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Odeniran PO, Paul-Odeniran KF, Ademola IO. The comprehensive epidemiological status of human African trypanosomiasis in Nigeria: meta-analysis and systematic review of the full story (1962-2022). Parasitol Res 2024; 123:291. [PMID: 39102014 DOI: 10.1007/s00436-024-08312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Abstract
Human African trypanosomiasis (HAT) in Nigeria is caused primarily by Trypanosoma brucei gambiense (gHAT), which has historically been a major human and animal health problem. This study aims to examine the status of gHAT in Nigeria over the past 60 years. The World Health Organization (WHO) set two targets to eliminate HAT as a public health concern by 2020 and terminate its global transmission by 2030. The former target has been achieved, but accurate monitoring and surveillance are important for maintaining this success and delivering the second target. Although recent cases in Nigeria are rare, accurately estimating the national seroprevalence and actual prevalence of gHATs remains challenging. To address this, a meta-analysis reviewed studies on gHATs in Nigeria from databases such as Embase, Global Health, Ovid Medline, Web of Science, and Google Scholar. Ten studies were included, ranging between 1962 and 2016, covering 52 clusters and 5,671,877 individuals, even though databases were scrutinized up to 2022. The seroprevalence ranged from 1.75 to 17.07%, with an overall estimate of 5.01% (95% CI 1.72-9.93). The actual gHAT prevalence detected by parasitological or PCR methods was 0.001 (95% CI 0.000-0.002), indicating a prevalence of 0.1%. Notably, the seroprevalence was greater in southern Nigeria than in northern Nigeria. These findings suggest that the disease might be spreading unnoticed due to the increased movement of people from endemic areas. This study highlights the paucity of studies in Nigeria over the last 60 years and emphasizes the need for further research, systematic surveillance, and proper reporting methods throughout the country.
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Affiliation(s)
- Paul Olalekan Odeniran
- Department of Veterinary Parasitology and Entomology, University of Ibadan, Ibadan, 200001, Nigeria.
| | | | - Isaiah Oluwafemi Ademola
- Department of Veterinary Parasitology and Entomology, University of Ibadan, Ibadan, 200001, Nigeria
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Mabe L, Muthevhuli M, Thekisoe O, Suleman E. Accuracy of molecular diagnostic assays for detection of Mycobacterium bovis: A systematic review and meta-analysis. Prev Vet Med 2024; 226:106190. [PMID: 38574490 DOI: 10.1016/j.prevetmed.2024.106190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
Bovine tuberculosis (bovine TB) is a chronic wasting disease of cattle caused primarily by Mycobacterium bovis. Controlling bovine TB requires highly sensitive, specific, quick, and reliable diagnostic methods. This systematic review and meta-analysis evaluated molecular diagnostic tests for M. bovis detection to inform the selection of the most viable assay. On a per-test basis, loop-mediated isothermal amplification (LAMP) showed the highest overall sensitivity of 99.0% [95% CI: 86.2%-99.9%] and specificity of 99.8% [95% CI: 96.2%-100.00%]. Quantitative real-time polymerase chain reaction (qPCR) outperformed conventional PCR and nested PCR (nPCR) with a diagnostic specificity of 96.6% [95% CI: 88.9%-99.0%], while the diagnostic sensitivity of 70.8% [95% CI: 58.6-80.5%] was comparable to that of nPCR at 71.4% [95% CI: 60.7-80.2%]. Test sensitivity was higher with the input of milk samples (90.9% [95% CI: 56.0%-98.7%]), while specificity improved with tests based on major M. bovis antigens (97.8% [95% CI: 92.3%-99.4%]), the IS6110 insertion sequence (95.4% [95% CI: 87.6%-98.4%]), and the RD4 gene (90.7% [95% CI: 52.2%-98.9%]). The design of the currently available molecular diagnostic assays, while mostly based on nonspecific gene targets, prevents them from being accurate enough to diagnose M. bovis infections in cattle, despite their promise. Future assay development should focus on the RD4 region since it is the only target identified by genome sequence data as being distinctive for detecting M. bovis. The availability of a sufficiently accurate diagnostic test combined with the routine screening of milk samples can decrease the risk of zoonotic transmissions of M. bovis.
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Affiliation(s)
- Lerato Mabe
- NextGen Health Cluster, Council for Scientific and Industrial Research, P.O. Box 395, Pretoria 0001, South Africa; Unit for Environmental Sciences and Management, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Mpho Muthevhuli
- NextGen Health Cluster, Council for Scientific and Industrial Research, P.O. Box 395, Pretoria 0001, South Africa
| | - Oriel Thekisoe
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Essa Suleman
- NextGen Health Cluster, Council for Scientific and Industrial Research, P.O. Box 395, Pretoria 0001, South Africa.
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Sima N, Dujeancourt-Henry A, Perlaza BL, Ungeheuer MN, Rotureau B, Glover L. SHERLOCK4HAT: A CRISPR-based tool kit for diagnosis of Human African Trypanosomiasis. EBioMedicine 2022; 85:104308. [PMCID: PMC9626900 DOI: 10.1016/j.ebiom.2022.104308] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background To achieve elimination of Human African Trypanosomiasis (HAT) caused by Trypanosoma brucei gambiense (gHAT), the development of highly sensitive diagnostics is needed. We have developed a CRISPR based diagnostic for HAT using SHERLOCK (Specific High-sensitivity Enzymatic Reporter unLOCKing) that is readily adaptable to a field-based setting. Methods We adapted SHERLOCK for the detection of T. brucei species. We targeted 7SLRNA, TgSGP and SRA genes and tested SHERLOCK against RNA from blood, buffy coat, dried blood spots (DBS), and clinical samples. Findings The pan-Trypanozoon 7SLRNA and T. b. gambiense-specific TgSGP SHERLOCK assays had a sensitivity of 0.1 parasite/μL and a limit of detection 100 molecules/μL. T. b. rhodesiense-specific SRA had a sensitivity of 0.1 parasite/μL and a limit of detection of 10 molecules/μL. TgSGP SHERLOCK and SRA SHERLOCK detected 100% of the field isolated strains. Using clinical specimens from the WHO HAT cryobank, the 7SLRNA SHERLOCK detected trypanosomes in gHAT samples with 56.1%, 95% CI [46.25–65.53] sensitivity and 98.4%, 95% CI [91.41–99.92] specificity, and rHAT samples with 100%, 95% CI [83.18–100] sensitivity and 94.1%, 95% CI [80.91–98.95] specificity. The species-specific TgSGP and SRA SHERLOCK discriminated between the gambiense/rhodesiense HAT infections with 100% accuracy. Interpretation The 7SLRNA, TgSGP and SRA SHERLOCK discriminate between gHAT and rHAT infections, and could be used for epidemiological surveillance and diagnosis of HAT in the field after further technical development. Funding Institut Pasteur (PTR-175 SHERLOCK4HAT), French Government's Investissement d’Avenir program Laboratoire d’Excellence Integrative Biology of Emerging Infectious Diseases (LabEx IBEID), and Agence Nationale pour la Recherche (ANR-PRC 2021 SherPa).
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Affiliation(s)
- Núria Sima
- Trypanosome Molecular Biology, Department of Parasites and Insect Vectors, Institut Pasteur, Université Paris Cité, F-75015, Paris, France,Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201 & Department of Parasites and Insect Vectors, Institut Pasteur, Université Paris Sorbonne, Paris, France
| | - Annick Dujeancourt-Henry
- Trypanosome Molecular Biology, Department of Parasites and Insect Vectors, Institut Pasteur, Université Paris Cité, F-75015, Paris, France
| | - Blanca Liliana Perlaza
- Institut Pasteur, ICAReB Platform (Clinical Investigation & Access to Research Bioresources) of the Center for Translational Science, Paris, France
| | - Marie-Noelle Ungeheuer
- Institut Pasteur, ICAReB Platform (Clinical Investigation & Access to Research Bioresources) of the Center for Translational Science, Paris, France
| | - Brice Rotureau
- Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201 & Department of Parasites and Insect Vectors, Institut Pasteur, Université Paris Sorbonne, Paris, France,Parasitology Unit, Institut Pasteur of Guinea, Conakry, Guinea,Corresponding author.
| | - Lucy Glover
- Trypanosome Molecular Biology, Department of Parasites and Insect Vectors, Institut Pasteur, Université Paris Cité, F-75015, Paris, France,Corresponding author.
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Mabe L, Onyiche TE, Thekisoe O, Suleman E. Accuracy of molecular diagnostic methods for the detection of bovine brucellosis: A systematic review and meta-analysis. Vet World 2022; 15:2151-2163. [PMID: 36341063 PMCID: PMC9631377 DOI: 10.14202/vetworld.2022.2151-2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Aim: Bovine brucellosis is a disease of global socio-economic importance caused by Brucella abortus. Diagnosis is mainly based on bacterial culture and serology. However, these methods often lack sensitivity and specificity. A range of molecular diagnostic methods has been developed to address these challenges. Therefore, this study aims to investigate the diagnostic accuracy of molecular tools, in comparison to gold standard bacterial isolation and serological assays for the diagnosis of bovine brucellosis. Materials and Methods: The systematic review and meta-analysis were conducted based on analyses of peer-reviewed journal articles published between January 1, 1990, and June 6, 2020, in the PubMed, Science Direct, Scopus, and Springer Link databases. Data were extracted from studies reporting the use of molecular diagnostic methods for the detection of B. abortus infections in animals according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of included journal articles was assessed using the quality assessment of diagnostic-accuracy studies assessment tool and meta-analysis was carried out using Review Manager. Results: From a total of 177 studies, only 26 articles met the inclusion criteria based on PRISMA guidelines. Data from 35 complete studies were included in the meta-analysis and used to construct 2 × 2 contingency tables. Improved diagnostic performance was observed when tissue (sensitivity 92.7% [95% confidence interval (CI) 82.0–98.0%]) and serum samples (sensitivity 91.3% [95% CI 86.0–95.0%]) were used, while the BruAb2_0168 locus was the gene of preference for optimal assay performance (sensitivity 92.3% [95% CI 87.0–96.0%] and specificity 99.3% [95% CI 98.0–100.0%]). Loop-mediated isothermal amplification (LAMP) had a higher diagnostic accuracy than polymerase chain reaction (PCR) and real-time quantitative PCR with sensitivity of 92.0% (95% CI 78.0–98.0%) and specificity of 100.0% (95% CI 97.0–100.0%). Conclusion: The findings of this study assign superior diagnostic performance in the detection of B. abortus to LAMP. However, due to limitations associated with decreased specificity and a limited number of published articles on LAMP, the alternative use of PCR-based assays including those reported in literature is recommended while the use of LAMP for the detection of bovine brucellosis gains traction and should be evaluated more comprehensively in future.
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Affiliation(s)
- Lerato Mabe
- NextGen Health Cluster, Council for Scientific and Industrial Research, P.O. Box 395, Pretoria, 0001, South Africa; Unit for Environmental Sciences and Management, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - ThankGod E. Onyiche
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa; Department of Veterinary Parasitology and Entomology, University of Maiduguri, P. M. B. 1069, Maiduguri 600230, Nigeria
| | - Oriel Thekisoe
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Essa Suleman
- NextGen Health Cluster, Council for Scientific and Industrial Research, P.O. Box 395, Pretoria, 0001, South Africa
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Sarma K, Eregowda CG, Roychoudhury P, Borthakur SK, Jawalagatti V, Prasad H, Behera SK, Thakur N, Bora N, Das D. A 5-Year Prospective Study on Incidence and Clinico-pathological Changes Associated with Naturally Occurring Trypanosomosis in Dogs of Mizoram, India. Acta Parasitol 2022; 67:61-71. [PMID: 34138413 DOI: 10.1007/s11686-021-00425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The present research was taken to study the hospital-based incidence and clinico-pathological changes associated with naturally occurring trypanosomosis in dogs of Mizoram. METHODS A 5-year prospective study on hospital-based incidence and clinico-pathological changes associated with naturally occurring trypanosomosis in dogs of Mizoram was carried out during the study period from April, 2015 to March, 2020. Trypanosoma evansi infection was confirmed by microscopic examination and polymerase chain reaction (PCR). Non-infected clinically healthy dogs (n = 6) served as control. Blood samples were collected to study the haemogram and serum samples were used for the evaluation of serum biochemical parameters and oxidant-antioxidant parameters. RESULTS During the study period, an overall incidence of 0.25% was recorded for trypanosomosis in dogs. The most consistent clinical findings noticed were anorexia/inappetence, pyrexia, depression/lethargy, pale mucous membrane, dehydration and lymphadenomegaly. Anaemia, granulocytopenia, lymphocytosis and thrombocytopenia were the major findings noticed in trypanosomosis affected dogs. The profile of vital organ function revealed that the mean values of total protein, albumin and random blood glucose were significantly (P < 0.05) lower, whereas the mean values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin, blood urea nitrogen (BUN) and creatinine were significantly (P < 0.05) higher in dogs affected with trypanosomosis. The mean value of lipid hydroperoxide (LPO) was significantly (P < 0.05) higher, whereas the mean values of glutathione (GSH), superoxide dismutase (SOD) and total antioxidant activity (TAOA) were significantly (P < 0.05) lower in trypanosomosis affected dogs. When total erythrocyte count (TEC) was correlated with LPO (r = - 0.631, P < 0.05), a negative correlation was found, while in case of GSH (r = 0.757, P < 0.05), SOD (r = 0.767, P < 0.05) and TAOA (r = 0.713, P < 0.05), it was positively correlated. CONCLUSION A negative correlation of TEC count with LPO, while a positive correlation with GSH, SOD and TAOA signify the role of oxidative stress in the pathogenesis of anaemia induced by T. evansi infection in dogs. The present study findings might be helpful to clinicians when treating clinical cases of this kind. Incorporation of organ protective drugs and antioxidants in the treatment schedule may result in better prognosis.
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Affiliation(s)
- Kalyan Sarma
- Department of Veterinary Medicine, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
| | - Chethan Gollahalli Eregowda
- Department of Veterinary Medicine, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India.
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India.
| | - Parimal Roychoudhury
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
| | - Sonjoy Kumar Borthakur
- Department of Veterinary Parasitology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
| | - Vijayakumar Jawalagatti
- Division of Parasitology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, 243122, India
- Jeonbuk National University, Jeonju, 54596, South Korea
| | - Hridayesh Prasad
- Department of Veterinary Medicine, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
| | - Suvendu Kumar Behera
- Department of Veterinary Medicine, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
| | - Neeraj Thakur
- Department of Veterinary Clinical Complex, Faculty of Veterinary and Animal Sciences, RGSC-Banaras Hindu University, Barkachha, Mirzapur, Uttar Pradesh, 231001, India
| | - Nikitasha Bora
- Department of Veterinary Medicine, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
| | - Dhruba Das
- Department of Veterinary Medicine, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University, Selesih, Aizawl, Mizoram, 796014, India
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Raman spectroscopic analysis of skin as a diagnostic tool for Human African Trypanosomiasis. PLoS Pathog 2021; 17:e1010060. [PMID: 34780575 PMCID: PMC8629383 DOI: 10.1371/journal.ppat.1010060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 11/29/2021] [Accepted: 10/23/2021] [Indexed: 02/08/2023] Open
Abstract
Human African Trypanosomiasis (HAT) has been responsible for several deadly epidemics throughout the 20th century, but a renewed commitment to disease control has significantly reduced new cases and motivated a target for the elimination of Trypanosoma brucei gambiense-HAT by 2030. However, the recent identification of latent human infections, and the detection of trypanosomes in extravascular tissues hidden from current diagnostic tools, such as the skin, has added new complexity to identifying infected individuals. New and improved diagnostic tests to detect Trypanosoma brucei infection by interrogating the skin are therefore needed. Recent advances have improved the cost, sensitivity and portability of Raman spectroscopy technology for non-invasive medical diagnostics, making it an attractive tool for gambiense-HAT detection. The aim of this work was to assess and develop a new non-invasive diagnostic method for T. brucei through Raman spectroscopy of the skin. Infections were performed in an established murine disease model using the animal-infective Trypanosoma brucei brucei subspecies. The skin of infected and matched control mice was scrutinized ex vivo using a confocal Raman microscope with 532 nm excitation and in situ at 785 nm excitation with a portable field-compatible instrument. Spectral evaluation and Principal Component Analysis confirmed discrimination of T. brucei-infected from uninfected tissue, and a characterisation of biochemical changes in lipids and proteins in parasite-infected skin indicated by prominent Raman peak intensities was performed. This study is the first to demonstrate the application of Raman spectroscopy for the detection of T. brucei by targeting the skin of the host. The technique has significant potential to discriminate between infected and non-infected tissue and could represent a unique, non-invasive diagnostic tool in the goal for elimination of gambiense-HAT as well as for Animal African Trypanosomiasis (AAT). Human African Trypanosomiasis (HAT), also known as sleeping sickness, is a disease caused by the parasite Trypanosoma brucei and has been responsible for the death of millions of people across Africa in the 20th century. It is also a major economic burden for countries endemic for trypanosomiasis, affecting livestock productivity in rural areas (Animal African Trypanosomiasis). A long-term international collaboration with the help of the World Health Organisation has resulted in the rate of human infection decreasing to less than 1000 new cases per year. However, the human disease continues to spread within remote villages. Current diagnosis is based on the detection of parasites in blood and serum samples, but this is challenging during chronic human infections with low or non-detectable parasitaemia. However, the recent discovery of extravascular skin-dwelling trypanosomes indicates that a reservoir of infection remains undetected, threatening the effort to eliminate the disease. In this study we have targeted the skin as a site for diagnosis using Raman spectroscopy and demonstrate that this method showed great promise in the laboratory, laying the foundation for field studies to examine its potential to strengthen current diagnostic strategies for detecting HAT cases.
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Prevalence of Trypanosoma congolense and Trypanosoma vivax in Lira District, Uganda. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7284042. [PMID: 34222483 PMCID: PMC8219416 DOI: 10.1155/2021/7284042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/24/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022]
Abstract
Trypanosomes are the causative agents of animal African trypanosomiasis (AAT) and human African trypanosomiasis (HAT), the former affecting domestic animals prevalent in Sub-Saharan Africa. The main species causing AAT in cattle are T. congolense, T. vivax, and T. b. brucei. Northern Uganda has been politically unstable with no form of vector control in place. The return of displaced inhabitants led to the restocking of cattle from AAT endemic areas. It was thus important to estimate the burden of trypanosomiasis in the region. This study was designed to compare the prevalence of animal African trypanosomes in cattle in Lira District using microscopy and polymerase chain reaction amplification (PCR) methods. In this cross-sectional study, a total of 254 cattle from the three villages of Acanakwo A, Barropok, and Acungkena in Lira District, Uganda, were selected by simple random sampling technique and screened for trypanosomiasis using microscopy and PCR methods. The prevalence of trypanosomiasis according to microscopic results was 5/254 (2.0%) as compared to 11/254 (4.3%) trypanosomiasis prevalence according to PCR analysis. The prevalence of trypanosomiasis infection in the animal studied is 11/254 (4.3%). Trypanosoma congolense was the most dominant trypanosome species with a proportion of 9/11 (81.8%), followed by T. vivax 1/11 (9.1%) and mixed infection of T. congolense/T. vivax1/11 (9.1%). Barropok village had the highest prevalence of trypanosomiasis with 6/11 (54.5%). There is a statistically significant relationship (OR = 6.041; 95% CI: 1.634-22.331; p < 0.05) between abnormal PCV and trypanosome infection. Polymerase reaction amplification was the most reliable diagnostic method due to its high sensitivity and specificity as compared to the conventional microscopic method. Polymerase reaction amplification appears to have adequate accuracy to substitute the use of a microscope where facilities allow. This study, therefore, underscores the urgent need for local surveillance schemes more especially at the grassroots in Uganda to provide data for reference guideline development needed for the control of trypanosomiasis in Uganda.
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Alfred Compaoré CF, Ilboudo H, Kaboré J, Kaboré JW, Camara O, Bamba M, Sakande H, Koné M, Camara M, Kaba D, Gaston Belem AM, Deborggraeve S, Büscher P, Bucheton B, Lejon V, Jamonneau V. Analytical sensitivity of loopamp and quantitative real-time PCR on dried blood spots and their potential role in monitoring human African trypanosomiasis elimination. Exp Parasitol 2020; 219:108014. [PMID: 33011238 DOI: 10.1016/j.exppara.2020.108014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/19/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
The objective set by WHO to reach elimination of human African trypanosomiasis (HAT) as a public health problem by 2020 is being achieved. The next target is the interruption of gambiense-HAT transmission in humans by 2030. To monitor progress towards this target, in areas where specialized local HAT control capacities will disappear, is a major challenge. Test specimens should be easily collectable and safely transportable such as dried blood spots (DBS). Monitoring tests performed in regional reference centres should be reliable, cheap and allow analysis of large numbers of specimens in a high-throughput format. The aim of this study was to assess the analytical sensitivity of Loopamp, M18S quantitative real-time PCR (M18S qPCR) and TgsGP qPCR as molecular diagnostic tests for the presence of Trypanosoma brucei gambiense in DBS. The sensitivity of the Loopamp test, with a detection limit of 100 trypanosomes/mL, was in the range of parasitaemias commonly observed in HAT patients, while detection limits for M18S and TgsGP qPCR were respectively 1000 and 10,000 trypanosomes/mL. None of the tests was entirely suitable for high-throughput use and further development and implementation of sensitive high-throughput molecular tools for monitoring HAT elimination are needed.
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Affiliation(s)
- Charlie Franck Alfred Compaoré
- Centre International of Recherche-Développement sur l'Élevage en Zone Subhumide, Unité de Recherche sur les Maladies à Vecteurs et Biodiversité, 01 BP 454, Bobo-Dioulasso 01, Burkina Faso; Université Nazi Boni, Unité de Formation et de Recherche Sciences et Techniques, 01 BP 1091, Bobo-Dioulasso, Burkina Faso
| | - Hamidou Ilboudo
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro, 11 BP 218, Ouagadougou CMS 11, Burkina Faso
| | - Jacques Kaboré
- Centre International of Recherche-Développement sur l'Élevage en Zone Subhumide, Unité de Recherche sur les Maladies à Vecteurs et Biodiversité, 01 BP 454, Bobo-Dioulasso 01, Burkina Faso; Université Nazi Boni, Unité de Formation et de Recherche Sciences et Techniques, 01 BP 1091, Bobo-Dioulasso, Burkina Faso
| | - Justin Windingoudi Kaboré
- Centre International of Recherche-Développement sur l'Élevage en Zone Subhumide, Unité de Recherche sur les Maladies à Vecteurs et Biodiversité, 01 BP 454, Bobo-Dioulasso 01, Burkina Faso; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, BP 581, Conakry, Guinea
| | - Oumou Camara
- Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, BP 581, Conakry, Guinea
| | - Mohamed Bamba
- Centre International of Recherche-Développement sur l'Élevage en Zone Subhumide, Unité de Recherche sur les Maladies à Vecteurs et Biodiversité, 01 BP 454, Bobo-Dioulasso 01, Burkina Faso
| | - Hassane Sakande
- Centre International of Recherche-Développement sur l'Élevage en Zone Subhumide, Unité de Recherche sur les Maladies à Vecteurs et Biodiversité, 01 BP 454, Bobo-Dioulasso 01, Burkina Faso
| | - Minayégninrin Koné
- Institut Pierre Richet, Unité de Recherche « Trypanosomoses », 01 BP 1500, Bouake, West Africa
| | - Mamadou Camara
- Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, BP 581, Conakry, Guinea
| | - Dramane Kaba
- Institut Pierre Richet, Unité de Recherche « Trypanosomoses », 01 BP 1500, Bouake, West Africa
| | - Adrien Marie Gaston Belem
- Université Nazi Boni, Unité de Formation et de Recherche Sciences et Techniques, 01 BP 1091, Bobo-Dioulasso, Burkina Faso
| | - Stijn Deborggraeve
- Institute of Tropical Medicine, Department of Biomedical Sciences, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Philippe Büscher
- Institute of Tropical Medicine, Department of Biomedical Sciences, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Bruno Bucheton
- Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, BP 581, Conakry, Guinea; Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Université de Montpellier, TA A-17/G, Campus International de Baillarguet, F-34398, Montpellier, France
| | - Veerle Lejon
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Université de Montpellier, TA A-17/G, Campus International de Baillarguet, F-34398, Montpellier, France
| | - Vincent Jamonneau
- Institut Pierre Richet, Unité de Recherche « Trypanosomoses », 01 BP 1500, Bouake, West Africa; Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Université de Montpellier, TA A-17/G, Campus International de Baillarguet, F-34398, Montpellier, France.
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Gummery L, Jallow S, Raftery AG, Bennet E, Rodgers J, Sutton DGM. Comparison of loop-mediated isothermal amplification (LAMP) and PCR for the diagnosis of infection with Trypanosoma brucei ssp. in equids in The Gambia. PLoS One 2020; 15:e0237187. [PMID: 32833981 PMCID: PMC7444819 DOI: 10.1371/journal.pone.0237187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Infection of equids with Trypanosoma brucei (T. brucei) ssp. is of socioeconomic importance across sub-Saharan Africa as the disease often progresses to cause fatal meningoencephalitis. Loop-mediated isothermal amplification (LAMP) has been developed as a cost-effective molecular diagnostic test and is potentially applicable for use in field-based laboratories. Part I Threshold levels for T. brucei ssp. detection by LAMP were determined using whole equine blood specimens spiked with known concentrations of parasites. Results were compared to OIE antemortem gold standard of T. brucei-PCR (TBR-PCR). Results I Threshold for detection of T. brucei ssp. on extracted DNA from whole blood was 1 parasite/ml blood for LAMP and TBR-PCR, and there was excellent agreement (14/15) between tests at high (1 x 103/ml) concentrations of parasites. Detection threshold was 100 parasites/ml using LAMP on whole blood (LWB). Threshold for LWB improved to 10 parasites/ml with detergent included. Performance was excellent for LAMP at high (1 x 103/ml) concentrations of parasites (15/15, 100%) but was variable at lower concentrations. Agreement between tests was weak to moderate, with the highest for TBR-PCR and LAMP on DNA extracted from whole blood (Cohen’s kappa 0.95, 95% CI 0.64–1.00). Part II A prospective cross-sectional study of working equids meeting clinical criteria for trypanosomiasis was undertaken in The Gambia. LAMP was evaluated against subsequent TBR-PCR. Results II Whole blood samples from 321 equids in The Gambia were processed under field conditions. There was weak agreement between LWB and TBR-PCR (Cohen’s kappa 0.34, 95% CI 0.19–0.49) but excellent agreement when testing CSF (100% agreement on 6 samples). Conclusions Findings support that LAMP is comparable to PCR when used on CSF samples in the field, an important tool for clinical decision making. Results suggest repeatability is low in animals with low parasitaemia. Negative samples should be interpreted in the context of clinical presentation.
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Affiliation(s)
- Lauren Gummery
- Weipers Centre Equine Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Saloum Jallow
- Gambia Horse and Donkey Trust, Sambel Kunda, The Gambia
| | - Alexandra G. Raftery
- Weipers Centre Equine Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Euan Bennet
- Weipers Centre Equine Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jean Rodgers
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David G. M. Sutton
- Weipers Centre Equine Hospital, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Masouris I, Klein M, Ködel U. The potential for CXCL13 in CSF as a differential diagnostic tool in central nervous system infection. Expert Rev Anti Infect Ther 2020; 18:875-885. [PMID: 32479125 DOI: 10.1080/14787210.2020.1770596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Central nervous system (CNS) infections can be life-threatening and are often associated with disabling sequelae. One important factor in most CNS infections is a timely pathogen-specific treatment. The diagnostic methods available, however, do not always reach a satisfying sensitivity and specificity. In these cases, there is need for additional diagnostic biomarkers. Chemokines represent potential candidates as biomarkers, since they are an important pillar of the host immune response. The aim of this review is to discuss the diagnostic potential of cerebrospinal fluid (CSF) CXCL13 in patients with CNS infections. Areas covered: Data were obtained from a literature search in PubMed up to October 2019. This review focusses on articles on the potential of CXCL13 as a diagnostic tool. The majority of identified studies aimed to characterize its role in two diseases, namely Lyme neuroborreliosis and neurosyphilis. Expert opinion: CSF CXCL13 has a significant potential as a diagnostic and monitoring add-on marker in Lyme neuroborreliosis. Differences in study design, control groups and clinical parameters between studies, however, affect sensitivity, specificity and cutoff values, underlining the need of further studies to address these issues and pave the way for a generalized clinical practice.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
| | - Matthias Klein
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
| | - Uwe Ködel
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
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11
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Kenfak A, Eperon G, Schibler M, Lamoth F, Vargas MI, Stahl JP. Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers. Clin Microbiol Infect 2019; 25:415-421. [PMID: 30708123 DOI: 10.1016/j.cmi.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/29/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Encephalitis and meningoencephalitis are severe, sometime life-threatening infections of the central nervous system. Travellers may be exposed to a variety of neurotropic pathogens. AIMS We propose to review known infectious causes of encephalitis in adults acquired outside Europe, and how to identify them. SOURCES We used Pubmed and Embase, to search the most relevant publications over the last years. CONTENT Microbiologic tests and radiological tools to best identify the causative pathogen in travellers presenting with encephalitis and ME are presented in this narrative review, as well as a diagnostic approach tailored to the visited area and types of exposures. IMPLICATIONS This review highlights the diagnostic difficulties inherent to exotic causes of central nervous system infections, and attempts to guide clinicians with respect to which microbiological tests to consider, in addition to brain MRI, when approaching a returning traveller presenting with encephalitis.
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Affiliation(s)
- A Kenfak
- Internal Medicine Service, Jura Bernois Hospital, Moutier, Switzerland
| | - G Eperon
- Tropical and Humanitarian Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - M Schibler
- Infectious Diseases Division and Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland.
| | - F Lamoth
- Infectious Diseases Service and Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - M I Vargas
- Diagnostic and Interventional Neuroradiology Division, Geneva University, Switzerland
| | - J P Stahl
- Infectious Diseases and Tropical Medicine, University Hospital, Grenoble, France
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Huits R, De Ganck G, Clerinx J, Büscher P, Bottieau E. A veterinarian with fever, rash and chancre after holidays in Uganda. J Travel Med 2018; 25:5134099. [PMID: 30329077 DOI: 10.1093/jtm/tay104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | - Gonda De Ganck
- Gonda's Veterinary Practice, Rotherham, 17 Blyth Rd, Maltby, Rotherham, UK
| | - Joannes Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | - Philippe Büscher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
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Abstract
Trypanosomes (genus Trypanosoma) are parasites of humans, and wild and domestic mammals, in which they cause several economically and socially important diseases, including sleeping sickness in Africa and Chagas disease in the Americas. Despite the development of numerous molecular diagnostics and increasing awareness of the importance of these neglected parasites, there is currently no universal genetic barcoding marker available for trypanosomes. In this review we provide an overview of the methods used for trypanosome detection and identification, discuss the potential application of different barcoding techniques and examine the requirements of the 'ideal' trypanosome genetic barcode. In addition, we explore potential alternative genetic markers for barcoding Trypanosoma species, including an analysis of phylogenetically informative nucleotide changes along the length of the 18S rRNA gene.
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Wamboga C, Matovu E, Bessell PR, Picado A, Biéler S, Ndung’u JM. Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda - Moving towards elimination. PLoS One 2017; 12:e0186429. [PMID: 29023573 PMCID: PMC5638538 DOI: 10.1371/journal.pone.0186429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction The incidence of gambiense human African trypanosomiasis (gHAT) in Uganda has been declining, from 198 cases in 2008, to only 20 in 2012. Interruption of transmission of the disease by early diagnosis and treatment is core to the control and eventual elimination of gHAT. Until recently, the format of available screening tests had restricted screening and diagnosis to central health facilities (passive screening). We describe a novel strategy that is contributing to elimination of gHAT in Uganda through expansion of passive screening to the entire population at risk. Methodology / Principal findings In this strategy, patients who are clinically suspected of having gHAT at primary health facilities are screened using a rapid diagnostic test (RDT), followed by parasitological confirmation at strategically located microscopy centres. For patients who are positive with the RDT and negative by microscopy, blood samples undergo further testing using loop-mediated isothermal amplification (LAMP), a molecular test that detects parasite DNA. LAMP positive patients are considered strong suspects, and are re-evaluated by microscopy. Location and upgrading of facilities to perform microscopy and LAMP was informed by results of georeferencing and characterization of all public healthcare facilities in the 7 gHAT endemic districts in Uganda. Three facilities were upgraded to perform RDTs, microscopy and LAMP, 9 to perform RDTs and microscopy, and 200 to screen patients with RDTs. This reduced the distance that a sick person must travel to be screened for gHAT to a median distance of 2.5km compared to 23km previously. In this strategy, 9 gHAT cases were diagnosed in 2014, and 4 in 2015. Conclusions This enhanced passive screening strategy for gHAT has enabled full coverage of the population at risk, and is being replicated in other gHAT endemic countries. The improvement in case detection is making elimination of the disease in Uganda an imminent possibility.
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Affiliation(s)
| | - Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | | | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Maharana BR, Tewari AK, Saravanan BC, Sudhakar NR. Important hemoprotozoan diseases of livestock: Challenges in current diagnostics and therapeutics: An update. Vet World 2016; 9:487-95. [PMID: 27284225 PMCID: PMC4893720 DOI: 10.14202/vetworld.2016.487-495] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/06/2016] [Indexed: 11/25/2022] Open
Abstract
Hemoprotozoan parasites pose a serious threat to the livestock population in terms of mortality, reduced milk yield and lowered draft power. Diagnosis of these diseases often poses a challenging task. Needless to say that impact of disease in health and productivity is huge though a fair economic assessment on the quantum of economic loss associated is yet to be worked out from India. The diagnosis of hemoprotozoan infections largely depends on various laboratory-based diagnostic methods as the clinical manifestations are often inconspicuous and non-specific. Traditional diagnostic methods rely on microscopical demonstration of infective stages in blood or tissue fluids. However, it is laborious, lesser sensitive, and cannot differentiate between morphologically similar organisms. Recent development in the technologies has opened new avenues for improvement in the accurate diagnosis of parasitic infections. Serological tests are simple, fast but lack specificity. With advent of molecular techniques, as DNA hybridization assays, polymerase chain reaction and its modifications ensure the detection of infection in the latent phase of the disease. Nucleic acid-based assays are highly sensitive, free from immunocompetence and can differentiate between morphologically similar parasites. With the advent of newer diagnostics complemented with traditional ones will be of huge help for targeted selective treatment with better chemotherapeutic agents.
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Affiliation(s)
- Biswa Ranjan Maharana
- Department of Veterinary Parasitology, College of Veterinary Science and Animal Husbandry, Junagadh Agricultural University, Junagadh, Gujarat, India
| | - Anup Kumar Tewari
- Division of Parasitology, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
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Bisser S, Lumbala C, Nguertoum E, Kande V, Flevaud L, Vatunga G, Boelaert M, Büscher P, Josenando T, Bessell PR, Biéler S, Ndung’u JM. Sensitivity and Specificity of a Prototype Rapid Diagnostic Test for the Detection of Trypanosoma brucei gambiense Infection: A Multi-centric Prospective Study. PLoS Negl Trop Dis 2016; 10:e0004608. [PMID: 27058033 PMCID: PMC4825971 DOI: 10.1371/journal.pntd.0004608] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 03/14/2016] [Indexed: 01/03/2023] Open
Abstract
Background A major challenge in the control of human African trypanosomiasis (HAT) is lack of reliable diagnostic tests that are rapid and easy to use in remote areas where the disease occurs. In Trypanosoma brucei gambiense HAT, the Card Agglutination Test for Trypanosomiasis (CATT) has been the reference screening test since 1978, usually on whole blood, but also in a 1/8 dilution (CATT 1/8) to enhance specificity. However, the CATT is not available in a single format, requires a cold chain for storage, and uses equipment that requires electricity. A solution to these challenges has been provided by rapid diagnostic tests (RDT), which have recently become available. A prototype immunochromatographic test, the SD BIOLINE HAT, based on two native trypanosomal antigens (VSG LiTat 1.3 and VSG LiTat 1.5) has been developed. We carried out a non-inferiority study comparing this prototype to the CATT 1/8 in field settings. Methodology/Principal Findings The prototype SD BIOLINE HAT, the CATT Whole Blood and CATT 1/8 were systematically applied on fresh blood samples obtained from 14,818 subjects, who were prospectively enrolled through active and passive screening in clinical studies in three endemic countries of central Africa: Angola, the Democratic Republic of the Congo and the Central African Republic. One hundred and forty nine HAT cases were confirmed by parasitology. The sensitivity and specificity of the prototype SD BIOLINE HAT was 89.26% (95% confidence interval (CI) = 83.27–93.28) and 94.58% (95% CI = 94.20–94.94) respectively. The sensitivity and specificity of the CATT on whole blood were 93.96% (95% CI = 88.92–96.79) and 95.91% (95% CI = 95.58–96.22), and of the CATT 1/8 were 89.26% (95% CI = 83.27–93.28) and 98.88% (95% CI = 98.70–99.04) respectively. Conclusion/Significance After further optimization, the prototype SD BIOLINE HAT could become an alternative to current screening methods in primary healthcare settings in remote, resource-limited regions where HAT typically occurs. Early diagnosis and treatment of human African trypanosomiasis is essential for safe and effective treatment. The tests used to screen suspected patients and populations at risk are difficult to implement in remote rural settings where the disease occurs. Availability of simple, easy to use, instrument-free rapid diagnostic tests would improve screening and coverage of the population at risk and contribute to elimination of the disease. It would enable technicians with limited training and clinicians in emergency or medical wards to make rapid differential diagnosis for neurological syndromes or malaria-like illnesses. Introduction of such tests in all healthcare facilities in endemic regions would enable early detection of cases, hence reducing the time lost by patients before they get adequate and safe treatment. Treatment delay occurs when such patients attend non-specialized health centres that are unable to perform diagnosis of the disease. We evaluated a prototype rapid diagnostic test for HAT, the SD BIOLINE HAT in Angola, the Democratic Republic of the Congo and the Central African Republic. We show here that the test is as sensitive as the CATT in a 1/8 dilution and less sensitive than CATT on whole blood, although this latter difference was not statistically significant. The prototype RDT is a promising alternative for serodiagnosis of HAT.
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Affiliation(s)
- Sylvie Bisser
- INSERM UMR1094, Institute of Neuroepidemiology and Tropical Neurology, Limoges, France
- * E-mail:
| | - Crispin Lumbala
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Kinshasa, Democratic Republic of the Congo
| | - Etienne Nguertoum
- Institut Centrafricain de la Recherche Agronomique (ICRA), Bangui, Central African Republic
| | - Victor Kande
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Kinshasa, Democratic Republic of the Congo
| | - Laurence Flevaud
- Médecins Sans Frontières (MSF) Operational Centre Barcelona-Athens (OCBA), Barcelona, Spain
| | - Gedeao Vatunga
- Instituto de Combate e Controlo das Tripanossomiases, Luanda, Angola
| | | | | | | | | | - Sylvain Biéler
- Foundation for Innovative New Diagnostics, Campus Biotech, Geneva, Switzerland
| | - Joseph M. Ndung’u
- Foundation for Innovative New Diagnostics, Campus Biotech, Geneva, Switzerland
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Büscher P, Deborggraeve S. How can molecular diagnostics contribute to the elimination of human African trypanosomiasis? Expert Rev Mol Diagn 2015; 15:607-15. [DOI: 10.1586/14737159.2015.1027195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Sutherland CS, Yukich J, Goeree R, Tediosi F. A literature review of economic evaluations for a neglected tropical disease: human African trypanosomiasis ("sleeping sickness"). PLoS Negl Trop Dis 2015; 9:e0003397. [PMID: 25654605 PMCID: PMC4318581 DOI: 10.1371/journal.pntd.0003397] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human African trypanosomiasis (HAT) is a disease caused by infection with the parasite Trypanosoma brucei gambiense or T. b. rhodesiense. It is transmitted to humans via the tsetse fly. Approximately 70 million people worldwide were at risk of infection in 1995, and approximately 20,000 people across Africa are infected with HAT. The objective of this review was to identify existing economic evaluations in order to summarise cost-effective interventions to reduce, control, or eliminate the burden of HAT. The studies included in the review were compared and critically appraised in order to determine if there were existing standardised methods that could be used for economic evaluation of HAT interventions or if innovative methodological approaches are warranted. A search strategy was developed using keywords and was implemented in January 2014 in several databases. The search returned a total of 2,283 articles. After two levels of screening, a total of seven economic evaluations were included and underwent critical appraisal using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist 6: Economic Evaluations. Results from the existing studies focused on the cost-effectiveness of interventions for the control and reduction of disease transmission. Modelling was a common method to forecast long-term results, and publications focused on interventions by category, such as case detection, diagnostics, drug treatments, and vector control. Most interventions were considered cost-effective based on the thresholds described; however, the current treatment, nifurtomix-eflornithine combination therapy (NECT), has not been evaluated for cost-effectiveness, and considerations for cost-effective strategies for elimination have yet to be completed. Overall, the current evidence highlights the main components that play a role in control; however, economic evaluations of HAT elimination strategies are needed to assist national decision makers, stakeholders, and key funders. These analyses would be of use, as HAT is currently being prioritized as a neglected tropical disease (NTD) to reach elimination by 2020.
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Affiliation(s)
- C. Simone Sutherland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Joshua Yukich
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Ron Goeree
- Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milano, Italy
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Abstract
Systematic reviews of diagnostic test accuracy summarize the accuracy, e.g. the sensitivity and specificity, of diagnostic tests in a systematic and transparent way. The aim of such a review is to investigate whether a test is sufficiently specific or sensitive to fit its role in practice, to compare the accuracy of two or more diagnostic tests, or to investigate where existing variation in results comes from. The search strategy should be broad and preferably fully reported, to enable readers to assess the completeness of it. Included studies usually have a cross-sectional design in which the tests of interest, ideally both the index test and its comparator, are evaluated against the reference standard. They should be a reflection of the situation that the review question refers to. The quality of included studies is assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 checklist, containing items such as a consecutive and all-inclusive patient selection process, blinding of index test and reference standard assessment, a valid reference standard, and complete verification of all included participants. Studies recruiting cases separately from (healthy) controls are regarded as bearing a high risk of bias. For meta-analysis, the bivariate model or the hierarchical summary receiver operating characteristic model is used. These models take into account potential threshold effects and the correlation between sensitivity and specificity. They also allow addition of covariates for investigatation of potential sources of heterogeneity. Finally, the results from the meta-analyses should be explained and interpreted for the reader, to be well understood.
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Affiliation(s)
- M M G Leeflang
- Clinical Epidemiology and Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Holzmuller P, Grébaut P, Semballa S, Gonzatti MI, Geiger A. Proteomics: a new way to improve human African trypanosomiasis diagnosis? Expert Rev Proteomics 2014; 10:289-301. [DOI: 10.1586/epr.13.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Deborggraeve S, Büscher P. Recent progress in molecular diagnosis of sleeping sickness. Expert Rev Mol Diagn 2014; 12:719-30. [DOI: 10.1586/erm.12.72] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mitashi P, Hasker E, Ngoyi DM, Pyana PP, Lejon V, Van der Veken W, Lutumba P, Büscher P, Boelaert M, Deborggraeve S. Diagnostic accuracy of loopamp Trypanosoma brucei detection kit for diagnosis of human African trypanosomiasis in clinical samples. PLoS Negl Trop Dis 2013; 7:e2504. [PMID: 24147176 PMCID: PMC3798548 DOI: 10.1371/journal.pntd.0002504] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Molecular methods have great potential for sensitive parasite detection in the diagnosis of human African trypanosomiasis (HAT), but the requirements in terms of laboratory infrastructure limit their use to reference centres. A recently developed assay detects the Trypanozoon repetitive insertion mobile element (RIME) DNA under isothermal amplification conditions and has been transformed into a ready-to-use kit format, the Loopamp Trypanosoma brucei. In this study, we have evaluated the diagnostic performance of the Loopamp Trypanosoma brucei assay (hereafter called LAMP) in confirmed T.b. gambiense HAT patients, HAT suspects and healthy endemic controls from the Democratic Republic of the Congo (DRC). METHODOLOGY/PRINCIPAL FINDINGS 142 T.b. gambiense HAT patients, 111 healthy endemic controls and 97 HAT suspects with unconfirmed status were included in this retrospective evaluation. Reference standard tests were parasite detection in blood, lymph or cerebrospinal fluid. Archived DNA from blood of all study participants was analysed in duplicate with LAMP. Sensitivity of LAMP in parasitologically confirmed cases was 87.3% (95% CI 80.9-91.8%) in the first run and 93.0% (95% CI 87.5-96.1%) in the second run. Specificity in healthy controls was 92.8% (95% CI 86.4-96.3%) in the first run and 96.4% (95% CI 91.1-98.6%) in the second run. Reproducibility was excellent with a kappa value of 0.81. CONCLUSIONS/SIGNIFICANCE In this laboratory-based study, the Loopamp Trypanosoma brucei Detection Kit showed good diagnostic accuracy and excellent reproducibility. Further studies are needed to assess the feasibility of its routine use for diagnosis of HAT under field conditions.
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Affiliation(s)
- Patrick Mitashi
- Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Dieudonné Mumba Ngoyi
- Faculty of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Pati Patient Pyana
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Veerle Lejon
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Van der Veken
- Belgian Development Agency, Kinshasa, Democratic Republic of the Congo
| | - Pascal Lutumba
- Faculty of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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Sullivan L, Wall SJ, Carrington M, Ferguson MAJ. Proteomic selection of immunodiagnostic antigens for human African trypanosomiasis and generation of a prototype lateral flow immunodiagnostic device. PLoS Negl Trop Dis 2013; 7:e2087. [PMID: 23469310 PMCID: PMC3584999 DOI: 10.1371/journal.pntd.0002087] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/17/2013] [Indexed: 11/30/2022] Open
Abstract
Background The diagnosis of Human African Trypanosomiasis relies mainly on the Card Agglutination Test for Trypanosomiasis (CATT). While this test is successful, it is acknowledged that there may be room for improvement. Our aim was to develop a prototype lateral flow test based on the detection of antibodies to trypanosome antigens. Methodology/Principal Findings We took a non-biased approach to identify potential immunodiagnostic parasite protein antigens. The IgG fractions from the sera from Trypanosoma brucei gambiense infected and control patients were isolated using protein-G affinity chromatography and then immobilized on Sepharose beads. The IgG-beads were incubated with detergent lysates of trypanosomes and those proteins that bound were identified by mass spectrometry-based proteomic methods. This approach provided a list of twenty-four trypanosome proteins that selectively bound to the infection IgG fraction and that might, therefore, be considered as immunodiagnostic antigens. We selected four antigens from this list (ISG64, ISG65, ISG75 and GRESAG4) and performed protein expression trials in E. coli with twelve constructs. Seven soluble recombinant protein products (three for ISG64, two for ISG65 and one each for ISG75 and GRESAG4) were obtained and assessed for their immunodiagnostic potential by ELISA using individual and/or pooled patient sera. The ISG65 and ISG64 construct ELISAs performed well with respect to detecting T. b. gambiense infections, though less well for detecting T. b. rhodesiense infections, and the best performing ISG65 construct was used to develop a prototype lateral flow diagnostic device. Conclusions/Significance Using a panel of eighty randomized T. b. gambiense infection and control sera, the prototype showed reasonable sensitivity (88%) and specificity (93%) using visual readout in detecting T. b. gambiense infections. These results provide encouragement to further develop and optimize the lateral flow device for clinical use. Human African Trypanosomiasis is caused by infection with Trypanosoma brucei gambiense or T. b. rhodesiense. Preliminary diagnosis of T. b. gambiense infection relies mainly on a Card Agglutination Test for Trypanosomiasis (CATT), which has acknowledged limitations. New approaches are needed, first to identify new diagnostic antigens and, second, to find a more suitable platform for field-based immunodiagnostic tests. We took an unbiased approach to identify candidate diagnostic antigens by asking which parasite proteins bind to the antibodies of infected patients and not to the antibodies of uninfected patients. From this list of twenty-four candidate antigens, we selected four and from these we selected the one that worked the best in conventional immunodiagnostic tests. This antigen, ISG65, was used to make lateral flow devices, where a small sample of patient serum is added to a pad and thirty minutes later infection can be inferred by simple optical read out. This simple prototype device works as well as the CATT test and may be developed and optimized for clinical use in the field.
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Affiliation(s)
- Lauren Sullivan
- College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | | | - Mark Carrington
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
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25
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Translation of human African trypanosomiasis biomarkers towards field application. TRANSLATIONAL PROTEOMICS 2013. [DOI: 10.1016/j.trprot.2013.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Kennedy PG. Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness). Lancet Neurol 2012; 12:186-94. [PMID: 23260189 DOI: 10.1016/s1474-4422(12)70296-x] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human African trypanosomiasis, or sleeping sickness, is caused by infection with parasites of the genus Trypanosoma, transmitted by the tsetse fly. The disease has two forms, Trypanosoma brucei (T b) rhodesiense and T b gambiense; and is almost always fatal if untreated. Despite a recent reduction in the number of reported cases, patients with African trypanosomiasis continue to present major challenges to clinicians. Because treatment for CNS-stage disease can be very toxic, diagnostic staging to distinguish early-stage from late-stage disease when the CNS in invaded is crucial but remains problematic. Melarsoprol is the only available treatment for late-stage T b rhodesiense infection, but can be lethal to 5% of patients owing to post-treatment reactive encephalopathy. Eflornithine combined with nifurtimox is the first-line treatment for late-stage T b gambiense. New drugs are in the pipeline for treatment of CNS human African trypanosomiasis, giving rise to cautious optimism.
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Affiliation(s)
- Peter Ge Kennedy
- Department of Neurology, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
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Abstract
Sleeping sickness describes two diseases, both fatal if left untreated: (i) Gambian sleeping sickness caused by Trypanosoma brucei gambiense, a chronic disease with average infection lasting around 3 years, and (ii) Rhodesian sleeping sickness caused by T. b. rhodesiense, an acute disease with death occurring within weeks of infection. Control of Gambian sleeping sickness is based on case detection and treatment involving serological screening, followed by diagnostic confirmation and staging. In stage I, patients can remain asymptomatic as trypanosomes multiply in tissues and body fluids; in stage II, trypanosomes cross the blood-brain barrier, enter the central nervous system and, if left untreated, death follows. Staging is crucial as it defines the treatment that is prescribed; for both forms of disease, stage II involves the use of the highly toxic drug melarsoprol or, in the case of Gambian sleeping sickness, the use of complex and very expensive drug regimes. Case detection of T. b. gambiense sleeping sickness is known to be inefficient but could be improved by the identification of parasites using molecular tools that are, as yet, rarely used in the field. Diagnostics are not such a problem in relation to T. b. rhodesiense sleeping sickness, but the high level of under-reporting of this disease suggests that current strategies, reliant on self-reporting, are inefficient. Sleeping sickness is one of the 'neglected tropical diseases' that attracts little attention from donors or policymakers. Proper quantification of the burden of sleeping sickness matters, as the primary reason for its 'neglect' is that the true impact of the disease is unknown, largely as a result of under-reporting. Certainly, elimination will not be achieved without vast improvements in field diagnostics for both forms of sleeping sickness especially if there is a hidden reservoir of 'chronic carriers'. Mass screening would be a desirable aim for Gambian sleeping sickness and could be handled on a national scale in the endemic countries - perhaps by piggybacking on programmes committed to other diseases. As well as improved diagnostics, the search for non-toxic drugs for stage II treatment should remain a research priority. There is good evidence that thorough active case finding is sufficient to control T. b. gambiense sleeping sickness, as there is no significant animal reservoir. Trypanosoma brucei rhodesiense sleeping sickness is a zoonosis and control involves interrupting the fly-animal-human cycle, so some form of tsetse control and chemotherapy of the animal reservoir must be involved. The restricted application of insecticide to cattle is the most promising, affordable and sustainable technique to have emerged for tsetse control. Animal health providers can aid disease control by treating cattle and, when allied with innovative methods of funding (e.g. public-private partnerships) not reliant on the public purse, this approach may prove more sustainable. Sleeping sickness incidence for the 36 endemic countries has shown a steady decline in recent years and we should take advantage of the apparent lull in incidence and aim for elimination. This is feasible in some sleeping sickness foci but must be planned and paid for increasingly by the endemic countries themselves. The control and elimination of T. b. gambiense sleeping sickness may be seen as a public good, as appropriate strategies depend on local health services for surveillance and treatment, but public-private funding mechanisms should not be excluded. It is timely to take up the tools available and invest in new tools - including novel financial instruments - to eliminate this disease from Africa.
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Affiliation(s)
- Susan C Welburn
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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Tiberti N, Hainard A, Lejon V, Courtioux B, Matovu E, Enyaru JC, Robin X, Turck N, Kristensson K, Ngoyi DM, Vatunga GML, Krishna S, Büscher P, Bisser S, Ndung’u JM, Sanchez JC. Cerebrospinal fluid neopterin as marker of the meningo-encephalitic stage of Trypanosoma brucei gambiense sleeping sickness. PLoS One 2012; 7:e40909. [PMID: 22815865 PMCID: PMC3399808 DOI: 10.1371/journal.pone.0040909] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/15/2012] [Indexed: 12/21/2022] Open
Abstract
Background Sleeping sickness, or human African trypanosomiasis (HAT), is a protozoan disease that affects rural communities in sub-Saharan Africa. Determination of the disease stage, essential for correct treatment, represents a key issue in the management of patients. In the present study we evaluated the potential of CXCL10, CXCL13, ICAM-1, VCAM-1, MMP-9, B2MG, neopterin and IgM to complement current methods for staging Trypanosoma brucei gambiense patients. Methods and Findings Five hundred and twelve T. b. gambiense HAT patients originated from Angola, Chad and the Democratic Republic of the Congo (D.R.C.). Their classification as stage 2 (S2) was based on the number of white blood cells (WBC) (>5/µL) or presence of parasites in the cerebrospinal fluid (CSF). The CSF concentration of the eight markers was first measured on a training cohort encompassing 100 patients (44 S1 and 56 S2). IgM and neopterin were the best in discriminating between the two stages of disease with 86.4% and 84.1% specificity respectively, at 100% sensitivity. When a validation cohort (412 patients) was tested, neopterin (14.3 nmol/L) correctly classified 88% of S1 and S2 patients, confirming its high staging power. On this second cohort, neopterin also predicted both the presence of parasites, and of neurological signs, with the same ability as IgM and WBC, the current reference for staging. Conclusions This study has demonstrated that neopterin is an excellent biomarker for staging T. b. gambiense HAT patients. A rapid diagnostic test for detecting this metabolite in CSF could help in more accurate stage determination.
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Affiliation(s)
- Natalia Tiberti
- Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
| | - Alexandre Hainard
- Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
| | - Veerle Lejon
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bertrand Courtioux
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, CNRS FR 3503 GEIST, University of Limoges, Limoges, France
| | - Enock Matovu
- Department of Veterinary Parasitology and Microbiology, School of Veterinary Medicine, Makerere University, Kampala, Uganda
| | - John Charles Enyaru
- Department of Biochemistry, College of Natural Sciences, Makerere University, Kampala, Uganda
| | - Xavier Robin
- Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
| | - Natacha Turck
- Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
| | | | - Dieudonné Mumba Ngoyi
- Department of Parasitology, Institut National de Recherche Biomédicale, Kinshasa, D. R. Congo
| | | | - Sanjeev Krishna
- Division of Cellular and Molecular Medicine, Centre for Infection, St. George’s, University of London, London, Great Britain
| | - Philippe Büscher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sylvie Bisser
- INSERM UMR1094, Tropical Neuroepidemiology, Limoges, France
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, CNRS FR 3503 GEIST, University of Limoges, Limoges, France
| | | | - Jean-Charles Sanchez
- Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland
- * E-mail:
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