Trypanosome infection establishment in the tsetse fly gut is influenced by microbiome-regulated host immune barriers

Tsetse flies (Glossina spp.) vector pathogenic African trypanosomes, which cause sleeping sickness in humans and nagana in domesticated animals. Additionally, tsetse harbors 3 maternally transmitted endosymbiotic bacteria that modulate their host's physiology. Tsetse is highly resistant to infection with trypanosomes, and this phenotype depends on multiple physiological factors at the time of challenge. These factors include host age, density of maternally-derived trypanolytic effector molecules present in the gut, and symbiont status during development. In this study, we investigated the molecular mechanisms that result in tsetse's resistance to trypanosomes. We found that following parasite challenge, young susceptible tsetse present a highly attenuated immune response. In contrast, mature refractory flies express higher levels of genes associated with humoral (attacin and pgrp-lb) and epithelial (inducible nitric oxide synthase and dual oxidase) immunity. Additionally, we discovered that tsetse must harbor its endogenous microbiome during intrauterine larval development in order to present a parasite refractory phenotype during adulthood. Interestingly, mature aposymbiotic flies (Gmm^Apo) present a strong immune response earlier in the infection process than do WT flies that harbor symbiotic bacteria throughout their entire lifecycle. However, this early response fails to confer significant resistance to trypanosomes. Gmm^Apo adults present a structurally compromised peritrophic matrix (PM), which lines the fly midgut and serves as a physical barrier that separates luminal contents from immune responsive epithelial cells. We propose that the early immune response we observe in Gmm^Apo flies following parasite challenge results from the premature exposure of gut epithelia to parasite-derived immunogens in the absence of a robust PM. Thus, tsetse's PM appears to regulate the timing of host immune induction following parasite challenge. Our results document a novel finding, which is the existence of a positive correlation between tsetse's larval microbiome and the integrity of the emerging adult PM gut immune barrier.

Tsetse flies serve as a host to many micro-organisms. Specifically, this fly houses beneficial endosymbiotic bacteria, and can also serve as a vector of pathogenic trypanosomes across much of sub-Saharan Africa. Although flies feed on parasite-infected reservoir hosts, only a small proportion (1–5%) of individuals that acquire an infectious meal become infected and subsequently transmit disease to a naïve host. Several physiological factors, including tsetse's age, nutritional status and innate immune mechanisms, contribute to trypanosome infection outcomes in the fly. We demonstrate that tsetse's endogenous microbiome also impacts the fly's resistance to parasites. Specifically, we show that tsetse must harbor it's symbiotic bacteria during larval development in order to present a trypanosome-refractory phenotype during adulthood. These microbes appear to indirectly regulate the fly's ability to immunologically detect and respond to the presence of trypanosomes. One of the mechanisms by which these microbes regulate parasite transmission involves modulating the formation of a physical barrier (called the ‘peritrophic matrix’) in their host's gut. Our findings are indicative of the complex functional association that exists between tsetse's symbiotic microbes and host immune mechanisms that regulate trypanosome infection outcomes.

Trypanosoma brucei rhodesiense infection in a German traveller returning from the Masai Mara area, Kenya, January 2012

In January 2012, a case of Human African Trypanosomiasis (HAT) has been identified in Germany in a traveller returning from the Masai Mara area in Kenya. The 62-year-old man had travelled to the Masai Mara game park from 18 to 19 January 2012 and developed fever on 28 January. The infection with Trypanosoma brucei rhodesiense was confirmed by laboratory testing three days hereafter.

[Molecular dialogue between African trypanosomes and humans]

The evolutionary origin of Man in the African continent has imposed the requirement to resist endemic parasites, in particular African trypanosomes (prototype: Trypanosoma brucei). Therefore, human serum is provided with an efficient system of innate immunity against these parasites, as discovered by A. Laveran in 1902. However, two T. brucei clones, termed T. b. rhodesiense and T. b. gambiense, managed to escape this immunity system, enabling them to grow in humans where they cause sleeping sickness. We have identified the gene allowing T. b. rhodesiense to resist trypanolysis by human serum, which led us to discover that the trypanolytic factor is apolipoprotein L1 (apoL1). ApoL1 is a human-specific serum protein bound to HDL particles that also contain another human-specific protein termed "haptoglobin-related protein " (Hpr). Following the binding of hemoglobin (Hb) to Hpr, the apoL1-bearing HDL particles are avidly taken up by the trypanosome through their binding to a parasite surface receptor for the Hp-Hb complex. After endocytosis apoL1 kills the parasite by generating anionic pores in the lysosomal membrane. In our laboratory, mutant versions of apoL1 have been constructed, which are no longer neutralized by the resistance protein of T. b. rhodesiense and are therefore able to kill this human pathogen. Unexpectedly, we have recently discovered that similar mutants do actually exist in nature : in Africans and Americans of recent African origin, even a single allele of these mutants allows protection against infection by T. b. rhodesiense, but the price to pay is a high frequency of end-stage renal disease when doubly allelic. The evidence of natural selection of these apoL1 mutations despite their deleterious potential for kidneys highlights the importance of the resistance to trypanosomes in the evolution of Man. The mechanism by which mutant apoL1 triggers end-stage renal disease is currently studied.

The human trypanolytic factor: a drug shaped naturally

African trypanosomes are responsible for sleeping sickness in man and nagana in cattle, which are both tremendous health burdens in Africa. Most African trypanosome species are killed by human serum. This is due to a serum trypanolytic particle specific of some old world monkeys and great apes, an HDL subclass containing two proteins which appeared recently in mammalian evolution, apolipoprotein L1 and haptoglobin related protein. Nevertheless, two African trypanosome species, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense are able to infect humans, because they developed resistance to trypanolysis. Resistance to human serum in Trypanosoma brucei rhodesiense is due to a single gene called SRA. This mechanism of lysis-resistance is therefore an example of a natural drug-antidote system which evolved during a pathogen-host arms race. The lysis and resistance mechanisms, their molecular components as well as their mode of action are reviewed. I also discuss how components of the system would be suitable drug targets and how the system could be engineered to generate an effective synthetic drug.

Infections with immunogenic trypanosomes reduce tsetse reproductive fitness: potential impact of different parasite strains on vector population structure

The parasite Trypanosoma brucei rhodesiense and its insect vector Glossina morsitans morsitans were used to evaluate the effect of parasite clearance (resistance) as well as the cost of midgut infections on tsetse host fitness. Tsetse flies are viviparous and have a low reproductive capacity, giving birth to only 6-8 progeny during their lifetime. Thus, small perturbations to their reproductive fitness can have a major impact on population densities. We measured the fecundity (number of larval progeny deposited) and mortality in parasite-resistant tsetse females and untreated controls and found no differences. There was, however, a typanosome-specific impact on midgut infections. Infections with an immunogenic parasite line that resulted in prolonged activation of the tsetse immune system delayed intrauterine larval development resulting in the production of fewer progeny over the fly's lifetime. In contrast, parasitism with a second line that failed to activate the immune system did not impose a fecundity cost. Coinfections favored the establishment of the immunogenic parasites in the midgut. We show that a decrease in the synthesis of Glossina Milk gland protein (GmmMgp), a major female accessory gland protein associated with larvagenesis, likely contributed to the reproductive lag observed in infected flies. Mathematical analysis of our empirical results indicated that infection with the immunogenic trypanosomes reduced tsetse fecundity by 30% relative to infections with the non-immunogenic strain. We estimate that a moderate infection prevalence of about 26% with immunogenic parasites has the potential to reduce tsetse populations. Potential repercussions for vector population growth, parasite-host coevolution, and disease prevalence are discussed.

African Trypanosomes: Intracellular Trafficking of Host Defense Molecules

Trypanosoma brucei brucei is the causative agent of Nagana in cattle and can infect a wide range of mammals but is unable to infect humans because it is susceptible to the innate cytotoxic activity of normal human serum. A minor subfraction of human high-density lipoprotein (HDL), containing apolipoprotein A-I (APOA1), apolipoprotein L-I (APOL1) and haptoglobin-related protein (HPR) provides this innate protection against T. b. brucei infection. Both HPR and APOL1 are cytotoxic to T. b. brucei but their specific activities for killing increase several hundred-fold when assembled in the same HDL. This HDL is called trypanosome lytic factor (TLF) and kills T. b. brucei following receptor binding, endocytosis, and lysosomal localization. Trypanosome lytic factor is activated in the acidic lysosome and facilitates lysosomal membrane disruption. Lysosomal localization is necessary for T. b. brucei killing by TLF. Trypanosoma brucei rhodesiense, which is indistinguishable from T. b. brucei, is resistant to TLF killing and causes human African sleeping sickness. Human infectivity by T. b. rhodesiense correlates with the evolution of a human serum resistance associated protein (SRA) that is able to ablate TLF killing. When T. b. brucei is transfected with the SRA gene it becomes highly resistant to TLF and human serum. In the SRA transfected cells, intracellular trafficking of TLF is altered and TLF mainly localizes to a subset of SRA containing cytoplasmic vesicles but not to the lysosome. These findings indicate that the cellular distribution of TLF is influenced by SRA expression and may directly determine susceptibility.

Signal transduction, gene transcription, and cytokine production triggered in macrophages by exposure to trypanosome DNA

Activation of a type I cytokine response is important for early resistance to infection with Trypanosoma brucei rhodesiense, the extracellular protozoan parasite that causes African sleeping sickness. The work presented here demonstrates that trypanosome DNA activates macrophages to produce factors that may contribute to this response. Initial results demonstrated that T. brucei rhodesiense DNA was present in the plasma of C57BL/6 and C57BL/6-scid mice following infection. Subsequently, the effect of trypanosome DNA on macrophages was investigated; parasite DNA was found to be less stimulatory than Escherichia coli DNA but more stimulatory than murine DNA, as predicted by the CG dinucleotide content. Trypanosome DNA stimulated the induction of a signal transduction cascade associated with Toll-like receptor signaling in RAW 264.7 macrophage cells. The signaling cascade led to expression of mRNAs, including interleukin-12 (IL-12) p40, IL-6, IL-10, cyclooxygenase-2, and beta interferon. The treatment of RAW 264.7 cells and bone marrow-derived macrophages with trypanosome DNA induced the production of NO, prostaglandin E2, and the cytokines IL-6, IL-10, IL-12, and tumor necrosis factor alpha. In all cases, DNase I treatment of T. brucei rhodesisense DNA abolished the activation. These results suggest that T. brucei rhodesiense DNA serves as a ligand for innate immune cells and may play an important contributory role in early stimulation of the host immune response during trypanosomiasis.

The trypanolytic factor of human serum

African trypanosomes (the prototype of which is Trypanosoma brucei brucei) are protozoan parasites that infect a wide range of mammals. Human blood, unlike the blood of other mammals, has efficient trypanolytic activity, and this needs to be counteracted by these parasites. Resistance to this activity has arisen in two subspecies of Trypanosoma brucei - Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense - allowing these parasites to infect humans, and this results in sleeping sickness in East Africa and West Africa, respectively. Study of the mechanism by which T. b. rhodesiense escapes lysis by human serum led to the identification of an ionic-pore-forming apolipoprotein - known as apolipoprotein L1 - that is associated with high-density-lipoprotein particles in human blood. In this Opinion article, we argue that apolipoprotein L1 is the factor that is responsible for the trypanolytic activity of human serum.

Experimental therapy of African trypanosomiasis with a nanobody-conjugated human trypanolytic factor

High systemic drug toxicity and increasing prevalence of drug resistance hampers efficient treatment of human African trypanosomiasis (HAT). Hence, development of new highly specific trypanocidal drugs is necessary. Normal human serum (NHS) contains apolipoprotein L-I (apoL-I), which lyses African trypanosomes except resistant forms such as Trypanosoma brucei rhodesiense. T. b. rhodesiense expresses the apoL-I-neutralizing serum resistance-associated (SRA) protein, endowing this parasite with the ability to infect humans and cause HAT. A truncated apoL-I (Tr-apoL-I) has been engineered by deleting its SRA-interacting domain, which makes it lytic for T. b. rhodesiense. Here, we conjugated Tr-apoL-I with a single-domain antibody (nanobody) that efficiently targets conserved cryptic epitopes of the variant surface glycoprotein (VSG) of trypanosomes to generate a new manmade type of immunotoxin with potential for trypanosomiasis therapy. Treatment with this engineered conjugate resulted in clear curative and alleviating effects on acute and chronic infections of mice with both NHS-resistant and NHS-sensitive trypanosomes.

Dot enzyme-linked immunosorbent assay for more reliable staging of patients with Human African trypanosomiasis

Human African trypanosomiasis (HAT) or sleeping sickness is a disease characterized by a hemolymphatic stage 1 followed by a meningoencephalitic stage 2 which is fatal without specific treatment. Furthermore, due to the toxicity of drugs used to treat stage 2 (mainly melarsoprol) accurate staging is required. Actual criteria employed during field surveys are not sensitive enough for precise staging. Antineurofilament (anti-NF) and antigalactocerebrosides (anti-GalC) antibodies have been identified in cerebrospinal fluid (CSF) as potential markers of central nervous system (CNS) involvement. We describe a dot enzyme-linked immunosorbent assay (dot-ELISA) to detect anti-GalC and anti-NF antibodies and its value in staging. NF- and GalC-dotted nitrocellulose strips were first developed in our laboratory. They were then evaluated in Angola and Central African Republic on 140 CSF samples. Compared to our staging criteria (i.e., CSF cell count > or = 20 cells/microl, CSF immunoglobulin M concentration > or = 100 mg/liter, and/or the presence of trypanosomes in the CSF), combined detection of both CSF anti-NF and CSF anti-GalC by dot-ELISA showed 83.2% sensitivity and 100.0% specificity. Dot-ELISA could be a useful test to diagnose CNS involvement in HAT in the less-equipped laboratories or in the field situation and to improve patient treatment.

Trypanosomes expressing a mosaic variant surface glycoprotein coat escape early detection by the immune system

Host resistance to African trypanosomiasis is partially dependent on an early and strong T-independent B-cell response against the variant surface glycoprotein (VSG) coat expressed by trypanosomes. The repetitive array of surface epitopes displayed by a monotypic surface coat, in which identical VSG molecules are closely packed together in a uniform architectural display, cross-links cognate B-cell receptors and initiates T-independent B-cell activation events. However, this repetitive array of identical VSG epitopes is altered during the process of antigenic variation, when former and nascent VSG proteins are transiently expressed together in a mosaic surface coat. Thus, T-independent B-cell recognition of the trypanosome surface coat may be disrupted by the introduction of heterologous VSG molecules into the coat structure. To address this hypothesis, we transformed Trypanosoma brucei rhodesiense LouTat 1 with the 117 VSG gene from Trypanosoma brucei brucei MiTat 1.4 in order to produce VSG double expressers; coexpression of the exogenous 117 gene along with the endogenous LouTat 1 VSG gene resulted in the display of a mosaic VSG coat. Results presented here demonstrate that the host's ability to produce VSG-specific antibodies and activate B cells during early infection with VSG double expressers is compromised relative to that during infection with the parental strain, which displays a monotypic coat. These findings suggest a previously unrecognized mechanism of immune response evasion in which coat-switching trypanosomes fail to directly activate B cells until coat VSG homogeneity is achieved. This process affords an immunological advantage to trypanosomes during the process of antigenic variation.

Options for field diagnosis of human african trypanosomiasis

Human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense or T. b. rhodesiense remains highly prevalent in several rural areas of sub-Saharan Africa and is lethal if left untreated. Therefore, accurate tools are absolutely required for field diagnosis. For T. b. gambiense HAT, highly sensitive tests are available for serological screening but the sensitivity of parasitological confirmatory tests remains insufficient and needs to be improved. Screening for T. b. rhodesiense infection still relies on clinical features in the absence of serological tests available for field use. Ongoing research is opening perspectives for a new generation of field diagnostics. Also essential for both forms of HAT is accurate determination of the disease stage because of the high toxicity of melarsoprol, the drug most widely used during the neurological stage of the illness. Recent studies have confirmed the high accuracy of raised immunoglobulin M levels in the cerebrospinal fluid for the staging of T. b. gambiense HAT, and a promising simple assay (LATEX/IgM) is being tested in the field. Apart from the urgent need for better tools for the field diagnosis of this neglected disease, improved access to diagnosis and treatment for the population at risk remains the greatest challenge for the coming years.

VSG-GPI anchors of African trypanosomes: their role in macrophage activation and induction of infection-associated immunopathology

African trypanosomes express a glycosylphosphatidyl inositol (GPI)-anchored variant-specific surface glycoprotein (VSG) as a protective coat. During infection, large amounts of VSG molecules are released into the circulation. Their interaction with various cells of the immune system underlies the severe infection-associated pathology. Recent results have shown that anti-GPI vaccination can prevent the occurrence of this pathology.

Stage determination and follow-up in sleeping sickness

In order to select a correct treatment after primary diagnosis of trypanosomiasis infection, accurate assessment of the disease stage, haemo-lymphatic or meningo-encephalitic, is essential. This is achieved by lumbar puncture and subsequent examination of the cerebrospinal fluid. These examinations have to be repeated during 2 years after treatment, and only after the cerebrospinal fluid has normalized one can decide on complete cure. The currently used cerebrospinal fluid parameters, i.e. white blood cell count, total protein determination and finding of trypanosomes, and practical problems encountered using these parameters are discussed. Alternative markers for stage determination and follow-up include trypanosome specific antibodies, anti-galactocerebroside antibodies and IgM measurement in CSF.

[Diagnosis of human African trypanosomiasis in 2001]

Human African trypanosomiasis is characterized by a non-specific clinical presentation with no consistent, pathognomonic manifestations. However definite diagnosis is necessary to avoid unnecessary therapeutic risks with toxic drugs. Further complicating this situation is the frequent need to achieve field diagnosis in remote locations with limited facilities. Serological tests such as CATT (card agglutination trypanosomiasis test) are useful for initial population screening to identify suspects but are not sufficiently reliable for definitive diagnosis since the variations in sensitivity and specificity have been observed between countries and disease pockets. Parasitological examination is still the only method of definitive diagnosis. Thresholds of trypanosome detection differ from one technique to another, i.e., 10,000 trypanosomes per millilitre (T/ml) for fresh blood smears, 5,000 T/ml for thick drop specimens stained with Giemsa, 500 T/ml for centrifugation in capillary tubes, less than 500 T/ml for the QBC test, and 100 T/ml for the ion exchange minicolumn system. The possibility that the QBC test and minicolumn anion exchange system may go out of production could pose a serious problem for field diagnosis. Decisional algorithms are being developed to optimize use of remaining techniques.

Molecular characterization of three gut genes from Glossina morsitans morsitans: cathepsin B, zinc-metalloprotease and zinc-carboxypeptidase

Insect gut enzymes are involved in digestion of dietary proteins. Additionally, these enzymes have been implicated in the process of pathogen establishment in several insects including the tsetse fly (Diptera:Glossinidae), which is the vector for African trypanosomes. Both the male and female tsetse can transmit trypanosomes and are strict blood feeders during all stages of their development. Here, we describe the molecular characterization of three gut genes: cathepsin B (GmCatB), zinc-metalloprotease (GmZmp) and zinc-carboxypeptidase (GmZcp). The cDNA for GmCatB encodes a protein for 340 amino acids with a predicted molecular mass of 38.2 kDa, while the 854 bp GmZmp cDNA encodes a protein of 254 amino acids with a molecular mass of 29 kDa. The GmZcp cDNA is 1319 bp in length and has a 354 amino acids open reading frame for coding a 40 kDa protein. All three cDNAs have signal peptide sequences associated with their N-terminal domains and structure analysis indicates that GmCatB and GmZmp are expressed as zymogens with pro-domains proteolytically removed for activity. The activation domain associated with the carboxypeptidase sequences is lacking in GmZcp. While GmCatB transcription is constitutive, teneral flies express very low levels of transcripts for GmZmp and GmZcp prior to the first bloodmeal. Transcription of all genes is induced and remains high throughout the digestion cycle within a few hours following the first bloodmeal ingestion. Both GmCatB and GmZcp are parasite responsive, with the expression of both genes being higher in trypanosome infected flies.

Increased trypanolytic activity in sera of sleeping sickness patients after chemotherapy

We tested sera from patients previously treated for human African trypanosomiasis, from patients infected with trypanosomes, and from individuals never diagnosed with African trypanosomiasis living in the Trypanosoma brucei gambiense sleeping sickness focus of Mbini in Equatorial Guinea for their trypanolytic activity against bloodstream forms of T. b. rhodesiense expressing a metacyclic and bloodstream variant surface glycoprotein (VSG). Nearly 80% of the sera from treated patients showed high trypanolytic activity against trypanosomes expressing a metacyclic VSG. The trypanolytic activity of part of these sera was mediated by IgM while that of the other part was antibody-independent. On the other hand, only 40% of the sera exhibited high trypanolytic activity against trypanosomes expressing a bloodstream VSG which also was almost completely abolished by heat-inactivation. In contrast, most sera from infected and negative individuals displayed only low to moderate trypanolytic activity against either trypanosomes expressing a metacyclic or a bloodstream VSG. These results suggest that trypanolytic activity of sera increases after African sleeping sickness and is directed against trypanosomes expressing metacyclic VSG.

Analysis of macrophage activation in African trypanosomiasis

African trypanosomes cause a fatal disease of man and animals that is characterized by extensive functional, histological, and pathological changes in the lymphoid tissues of infected hosts, including an increase in the numbers and activation state of macrophages. Macrophage activation during infection is the result of exposure of these cells to parasite components and host-derived IFN-gamma, produced in response to parasite antigens. The balance of these different activation signals may determine the outcome of infection. In the experiments described here, we assessed the ability of the variant surface glycoprotein (VSG) of the organism Trypanosoma brucei rhodesiense (T.b. rhodesiense) to activate macrophages directly. Our results demonstrate that macrophages bind and are activated by the VSG molecule. The resulting profile of activation differs from that stimulated by IFN-gamma. These results suggest that the interaction of host macrophages with VSG released during parasite infection may be a key component of trypanosomiasis.

Expression and localization of serum resistance associated protein in Trypanosoma brucei rhodesiense

The trypanosome lytic factor (TLF) is a primate specific innate defense mechanism that restricts the host range of African trypanosomes. Trypanosoma brucei rhodesiense, the causative agent of the acute form of human sleeping sickness, is resistant to the cytolytic action of TLF. By differential display PCR we have identified a gene in T. b. rhodesiense that is preferentially expressed in cell lines resistant to TLF. The protein sequence predicted from the gene shows homology to the trypanosome variable surface glycoprotein (VSG) gene family and in particular, to the previously reported human serum resistance associated gene (SRA). The amount of SRA mRNA is over 1000-fold higher in TLF resistant cells relative to TLF sensitive trypanosomes. Treatment of TLF sensitive trypanosomes with increasing concentrations of TLF in mice results in the selection of parasites that have reverted back to the TLF resistant phenotype. These trypanosomes also showed high levels of SRA mRNA. Antibodies against recombinant SRA react with a 59 kDa protein on western blots of total cell protein from TLF resistant trypanosomes but not TLF sensitive cells. Indirect immunofluorescence revealed that SRA is a cell surface protein present only in TLF resistant trypanosomes. These results suggest that TLF resistance in human sleeping sickness trypanosomes is a consequence of the selective, high level expression of a cell surface molecule(s). In addition, these studies support the role of TLF as a major factor in human serum mediated killing of susceptible trypanosomes.

IFN-gamma-dependent nitric oxide production is not linked to resistance in experimental African trypanosomiasis

Resistance to African trypanosomes is dependent on B cell and Th1 cell responses to the variant surface glycoprotein (VSG). While B cell responses to VSG control levels of parasitemia, the cytokine responses of Th1 cells to VSG appear to be linked to the control of parasites in extravascular tissues. We have recently shown that IFN-gamma knockout (IFN-gamma KO) mice are highly susceptible to infection and have reduced levels of macrophage activation compared to the wild-type C57BL/6 (WT) parent strain, even though parasitemias were controlled by VSG-specific antibody responses in both strains. In the present work, we examine the role of IFN-gamma in the induction of nitric oxide (NO) production and host resistance and in the development of suppressor macrophage activity in mice infected with Trypanosoma brucei rhodesiense. In contrast to WT mice, susceptible IFN-gamma KO mice did not produce NO during infection and did not develop suppressor macrophage activity, suggesting that NO might be linked to resistance but that suppressor cell activity was not associated with resistance or susceptibility to trypanosome infection. To further examine the consequence of inducible NO production in infection, we monitored survival, parasitemia, and Th cell cytokine production in iNOS KO mice. While survival times and parasitemia of iNOS KO mice did not differ significantly from WT mice, VSG-specific Th1 cells from iNOS KO mice produced higher levels of IFN-gamma and IL-2 than cells from WT mice. Together, these results show for the first time that inducible NO production is not the central defect associated with susceptibility of IFN-gamma KO mice to African trypanosomes, that IFNgamma-induced factors other than iNOS may be important for resistance to the trypanosomes, and that suppressor macrophage activity is not linked to either the resistance or the susceptibility phenotypes.

Trypanosomosis agglutination card test for Trypanosoma brucei rhodesiense sleeping sickness

OBJECTIVE

To develop a simple field test for diagnosis of Trypanosoma brucei rhodesiense in man.

DESIGN

Trypanosomosis Agglutination Card Test (TACT) was developed for the diagnosis of sleeping sickness due to Trypanosoma brucei rhodesiense infection, based on stabilised procyclic forms derived from Utat 4.1. Procyclics were fixed in buffered formalin at 4 degrees for 24 hours and further stabilised in acid/alcohol mixture for 30 minutes. The fixed antigen was stained with Coomassie blue and suspended in 0.1 M PBS/sodium azide buffer pH 7.2 at a concentration of 1 x 10(8) trypanosomes/ml and kept at room temperature. This antigen was used to screen 100 sera from rabbits infected with T. b. rhodesiense, eight from normal rabbits, and 220 only sera 60 of which were from sleeping sickness patients, 50 from normal persons and 110 from other parasitic infections.

SETTING

Laboratory testing of the antigen types against the rabbit and human sera infected with cloned variable antigen types of T. b. rhodesiense, was routinely carried on test cards under room temperature.

SUBJECTS/PARTICIPANTS

Serum samples from normal and infected rabbits and human subjects.

RESULTS

All sera from infected rabbits and 59 from sleeping sickness patients reacted strongly with the antigen showing agglutination reaction which ranged from 1:4 to 1:1024 serum dilution. There was minimal cross reaction with other parasitic infections as follows: one out of 20 malaria patients none of the 20 hookworm patients, one out of 30 for schistosomiasis patients, none of the 10 amoebiasis patients and one out of 20 for filariasis patients. Agglutination titres from all these non-sleeping sickness patients were below 1:16. Based on rabbit positive and negative sera, TACT gave a sensitivity and specificity of 100% and 80% while for human sera a sensitivity of 98.3% and specificity of 96% were observed.

CONCLUSION

These preliminary results show that TACT could be a promising screening field test for T. b. rhodesiense sleeping sickness.

A VSG expression site-associated gene confers resistance to human serum in Trypanosoma rhodesiense

Infectivity of Trypanosoma brucei rhodesiense to humans is due to its resistance to a lytic factor present in human serum. In the ETat 1 strain this character was associated with antigenic variation, since expression of the ETat 1.10 variant surface glycoprotein was required to generate resistant (R) clones. In addition, in this strain transcription of a gene termed SRA was detected in R clones only. We show that the ETat 1.10 expression site is the one selectively transcribed in R variants. This expression site contains SRA as an expression site-associated gene (ESAG) and is characterized by the deletion of several ESAGs. Transfection of SRA into T.b. brucei was sufficient to confer resistance to human serum, identifying this gene as one of those responsible for T.b. rhodesiense adaptation to humans.

A multi-centre evaluation of the card indirect agglutination test for trypanosomiasis (TrypTect CIATT)

A version of the card indirect agglutination test for trypanosomiasis, the TrypTect CIATT, was evaluated for the diagnosis of Trypanosoma brucei gambiense and T. b. rhodesiense sleeping sickness. The results of this antigen-detection test indicated high relative sensitivity (99.3%) and specificity (99.4%), and also much higher prevalences of infection in the general population of endemic foci (27.9% for T. b. gambiense and 21.8% for T. b. rhodesiense) than detected by parasitological diagnosis (1.6% and 1.1%, respectively). TrypTect CIATT detected (and could therefore be used for the diagnosis of) non-patent infections. Among the suspected cases (i.e. those initially found to be parasite-negative but to be antigen-positive), trypanosomes were detected in 29 (4.2%) of those checked at a 3-month follow-up, and 17 more such suspects when they were followed up at 6-18 months. Moreover, a high proportion of blood samples from a random sample of the rest of the suspects tested positive for trypanosome-specific DNA by PCR (79.9% for T. b. gambiense and 13.9% for T. b. rhodesiense). ELISA also demonstrated the presence of anti-trypanosome antibodies in many of the suspects tested (63%, 38%, 24% and 66.9% of those in Cameroon, Côte d'Ivoire, Tanzania, and Malawi, respectively). A follow-up of 164 patients treated with melarsoprol revealed that, by 9 months post-treatment, 113 (69.0%) had no detectable trypanosome antigens in their peripheral blood. The test could therefore be used for evaluating chemotherapeutic cure, as well as for diagnosis.

Interleukin-4-dependent immunoglobulin G1 isotype switch in the presence of a polarized antigen-specific Th1-cell response to the trypanosome variant surface glycoprotein

This study examines B-cell immunoglobulin (Ig) class-switching events in the context of parasite antigen-specific Th-cell responses in experimental African trypanosomiasis. Inbred mice were infected with Trypanosoma brucei rhodesiense, and the coordinate stimulation of Th-cell cytokine responses and B-cell responses to the trypanosome variant surface glycoprotein (VSG) was measured. The cytokines produced by T cells in response to VSG, at both the transcript and protein levels, were gamma interferon and interleukin-2 (IL-2) but not IL-4 or IL-5. Isotype profiles of antibodies specific for VSG showed that IgG1, IgG2a, and IgG3 switch responses predominated; no VSG-specific IgE responses were detected. To determine whether cryptic IL-4 responses played a role in promoting the unexpected IgG1 switch response, IL-4 knockout mice were infected; the cytokine responses and Ig isotype profiles of IL-4 knockout mice were identical to those of the wild-type control mice except for dramatically reduced IgG1 levels in response to VSG. Thus, these results revealed an IL-4-dependent component of the VSG-driven B-cell Cmu-to-Cgamma1 switch. We speculate that an IL-4 response is mediated primarily by cells other than T lymphocytes since IL-4-secreting but parasite antigen-unresponsive, "background" cells were detected in all infected mice and since infected nude mice also displayed a detectable IgG1 switch response. Overall, our results suggest that B-cell clonal stimulation, maturation, and Ig class switching in African trypanosomiasis may be partially regulated by unusual mechanisms that do not include antigen-specific Th1 or Th2 cells.

[African sleeping sickness in The Netherlands]

Of the four most dangerous protozoal infections acquired in (sub)tropical regions, falciparum malaria, amoebic abscess of the liver, visceral leishmaniasis (kala azar) and African trypanosomiasis (sleeping sickness) only the fourth was up to now unreported in the Dutch medical literature. Two case histories are presented: a Cameroonian woman, resident in the Netherlands for two years, suffering from West African type sleeping sickness, and a Dutch tourist who acquired East African trypanosomiasis while travelling through Zimbabwe. Although the parasites are morphologically identical, clinical and epidemiological characteristics are distinctly different. The West African type, rarely if ever observed in Europeans, has an insidious chronic course leading to the features of classical sleeping sickness. Differential diagnosis is difficult. The East African variety runs an acute course in Europeans leading to death within days due to myocarditis. It is therefore mandatory for the diagnosis to be made as soon as possible in order to initiate specific therapy. Both patients recovered after specific therapy.

The inheritance of factors controlling resistance in mice infected with Trypanosoma brucei rhodesiense

In crosses between 2 recombinant inbred strains of mice (B x H-2 and B x H-14), resistance to infection with Trypanosoma brucei rhodesiense as measured by survival time is suggested to be controlled by a dominant gene(s). In prior studies using the same clone of trypanosomes, but a different set of inbred mouse strains, it was demonstrated that resistance in H-2 congenic mice was a recessive trait. This work suggests that in mouse trypanosomiasis, the number of genes involved in resistance and their dominant or recessive nature will vary between different inbred mouse strains. There was a statistically significant difference between the survival times of animals with high or low antibody anti-trypanosome titers. Differences in survival time were not correlated with the height of the first parasitemia. There was, however, a strong negative correlation between the number of trypanosomes at the second peak in parasitemia and survival time. It is also suggested that the extent to which the host is immunosuppressed early in infection determines the ability to control the later peaks in parasitemia, and, therefore, survival time.

Use of monoclonal antibodies for detecting T brucei brucei infection in splenectomised dogs

A monoclonal antibody against a plasma membrane antigen of Trypanosoma rhodesiense was used for the detection of T brucei group-specific circulating antigen in 24 adult local dogs experimentally infected with T brucei brucei strain 8/18. Ten of the dogs were splenectomised and the remainder non-splenectomised (intact). Five dogs each from the splenectomised and intact groups were inoculated intravenously with trypanosomes. The infected dogs developed trypanosomiasis between days 4 and 8 after infection. The circulating antigens were detected as early as six days after infection and remained high until two weeks after treatment, when the circulating antigen declined. The detection of the antigens showed the existence of infection unlike the antibody test. The treatment of the infected dogs with diminazene aceturate (Berenil; Hoechst) at a dose of 7.0 mg/kg on day 21 after infection cleared all the parasites but elevated the circulating antigen levels. The antigen capture enzyme-linked immunosorbent assay is a useful diagnostic tool for complementing parasitological diagnosis, for detecting infection in the field and for ascertaining the efficacy of trypanocidal drugs.

Partial protection against natural trypanosomiasis after vaccination with a flagellar pocket antigen from Trypanosoma brucei rhodesiense

Cattle that were inoculated with an antigen derived from the flagellar pocket of Trypanosoma brucei rhodesiense and then infected with Trypanosoma congolense and Trypanosoma vivax were compared with unvaccinated cattle when both groups of cattle were placed in regions of Kenya endemic for tsetse flies known to harbour T. congolense and T. vivax. In one trial, 90 cattle were employed, 40 untreated controls, 30 cattle given prior treatment with samorin, and 20 inoculated with a flagellar pocket (Fp) antigen derived from T. brucei rhodesiense, with bovine serum albumin as the carrier and alum as the adjuvant. The animals were monitored for parasitaemia, by buffy coat analysis, during one rainy season. The untreated controls had 58% infection, the samorin-treated cattle had 43% infection, and the immunized cattle had 26% infection. Simultaneously, a second trial was conducted using 250 cattle, 100 untreated controls and 150 inoculated with the above antigen, carrier and adjuvant. At the end of the same rainy season, the untreated controls had 22% infection while the immunized animals had 9% infection. In a third experiment, on the same ranch as the latter experiment, ovalbumin was employed as the carrier. After 15 months, or over three rainy seasons, 13% of the untreated controls became infected while of the 177 immunized animals 0.9% became infected. These results are the first report of heterologous immunoprotection against trypanosomiasis in cattle.

Transport of a lysosomal membrane glycoprotein from the Golgi to endosomes and lysosomes via the cell surface in African trypanosomes

gp57/42 is a membrane glycoprotein localized in the trans-Golgi, flagellar pocket region of the cell surface, endosomes and lysosomes of bloodstream forms of Trypanosoma brucei rhodesiense. Pulse-chase immunoprecipitation experiments revealed that gp57/42 acquires a unique N-linked oligosaccharide recognized by the CB1 monoclonal antibody 20–30 minutes after protein synthesis, probably in the trans-Golgi. We refer to gp57/42 molecules that carry the CB1 epitope as CB1-gp. Pulse labeled CB1-gp contained only one core protein, p57, when chase times were 30 minutes or less. As time of chase increased from 30 to 60 minutes, a new polypeptide, p42, appeared in N-glycanase-treated CB1 immunoprecipitates. Since p57 and p42 share 10 of 13 methionyl peptides, we conclude that p42 is a fragment of p57. Cleavage of p57 to p42 was not inhibited when cells were chased in two thiol protease inhibitors or in 3,4-diisocoumarin, but was inhibited by leupeptin. Cell surface biotinylation was used to determine if newly synthesized CB1-gp was transported from the Golgi to the surface. When cells were pulse labeled and chased for 30 minutes, as much as 40% of the radiolabeled CB1-gp could be biotinylated on the cell surface. The amount of CB1-gp that could be biotinylated decreased when chases were extended from 30 to 60 minutes, suggesting that pulse labeled CB1-gp left the surface. In contrast, pulse labeled variant surface glycoprotein molecules continued to accumulate on the surface where they could be biotinylated between 30 and 60 minutes of chase. Biotinylated CB1-gp derived from cells chased for 30 minutes contained p57 but no p42. However, when labeled cells were biotinylated after a 30 minute chase and then incubated another 30 minutes at 37 degrees C, the biotinylated CB1-gp contained both p57 and p42. The p57 in biotinylated CB1-gp was not cleaved to p42 if the additional incubation was done at 4 or 12 degrees C. This suggests that transport to a compartment where processing occurs and/or the processing enzymes are inhibited by low temperature. When surface biotinylation was done after a 60 minute chase, p42 was detected in biotinylated CB1-gp, suggesting that CB1-gp molecules had passed through the processing compartment and then appeared on the cell surface. Thus, a major portion of the newly synthesized CB1-gp is routed from the Golgi to endocytic compartments via the cell surface. In trypanosomes this process involves a unique surface domain, the flagellar pocket.(ABSTRACT TRUNCATED AT 400 WORDS)

A multiple antigen detection dipstick colloidal dye immunoassay for the field diagnosis of trypanosome infections in cattle

Monoclonal antibodies (McAbs) were developed against aspartate aminotransferase purified from Trypanosoma brucei rhodesiense bloodstream form (bf) soluble extracts using a combination of anion-exchange and hydrophobic interaction chromatography. McAb 1A1 was Trypanozoon and Nannomonas specific while 2F1 was Trypanozoon bloodstream form specific. A dipstick colloidal dye immunoassay (DIA) was employed as a field diagnostic test for African trypanosome infections and designed using affinity purified polyclonal antibodies (PcAbs) raised against T. b. rhodesiense bf and the two McAbs, 1A1 and 2F1. PcAbs were adsorbed onto Palanil Red dye particles and used as dye reagents. Dipsticks were dotted with the three different antibodies, which captured trypanosomal antigens in samples tested, while the dye reagent bound to the captured antigens; the presence of coloured dots on the dipstick identified trypanosome infections. A field trial of the DIA was carried out in southeastern Uganda. A total of 1686 cattle from seven areas were bled and tested by DIA and haematocrit centrifuge technique (HCT). A total of 798 cattle (47.3%) were found to be trypanosomal antigen positive by DIA while only 162 (9.6%) were revealed to harbour trypanosomes by HCT, of which 151 (93%) were also positive by DIA.

Trypanosoma brucei rhodesiense: use of an antigen detection enzyme immunoassay for evaluation of response to chemotherapy in infected vervet monkeys (Cercopithecus aethiops)

Thirty eight Trypanosoma brucei rhodesiense-infected vervet monkeys (Cercopithecus aethiops) in the late (meningoencephalitic) stage of disease, treated with various trypanocidal drugs, were monitored for a period of more than 600 days to assess the rate of clearance of trypanosome antigens from serum and cerebrospinal fluid (CSF). There was a complete but gradual reduction in antigen titres, as assessed by ELISA, in animals treated intravenously with melarsoprol, the standard drug for the late stage disease. In 8 of the 9 monkeys treated with melarsoprol, the antigen titres, as assessed by optical density values, dropped by 50% within 252 days (mean value 68 days for antigens in CSF and 116 for serum) following treatment. The remaining animal in this group, that displayed persistent antigenaemia, had been treated with a sub-curative drug dosage level. Thus, if time to 50% reduction in antigen levels were to be taken as an index to predict cure, the follow-up period after melarsoprol treatment could have been reduced from 600 to 252 days for 8 of the 9 animals, leaving only one animal for further follow up. The animals treated with experimental drug combinations displayed a variable picture. Five monkeys showed a persistence of antigens in both serum and CSF throughout the observation period, suggesting failure of the drugs to cure the infection. Parasitologically confirmed relapse of the infection was indeed observed in all the five monkeys. In some monkeys, the parasite antigens eventually cleared from serum and CSF completely, but this took a longer time duration than in the melarsoprol treated animals; others showed persistence of parasite antigens in serum, but the parasites were not detected in blood or CSF throughout the entire follow-up period. These results suggest that the experimental drug combinations used were not effective in clearing the parasites from cryptic foci and hence the persistence of antigens in serum and/or CSF.(ABSTRACT TRUNCATED AT 250 WORDS)

Human serum-sensitive Trypanosoma brucei rhodesiense: a comparison with serologically identical human serum-resistant clones

Trypanosoma brucei rhodesiense clones, which are susceptible to lysis by normal human serum, were isolated from 3 different human serum-resistant clones originally derived from strain ETat 1.10. Serologically, these pairs of serum-sensitive and serum-resistant clones displayed the same variant surface glycoprotein (VSG) on their surface. Acquisition of human serum sensitivity correlated with susceptibility to lysis by human high density lipoprotein, a trypanocidal factor in normal human serum. Analysis of these paired populations by two-dimensional gel electrophoresis of whole trypanosomes and various subcellular fractions failed to reveal any differences in mobility of VSG and other proteins. Northern blot analysis of mRNAs from serum-sensitive and serum-resistant clones showed no differences when probed with a previously described resistance-specific probe. In addition, the ethanolamine membrane transport system and the overall membrane lipid fluidity did not reveal any detectable biochemical or biophysical differences in membrane properties. If resistance to lysis is indeed mediated by membrane changes at the enzymatic or structural level, the data presented suggest that the gene product(s) responsible for this change in human serum sensitivity may be present in very small quantities.

Immunoassay of circulating trypanosomal antigens in sleeping sickness patients undergoing treatment

Sera from 99 patients infected with Trypanosoma brucei rhodesiense and undergoing treatment, were analyzed for circulating trypanosomal antigens using a sandwich antigen-trapping enzyme-linked immunosorbent assay (ELISA). Trypanosomal antigens were detected in 83 (84%) of the patients. Post-treatment antigen profile in 67 patients showed five distinct patterns: in 48% of the patients antigen levels remained elevated throughout the time of hospitalisation and follow-up; in 31%, antigens dropped to the negative value by the second month; in 7.5%, antigens dropped to the negative level and became elevated afterwards; in 7.5%, antigen levels were negative initially, but later, became elevated and remained so throughout the observation period; in 6%, antigen levels remained below the negative value throughout. All patients who relapsed on follow-up had earlier shown evidence of elevated antigen profile. There were no cases of relapses among 21 patients whose antigen levels dropped subsequent to treatment. This ELISA trypanosome antigen detection test could be useful in evaluating treatment success, when used together with parasitological diagnostic techniques.

Cytoskeleton-associated antigens from African trypanosomes are recognized by self-reactive antibodies of uninfected mice

Serum from uninfected mice of different strains, as well as from germ-free animals, contains antibodies which react specifically with at least two trypanosomal proteins, I/6 and MARP1. These antibody populations are highly specific for the respective proteins, are of similar affinity as hyperimmune antibodies, and consist of IgM as well as IgG isotypes. Hyperimmune antibody raised against the cross-reacting trypanosomal protein I/6 detects a 60 kDa protein in mouse 3T6 cells, which is a component of the fibroblast cytoskeleton.

Use of immunoplot analysis for the identification of immunodominant non-variant antigens of Trypanosoma brucei rhodesiense

The application of the 'immunoplot' technique to the analysis of a complex series of immunoblots is described. A number of isolates of Trypanosoma brucei rhodesiense blood forms from Uganda, Kenya and Zambia were separated by SDS-PAGE under reducing and non-reducing conditions and transferred by immunoblotting onto nitrocellulose paper. The separated antigens from each isolate were then probed with sera from European and endemic controls, and a large panel of sera from confirmed trypanosomiasis patients. The resulting series of immunoblots was examined by the 'immunoplot' technique, which involves comparing frequencies of recognition of each band by the sera of controls and patients. A number of antigens of possible diagnostic interest were identified; a bad of 37/38 kDa was found to be recognised with high frequency (> 55%) by the sera of patients and virtually not at all by control sera under both reducing and non-reducing conditions. When this band was combined with one of the other frequently recognised bands, recognition by patient sera was raised to 92% (reduced) and 76% (non-reduced). This did not appear to be isolate-specific. The 'immunoplot' technique has potential for further development and wider use in immunoepidemiology and immunodiagnostic research.

Suppression by Trypanosoma cruzi of T-cell receptor expression by activated human lymphocytes

The immunosuppression that develops during Chagas' disease and African sleeping sickness is thought to facilitate survival of the causative agents in their mammalian hosts. Whereas a number of manifestations of immunosuppression manifested during the course of these diseases has been reported in patients and animals, the mechanisms by which they are induced remain obscure. An in vitro system in which phytohaemagglutinin (PHA)-stimulated human peripheral blood mononuclear (PBMC) were co-cultured with purified Trypanosoma cruzi or T. brucei rhodesiense was used in the present work to establish whether these organisms were able to alter the capacity of activated helper/inducer (CD4+) or cytotoxic/suppressor (CD8+) cells to express T-cell receptor (TcR). Suppressed interleukin-2 receptor (IL-2R), known to be caused by both the trypanosomes and supernatants containing their secretion products, was the independent parameter used to demonstrate the occurrence of immunosuppression in all experiments. We found marked reductions in the percentage of TcR+ cells in T. cruzi-containing cultures as early as 18 hr after PHA stimulation. This alteration was still readily demonstrable after 72 hr of culture, i.e. when last tested for. Suppressed TcR expression occurred concomitantly with reduced levels of CD4 or CD8 molecules on the surface of helper/inducer and cytotoxic/suppressor T lymphocytes, respectively, indicating that the parasite had induced more than one alteration in the same cells. These effects were reproduced when the trypanosomes were separated from the PBMC by a 0.45 micron pore size filter or when filtrates from T. cruzi suspensions substituted for the parasite in the cultures, indicating that TcR suppression was mediated by a parasite secretion product(s). Interestingly, neither T. b. rhodesiense nor filtrates of suspensions of this organism altered significantly the level of TcR expression in cultures in which suppressed IL-2R expression by activated human T cells took place. Thus despite sharing the ability to impair IL-2R expression, T. cruzi and T.b. rhodesiense appear to differ in other mechanisms by which they affect human T-cell function. If occurring in infected hosts, the alterations that T. cruzi causes in the expression of TcR, CD4, CD8 and IL-2R--all molecules playing important roles in lymphocyte activation--could contribute to the development of the immunosuppression observed during the acute phase of Chagas' disease.

The significance of human serum sensitivity in the context of T.B. rhodesiense sleeping sickness epidemiology and control

Earlier this century the postulate that Trypanosoma brucei brucei and T.b. rhodesiense had a common identity and that human infectability was linked with resistance to normal human serum (NHS) in vitro, were both finally refuted in the classical Tinde experiment. Interest in serum sensitivity was reawakened with the advent of the BIIT in 1970 and the studies that followed demonstrated the presence of both human-serum-resistant (HSR) and sensitive (HSS) variant antigen types, within the surface antigen repertoire of a single T.b. rhodesiense organism. This confirmed the bimodal human-infectivity potential of some, if not of all, 'brucei' trypanosomes. Changes from sensitive ('S') to resistant ('R') forms in a T.b. brucei clone have been shown to occur in chickens and have also been reported in a 'clean' bushbuck infected with a T.b. rhodesiense clone. The subsequent expression of 'S' forms by T.b. rhodesiense, when isolated from man into clean rats, has also been demonstrated. Sera from some game animals in Zambia have been shown to be highly trypanolytic. Trypanozoon organisms are almost constantly in contact with mammalian blood elements, in the vertebrate and invertebrate hosts, and more recent studies have demonstrated changes in the serum sensitivity/resistance of Trypanozoon, during metacyclic development in Glossina. In view of this, it is felt that the effects of physiological host factors, on these parasites, may well prove to be a scientifically lucrative field for further research. The bimodal potentiality for human infectivity is clearly a character of fundamental epidemiological and epizootiological importance in the transmission dynamics of this parasite complex.

Evaluation of Procyclic Agglutination Trypanosomiasis Test (PATT) for the immunodiagnosis of Trypanosoma brucei rhodesiense sleeping sickness in Kenya

Documented sera from 156 patients admitted to Alupe Sleeping Sickness Hospital in Western Kenya were tested to determine the potential usefulness of Procclic Agglutination Trypanosomiasis Test (PATT) for the diagnosis of Trypanosoma brucei rhodesiense African sleeping sickness. A total of 490 serum samples were tested, including 42 controls. Anti-trypanosome antibodies were detected in 99% of the sera taken prior to trypanocidal drug therapy. Antibody levels remained high during course of treatment. In cured cases antibodies declined to negative or low levels 4 months to one year after treatment. High antibody levels persisted in patients who relapsed. Although the results showed a high sensitivity and specificity, confirming the potential usefulness of the test for serodiagnosis of African sleeping sickness, PATT, in its present form is unsuitable for routine diagnosis. This is due to difficulties inherent in the use of live trypanosomes as detector antigen.

Multicentre evaluation of an antigen-detection ELISA for the diagnosis of Trypanosoma brucei rhodesiense sleeping sickness

The performance of an enzyme-linked immunosorbent assay (antigen ELISA) for the detection, in serum or cerebrospinal fluid, of an invariant trypanosome antigen to diagnose Trypanosoma brucei rhodesiense sleeping sickness was evaluated in four clinical treatment centres. The test, which was carried out in polystyrene test-tubes, was positive in 88 (88.9%) of 99 parasitologically confirmed cases that were tested at the National Institute for Medical Research, Tabora, United Republic of Tanzania; 99 (94.3%) of 105 cases tested at the National Sleeping Sickness Control Programme, Jinja, Uganda; 86 (87.8%) of 98 cases tested at the Uganda Trypanosomiasis Research Organisation, Tororo, Uganda; and 59 (96.7%) of 61 cases tested at the Tropical Diseases Research Centre, Ndola, Zambia. The overall detection rate was 91.5%. There was no cross-reactivity with the agents of the common bacterial, viral, or parasitic diseases prevalent in the areas where the studies were conducted. The only false-positive result involved a blood donor from a trypanosomiasis endemic focus. The test was simple to perform, was read visually, and is therefore a potential tool for diagnosing human African trypanosomiasis.

Evidence for widespread asymptomatic Trypanosoma rhodesiense human infection in the Luangwa Valley (Zambia)

The RoTat 1/2 CATT test developed for Trypanosoma evansi was used in comparison with other diagnostic tests for the detection of T. rhodesiense infection in the northern part of the Luangwa Valley. The human population, the domestic and a large number of game animals were positive with the RoTat 1/2 CATT, the Ag-ELISA, the IFAT and the radioimmunoprecipitation tests. Human sera from these areas precipitated the same trypanosome-antigen components 35S-methionine labelled whereas few differences in band patterns were found between individual game animals. Surprisingly, however, T. rhodesiense could not be isolated from the "Ag-ELISA and radioimmunoprecipitation" positive patients from the Musenga and Kasyasya localities. The fact that the CATT positive humans were positive in antigen detection tests, does indicate that in all probability they carry or had been carrying a subpatent infection. These results suggest that the reservoir for T. rhodesiense in that region is considerable, comprising the game animals and probably to an even greater extent, the human population.

[Evaluation of the humoral response in patients infected with Trypanosoma rhodesiense in Mozambique]

Indirect immunofluorescence and simple immunodiffusion for trypanosomiasis were normalized. A high percent of patients were found to be positive, both by simple immunodiffusion and indirect immunofluorescence. The use of these techniques is recommended in epidemiological studies.