المؤلفون: François Xavier N'Siesi, Simon Van Nieuwenhove, Sylvie Bisser, Constantin Miaka Mia Bilenge, Veerle Lejon, Pierre-Marie Preux, Philippe Büscher

المساهمون: Neuroépidémiologie Tropicale et Comparée (NETEC), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM), Institut de Médecine Tropicale (IMT), Institut de Médecine Tropicale d'Anvers, Centre de Développement Intégral, République Démocratique du Congo, Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges (UNILIM), Unité Fonctionnelle de Recherche Clinique et de Biostatistique (UFRCB), CHU Limoges, World Health Organization, Democratic Republic of Congo

المصدر: Scopus-Elsevier
Journal of Infectious Diseases
Journal of Infectious Diseases, Oxford University Press (OUP), 2007, 195 (3), pp.322-9. ⟨10.1086/510534⟩

مصطلحات موضوعية: Male, Trypanosoma brucei gambiense, MESH: Brain Diseases, Administration, Oral, Melarsoprol, MESH: Melarsoprol, Gastroenterology, MESH: Trypanosoma brucei gambiense, law.invention, 0302 clinical medicine, Randomized controlled trial, Recurrence, law, Immunology and Allergy, MESH: Animals, African trypanosomiasis, MESH: Trypanocidal Agents, MESH: Treatment Outcome, Brain Diseases, 0303 health sciences, Protozoal diseases, Trypanocidal Agents, 3. Good health, Congo-Kinshasa, Treatment Outcome, Infectious Diseases, Injections, Intravenous, MESH: Administration, Oral, Drug Therapy, Combination, Female, Drug therapy, Randomized clinical trials, medicine.drug, Adult, medicine.medical_specialty, Combination therapy, 030231 tropical medicine, MESH: Drug Administration Schedule, Biology, Drug Administration Schedule, 03 medical and health sciences, Internal medicine, parasitic diseases, medicine, Animals, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Africa, Central, Nifurtimox, Adverse effect, MESH: Humans, MESH: Nifurtimox, 030306 microbiology, MESH: Adult, Monotherapy, medicine.disease, MESH: Injections, Intravenous, MESH: Male, MESH: Recurrence, Surgery, MESH: Drug Therapy, Combination, Regimen, MESH: Trypanosomiasis, African, Trypanosomiasis, African, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, Trypanosomiasis

الوصف: Background. Treatment of second-stage sleeping sickness relies mainly on melarsoprol. Nifurtimox has been successfully used to cure melarsoprol-refractory sleeping sickness caused by Trypanosoma brucei gambiense infection. Methods. An open, randomized trial was conducted to test for equivalence between the standard melarsoprol regimen and 3 other regimens, as follows: standard melarsoprol therapy (3 series of 3.6 mg/kg/day intravenously [iv] for 3 days, with 7-day breaks between the series); 10-day incremental-dose melarsoprol therapy (0.6 mg/kg iv on day 1, 1.2 mg/kg iv on day 2, and 1.8 mg/kg iv on days 3-10); nifurtimox monotherapy for 14 days (5 mg/ kg orally 3 times per day); and consecutive 10-day melarsoprol-nifurtimox combination therapy (0.6 mg/kg iv melarsoprol on day 1, 1.2 mg/kg iv melarsoprol on day 2, and 1.2 mg/kg/day iv melarsoprol combined with oral 7.5 mg/kg nifurtimox twice a day on days 3-10). Primary outcomes were relapse, severe adverse events, and death attributed to treatment. Results. A total of 278 patients were randomized. The frequency of adverse events was similar between the standard melarsoprol regimen and the other regimens. Encephalopathic syndromes occurred in all groups and caused all deaths that were likely due to treatment. Relapses (n = 48 ) were observed only with the 3 monotherapy regimens. Conclusion. A consecutive 10-day low-dose melarsoprol-nifurtimox combination is more effective than the standard melarsoprol regimen.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9bbd3805533ce5a7b8454f9cd2983e3a
https://doi.org/10.1086/510534

المؤلفون: Simon Van Nieuwenhove, Veerle Lejon, Médard Ilunga, Jean Pierre Mulunda, Jean Jacques Muyembe Tamfum, Dieudonné Mumba Ngoyi, Pati Pyana, Joris Menten, Marleen Boelaert, Philippe Büscher

المصدر: The Journal of Infectious Diseases. 201:453-463

مصطلحات موضوعية: Male, Time Factors, Trypanosoma brucei gambiense, Gastroenterology, Leukocyte Count, Sensitivity, Cerebrospinal fluid, Immunology and Allergy, African trypanosomiasis, Treatment outcome, Prospective cohort study, Cerebrospinal Fluid, biology, Follow-up, Tsetse flies, Protozoal diseases, Vectors, Congo-Kinshasa, Titer, Infectious Diseases, Democratic Republic of the Congo, Specificity, Female, Algorithms, Regimens, Adult, medicine.medical_specialty, Monitoring, Antiprotozoal Agents, White blood cell count, Sensitivity and Specificity, Young Adult, Internal medicine, medicine, Animals, Humans, Africa, Central, Risk factor, medicine.disease, Criteria, Trypanosomiasis, African, Duration, Risk factors, Treatment failure, Immunoglobulin M, Immunology, biology.protein, Trypanosomiasis, Biomarkers

الوصف: BACKGROUND. Clinical management of human African trypanosomiasis requires patient follow-up of 2 years' duration. At each follow-up visit, cerebrospinal fluid (CSF) is examined for trypanosomes and white blood cells (WBCs). Shortening follow-up would improve patient comfort and facilitate control of human African trypanosomiasis. METHODS. A prospective study of 360 patients was performed in the Democratic Republic of the Congo. The primary outcomes of the study were cure, relapse, and death. The WBC count, immunoglobulin M level, and specific antibody levels in CSF samples were evaluated to detect treatment failure. The sensitivity and specificity of shortened follow-up algorithms were calculated. RESULTS. The treatment failure rate was 37%. Trypanosomes, a WBC count of > or = 100 cells/microL, and a LATEX/immunoglobulin M titer of 1:16 in CSF before treatment were risk factors for treatment failure, whereas human immunodeficiency virus infection status was not a risk factor. The following algorithm, which had 97.8% specificity and 94.4% sensitivity, is proposed for shortening the duration of follow-up: at 6 months, patients with trypanosomes or a WBC count of > or = 50 cells/microL in CSF are considered to have treatment failure, whereas patients with a CSF WBC count of > or = 5 cells/microL are considered to be cured and can discontinue follow-up. At 12 months, the remaining patients (those with a WBC count of > or = 6-49 cells/microL) need a test of cure, based on trypanosome presence and WBC count, applying a cutoff value of > or = 20 cells/microL. CONCLUSION. Combining criteria for failure and cure allows follow-up of patients with second-stage human African trypanosomiasis to be shortened to a maximum duration of 12 months.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3f2d897b1c50005dd804b06e1d449149
https://doi.org/10.1086/649917

المؤلفون: Veerle Lejon, Ingrid Wouters, Dominique Legros, Christian Sindic, Eddy Magnus, Philippe Büscher, Norbert Djé, Hansotto Reiber

المصدر: The Journal of infectious diseases. 187(9)

مصطلحات موضوعية: Immunoglobulin A, Adult, Male, Pathology, medicine.medical_specialty, IgM, IgG, Trypanosoma brucei gambiense, 030231 tropical medicine, Antibodies, Protozoan, Immunoglobulins, CSF, Intrathecal humoral immune response, Immunoglobulin G, Diagnosis, Differential, Sensitivity testing, 03 medical and health sciences, Leukocyte Count, 0302 clinical medicine, Cerebrospinal fluid, Immune system, Central Nervous System Diseases, White blood cell, medicine, Immunology and Allergy, Animals, Humans, Lactic Acid, Child, Cerebrospinal Fluid, biology, Protozoal diseases, medicine.disease, 3. Good health, Infectious Diseases, medicine.anatomical_structure, Trypanosomiasis, African, Immunoglobulin M, Central nervous system, Blood-Brain Barrier, Laboratory diagnosis, Immunology, biology.protein, Female, Antibody, Trypanosomiasis, 030217 neurology & neurosurgery

الوصف: Diagnosis of central nervous system (CNS) involvement in human African trypanosomiasis is crucial in determination of therapy. Cerebrospinal fluid (CSF) and serum immunoglobulin concentrations, blood-CSF barrier dysfunction, pattern of intrathecal immunoglobulin synthesis, trypanosome-specific antibody synthesis, and CSF lactate concentrations were analyzed in 272 patients with Trypanosoma brucei gambiense infection. As part of the 2- or 3-class immune response, the predominant intrathecal IgM synthesis was the most sensitive (95%) marker for inflammation of the brain. We propose to replace the World Health Organization (WHO) criteria (white blood cell count >5 cells/microL and presence of trypanosomes in CSF) with a new approach for stage determination in trypanosomiasis: CNS involvement is diagnosed only in patients with >20 cells/microL or with intrathecal IgM synthesis, independent of the presence of trypanosomes in CSF. Compared with the use of these new criteria, the WHO criteria incorrectly classified 49 of 234 patients in the meningoencephalitic stage and 7 of 38 patients in the hemolymphatic disease stage. We also show that trypanosomiasis-related immunoglobulin patterns are of value in differential diagnosis.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d7e0df2976e959a7b1fb741f6c43d861
https://pubmed.ncbi.nlm.nih.gov/12717630

المؤلفون: Hetty A. Waskin, Roger E. Nieman, John J. Kelly

المصدر: The Journal of infectious diseases. 159(2)

مصطلحات موضوعية: Blood Glucose, Pediatrics, medicine.medical_specialty, business.industry, Trypanosoma brucei gambiense, Suramin, Hypoglycemia, Middle Aged, medicine.disease, Infectious Diseases, Trypanosomiasis, African, medicine, Immunology and Allergy, Animals, Humans, African trypanosomiasis, Female, Diagnostic Errors, Spurious relationship, business

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::304b8bff4768fdf54ed9f02126de906a
https://pubmed.ncbi.nlm.nih.gov/2915160