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Treatment failure related to intrathecal immunoglobulin M (IgM) synthesis, cerebrospinal fluid IgM, and interleukin-10 in patients with hemolymphatic-stage sleeping sickness

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dc.contributor.author Lejon, V. en_US
dc.contributor.author Robays, J. en_US
dc.contributor.author N'Siesi, F. X. en_US
dc.contributor.author Mumba, D. en_US
dc.contributor.author Hoogstoel, A. en_US
dc.contributor.author Bisser, S. en_US
dc.contributor.author Reiber, H. en_US
dc.contributor.author Boelaert, 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 2007 en_US
dc.identifier.issn 1556-6811 en_US
dc.identifier.doi http://dx.doi.org/10.1128/CVI.00103-07
dc.identifier.other ITG-P1A en_US
dc.identifier.other ITG-H2A en_US
dc.identifier.other ITG-H8A 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 HEALTH en_US
dc.identifier.other U-EPID en_US
dc.identifier.other JIF en_US
dc.identifier.other DOI en_US
dc.identifier.other ABSTRACT en_US
dc.identifier.other MULTI en_US
dc.identifier.other FTC
dc.identifier.uri http://hdl.handle.net/10390/210
dc.description.abstract Human African trypanosomiasis treatment is stage dependent, but the tests used for staging are controversial. Central nervous system involvement and its relationship with suramin treatment failure were assessed in 60 patients with parasitologically confirmed hemolymphatic-stage Trypanosoma brucei gambiense infection (white blood cell count of <or=5/microl and no trypanosomes in the cerebrospinal fluid [CSF]). The prognostic value of CSF interleukin-10, immunoglobulin M (IgM; as determined by nephelometry and the point-of-care LATEX/IgM test), total protein, and trypanosome-specific antibody was assessed. The IgM and interleukin-10 levels in serum were measured; and the presence of neurological signs, intrathecal IgM synthesis, and blood-CSF barrier dysfunction was determined. After suramin treatment, 14 of 60 patients had relapses (23%). Relapses were significantly correlated with intrathecal IgM synthesis (odds ratio [OR], 46; 95% confidence interval [CI], 8 to 260), a CSF IgM concentration of >or=1.9 mg/liter (OR, 11.7; 95% CI, 2.7 to 50), a CSF end titer by the LATEX/IgM assay of >or=2 (OR, 10.4; 95% CI, 2.5 to 44), and a CSF interleukin-10 concentration of >10 pg/ml (OR, 5; 95% CI, 1.3 to 20). The sensitivities of these markers for treatment failure ranged from 43 to 79%, and the specificities ranged from 74 to 93%. The results show that T. brucei gambiense-infected patients who have signs of neuroinflammation in CSF and who are treated with drugs recommended for use at the hemolymphatic stage are at risk of treatment failure. This highlights the need for the development and the evaluation of accurate point-of-care tests for the staging of human African trypanosomiasis. en_US
dc.language English en_US
dc.subject Protozoal diseases en_US
dc.subject Trypanosomiasis, African en_US
dc.subject Trypanosoma brucei gambiense en_US
dc.subject Stage determination en_US
dc.subject Laboratory techniques and procedures en_US
dc.subject Treatment failure en_US
dc.subject Relapses en_US
dc.subject Risk assessment en_US
dc.subject Neurologic disorders en_US
dc.subject Drug therapy en_US
dc.subject Suramin en_US
dc.subject Markers en_US
dc.subject Sensitivity en_US
dc.subject Specificity en_US
dc.title Treatment failure related to intrathecal immunoglobulin M (IgM) synthesis, cerebrospinal fluid IgM, and interleukin-10 in patients with hemolymphatic-stage sleeping sickness en_US
dc.type Article en_US
dc.citation.issue 6 en_US
dc.citation.jtitle Clinical and Vaccine Immunology en_US
dc.citation.volume 14 en_US
dc.citation.pages 732-737 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/17428948
dc.citation.jabbreviation Clin Vaccine Immunol en_US


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