Treatment outcomes and risk factors for relapse in patients with early-stage human African trypanosomiasis (HAT) in the Republic of the Congo


Balasegaram, M; Harris, S; Checchi, F; Hamel, C; Karunakara, U; (2006) Treatment outcomes and risk factors for relapse in patients with early-stage human African trypanosomiasis (HAT) in the Republic of the Congo. Bulletin of the World Health Organization, 84 (10). pp. 777-82. ISSN 0042-9686 DOI: https://doi.org/10.2471/BLT.05.028399

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Abstract

OBJECTIVE: In 2002-03, the Republic of the Congo increased the threshold separating stage 1 and 2 cases of human African trypanosomiasis (HAT) from a cerebrospinal fluid (CSF) white cell count of 5 cells/mm(3) to 10 cells/mm(3). We aimed to assess whether the increased threshold of 10 cells/mm(3) is a safe indicator of stage 2 disease. METHODS: We assessed patients treated for stage 1 HAT caused by Trypanosoma brucei gambiense in the Republic of the Congo between April 2001 and April 2005. Patients with 0-10 cells/mm(3) in CSF were classed as stage 1 and treated with pentamidine. Patients with CSF of > 10 cells/mm(3) were classed as stage 2 and treated with either melarsoprol or eflornithine. We did a retrospective analysis of all patients treated after the September 2002 increase in threshold for classification of HAT disease stage 2, and who were eligible for at least 1 year of follow-up. Primary outcome was survival without death or relapse within 1 year of discharge. Risk factors for treatment failure, in particular CSF white cell count on diagnosis, were assessed. FINDINGS: Between September 2002 to April 2004, 692 patients eligible for our analysis were treated with pentamidine. All were discharged alive. Relapse rate was 5% (n = 33). The only identified risk factor for relapse was a CSF white cell count of 6-10 cells/mm(3) rather than 0-5 cells/mm(3) (adjusted hazard ratio 3.27 (95% confidence interval, 1.52-7.01); P = 0.002). CONCLUSION: A threshold of 5 white cells/mm(3) in CSF is safer than 10 cells/mm(3) to determine stage 2 HAT and reduce risk of relapse.

Item Type: Article
Keywords: GAMBIENSE SLEEPING SICKNESS, BRUCEI-GAMBIENSE, COTE-DIVOIRE, PENTAMIDINE, EFLORNITHINE, INDIVIDUALS, MELARSOPROL, EFFICACY, ANGOLA, TRIAL, Adolescent, Adult, Animals, Child, Cohort Studies, Democratic Republic of the Congo, epidemiology, Disease Progression, Eflornithine, administration & dosage, therapeutic use, Female, Humans, Male, Pentamidine, administration & dosage, therapeutic use, Recurrence, Retrospective Studies, Risk Assessment, Risk Factors, Treatment Failure, Treatment Outcome, Trypanocidal Agents, administration & dosage, therapeutic use, Trypanosoma brucei gambiense, drug effects, Trypanosomiasis, African, drug therapy, epidemiology, parasitology
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: ECOHOST - The Centre for Health and Social Change
Health in Humanitarian Crises Centre
PubMed ID: 17128357
Web of Science ID: 241130900008
URI: http://researchonline.lshtm.ac.uk/id/eprint/10607

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