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How to shorten patient follow-up after treatment for Trypanosoma brucei gambiense sleeping sickness

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dc.contributor.author Ngoyi, D. M.
dc.contributor.author Lejon, V.
dc.contributor.author Pyana, P.
dc.contributor.author Boelaert, M.
dc.contributor.author Ilunga, M.
dc.contributor.author Menten, J.
dc.contributor.author Mulunda, J. P.
dc.contributor.author Van Nieuwenhove, S.
dc.contributor.author Muyembe Tamfum, J. J.
dc.contributor.author Büscher, P.
dc.date.accessioned 2010-02-10T14:45:08Z
dc.date.available 2010-02-10T14:45:08Z
dc.date.issued 2010
dc.identifier.issn 0022-1899
dc.identifier.doi http://dx.doi/org/10.1086/649917
dc.identifier.other ITG-P1B
dc.identifier.other ITG-P2A
dc.identifier.other ITG-P3B
dc.identifier.other ITG-H4A
dc.identifier.other ITG-I6A
dc.identifier.other ITG-PLA
dc.identifier.other PARAS
dc.identifier.other U-SEROL
dc.identifier.other HEALTH
dc.identifier.other U-EPID
dc.identifier.other INTER
dc.identifier.other U-CTU
dc.identifier.other MULTI
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other UPD18
dc.identifier.other ABSTRACT
dc.identifier.other FTA
dc.identifier.uri http://hdl.handle.net/10390/2947
dc.description.abstract 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 > or = 100 cells/microL, and a LATEX/immunoglobulin M titer of 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 > or = 50 cells/microL in CSF are considered to have treatment failure, whereas patients with a CSF WBC count of > or = 5 cells/microL are considered to be cured and can discontinue follow-up. At 12 months, the remaining patients (those with a WBC count of > or = 6-49 cells/microL) need a test of cure, based on trypanosome presence and WBC count, applying a cutoff value of > or = 20 cells/microL. 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. en
dc.language English en
dc.subject Protozoal diseases en
dc.subject Trypanosomiasis, African en
dc.subject Trypanosoma brucei gambiense en
dc.subject Vectors en
dc.subject Tsetse flies en
dc.subject Treatment outcome en
dc.subject Risk factors en
dc.subject Biomarkers en
dc.subject Treatment failure en
dc.subject Criteria en
dc.subject Follow-up en
dc.subject Duration en
dc.subject Algorithms en
dc.subject Monitoring en
dc.subject Regimens en
dc.subject White blood cell count en
dc.subject Sensitivity en
dc.subject Specificity en
dc.subject Congo-Kinshasa en
dc.subject Africa, Central en
dc.title How to shorten patient follow-up after treatment for Trypanosoma brucei gambiense sleeping sickness en
dc.type Article en
dc.citation.issue 3 en
dc.citation.jtitle Journal of Infectious Diseases en
dc.citation.volume 201 en
dc.citation.pages 453-463 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/20047500
dc.citation.jabbreviation J Infect Dis en


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