institut National de Recherche Biomédicale
Ilunga, Médard
Democratic Republic Congo, Kinshasa
Programme National de Lutte Contre la Trypanosomiase Humaine Africaine
Mulunda, Jean Pierre
Democratic Republic Congo, Kinshasa
Programme National de Lutte Contre la Trypanosomiase Humaine Africaine
Büscher, Philippe
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Statistics
Citations: 62
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pntd.0000972
Research Areas
Genetics And Genomics
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Congo