Journal Article

Novel Markers for Treatment Outcome in Late-Stage <i>Trypanosoma brucei gambiense</i> Trypanosomiasis

Veerle Lejon, Isabelle Roger, Dieudonné Mumba Ngoyi, Joris Menten, Jo Robays, Francois X. N'Siesi, Sylvie Bisser, Marleen Boelaert and Philippe Büscher

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 1, pages 15-22
Published in print July 2008 | ISSN: 1058-4838
Published online July 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/588668
Novel Markers for Treatment Outcome in Late-Stage Trypanosoma brucei gambiense Trypanosomiasis

More Like This

Show all results sharing these subjects:

  • Infectious Diseases
  • Immunology
  • Public Health and Epidemiology
  • Microbiology

GO

Show Summary Details

Preview

Background. To date, no biological marker for treatment outcome in human African trypanosomiasis (HAT) has been described. The accuracy of biological markers for prediction of treatment outcome of HAT caused by Trypanosoma brucei gambiense was assessed.

Methods. Cerebrospinal fluid (CSF) white blood cell (WBC) count and immunoglobulin M (IgM), trypanosome-specific antibody, total protein, and interleukin-10 levels were determined before and up to 24 months after treatment of late-stage HAT.

Results. Treatment failure was experienced by 48 of 260 patients. Pretreatment CSF WBC counts ⩾102 cells/μL, IL-10 concentrations ⩾37 pg/mL, LATEX/IgM end titers ⩾1:32, LATEX/T. b. gambiense end titers ⩾1:2, and protein concentrations ⩾674 mg/L were associated with treatment failure. Six months after treatment, patients with CSF WBC counts ⩽5 cells/μL were at low risk of HAT recurrence (negative predictive value, >0.93). After 12 months, the combination of CSF WBC count ⩾8 cells/μL and LATEX/IgM end titer ⩾1:4 predicted treatment failure with 97% specificity and 79% sensitivity. Eighteen months after treatment, each marker accurately predicted treatment outcome. The combination of CSF WBC count ⩾8 cells/μL and LATEX/IgM end titer ⩾1:4 was 100% specific for treatment failure after 18 and 24 months.

Conclusions. HAT-affected patients with elevated pretreatment CSF levels of WBC, interleukin-10, IgM, trypanosome-specific antibody, and total protein are at risk of treatment failure. Six months after treatment, patients with CSF WBC counts ⩽5 cells/μL can be considered to be cured. The assessment of a combination of CSF WBC count and LATEX/IgM level allowed accurate prediction of outcome beginning at 12 months after treatment, as did each individual marker at 18 months after treatment.

Journal Article.  4665 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.