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Intrathecal immune response pattern for improved diagnosis of central nervous system involvement in trypanosomiasis

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dc.contributor.author Lejon, V. en_US
dc.contributor.author Reiber, H. en_US
dc.contributor.author Legros, D. en_US
dc.contributor.author Djé, N. en_US
dc.contributor.author Magnus, E. en_US
dc.contributor.author Wouters, I. en_US
dc.contributor.author Sindic, C. J. M. en_US
dc.contributor.author Büscher, P. en_US
dc.date.accessioned 2007-12-06T14:33:47Z
dc.date.available 2007-12-06T14:33:47Z
dc.date.issued 2003 en_US
dc.identifier.issn 0022-1899 en_US
dc.identifier.doi http://dx.doi.org/10.1086/374645
dc.identifier.other ITG-P1A en_US
dc.identifier.other ITG-P5B en_US
dc.identifier.other ITG-P6B en_US
dc.identifier.other ITG-PLA en_US
dc.identifier.other PARAS en_US
dc.identifier.other U-SEROL en_US
dc.identifier.other JIF en_US
dc.identifier.other DOI en_US
dc.identifier.other FTA en_US
dc.identifier.other ABSTRACT en_US
dc.identifier.uri http://hdl.handle.net/10390/209
dc.description.abstract Diagnosis of central nervous system (CNS) involvement in human African trypanosomiasis is crucial in determination of therapy. Cerebrospinal fluid (CSF) and serum immunoglobulin concentrations, blood-CSF barrier dysfunction, pattern of intrathecal immunoglobulin synthesis, trypanosome-specific antibody synthesis, and CSF lactate concentrations were analyzed in 272 patients with Trypanosoma brucei gambiense infection. As part of the 2- or 3-class immune response, the predominant intrathecal IgM synthesis was the most sensitive (95%) marker for inflammation of the brain. We propose to replace the World Health Organization (WHO) criteria (white blood cell count >5 cells/microL and presence of trypanosomes in CSF) with a new approach for stage determination in trypanosomiasis: CNS involvement is diagnosed only in patients with >20 cells/microL or with intrathecal IgM synthesis, independent of the presence of trypanosomes in CSF. Compared with the use of these new criteria, the WHO criteria incorrectly classified 49 of 234 patients in the meningoencephalitic stage and 7 of 38 patients in the hemolymphatic disease stage. We also show that trypanosomiasis-related immunoglobulin patterns are of value in differential diagnosis. en_US
dc.language English en_US
dc.publisher University of Chicago Press en_US
dc.subject Protozoal diseases en_US
dc.subject Trypanosomiasis, African en_US
dc.subject Trypanosoma brucei gambiense en_US
dc.subject Central nervous system en_US
dc.subject Intrathecal humoral immune response en_US
dc.subject Laboratory diagnosis en_US
dc.subject CSF en_US
dc.subject Cerebrospinal fluid en_US
dc.subject IgG en_US
dc.subject Immunoglobulin G en_US
dc.subject IgM en_US
dc.subject Immunoglobulin M en_US
dc.subject Sensitivity testing en_US
dc.title Intrathecal immune response pattern for improved diagnosis of central nervous system involvement in trypanosomiasis en_US
dc.type Article en_US
dc.citation.issue 9 en_US
dc.citation.jtitle Journal of Infectious Diseases en_US
dc.citation.volume 187 en_US
dc.citation.pages 1475-1483 en_US
dc.publisher.place Chicago en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/12717630
dc.citation.jabbreviation J Infect Dis en_US


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