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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
How to shorten patient follow-up after treatment for trypanosoma brucei gambiense sleeping sickness
Journal of Infectious Diseases, Volume 201, No. 3, Year 2010
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Description
Background. Clinical management of human African trypanosomiasis requires patient follow-up of 2 years' duration. At each follow-up visit, cerebrospinal fluid (CSF) is examined for trypanosomes and white blood cells (WBCs). Shortening follow-up would improve patient comfort and facilitate control of human African trypanosomiasis. Methods. A prospective study of 360 patients was performed in the Democratic Republic of the Congo. The primary outcomes of the study were cure, relapse, and death. The WBC count, immunoglobulin M level, and specific antibody levels in CSF samples were evaluated to detect treatment failure. The sensitivity and specificity of shortened follow-up algorithms were calculated. Results. The treatment failure rate was 37%. Trypanosomes, a WBC count of 5≥100 cells/μL, and a LATEX/ immunoglobulin M titer of 5≥ 1:16 in CSF before treatment were risk factors for treatment failure, whereas human immunodeficiency virus infection status was not a risk factor. The following algorithm, which had 97.8% specificity and 94.4% sensitivity, is proposed for shortening the duration of follow-up: at 6 months, patients with trypanosomes or a WBC count of 5≤50 cells/μL in CSF are considered to have treatment failure, whereas patients with a CSF WBC count of ≤S5 cells/μL are considered to be cured and can discontinue follow-up. At 12 months, the remaining patients (those with a WBC count of 6-49 cells/μL) need a test of cure, based on trypanosome presence and WBC count, applying a cutoff value of 20 cells/μL. Conclusion. Combining criteria for failure and cure allows follow-up of patients with second-stage human African trypanosomiasis to be shortened to a maximum duration of 12 months. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Mumba Ngoyi, Dieudonné
Belgium, Antwerpen
Departments of Parasitology
Lejon, Veerle
Belgium, Antwerpen
Departments of Parasitology
Pyana, Pati Patient
Belgium, Antwerpen
Departments of Parasitology
Boelaert, Marleen C.
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Llunga, Médard
Democratic Republic Congo
Prog. Natl. de Lutte Contre la Trypanosomiase Hum Africaine
Menten, Joris
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Mulunda, Jean Pierre
Democratic Republic Congo
Prog. Natl. de Lutte Contre la Trypanosomiase Hum Africaine
Van Nieuwenhove, Simon
Switzerland, Geneva
Organisation Mondiale de la Santé
Tamfum, Jean Jacques Muyembe
Unknown Affiliation
Büscher, Philippe
Belgium, Antwerpen
Departments of Parasitology
Statistics
Citations: 70
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1086/649917
ISSN:
00221899
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Locations
Congo