Skip to main content

Advertisement

Log in

Human African trypanosomiasis in endemic populations and travellers

  • Review
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Human African trypanosomiasis (HAT) or sleeping sickness is caused by the protozoan parasites Trypanosoma brucei (T.b.) gambiense (West African form) and T.b. rhodesiense (East African form) that are transmitted by the bite of the tsetse fly, Glossina spp.. Whereas most patients in endemic populations are infected with T.b. gambiense, most tourists are infected with T.b. rhodesiense. In endemic populations, T.b. gambiense HAT is characterized by chronic and intermittent fever, headache, pruritus, and lymphadenopathy in the first stage and by sleep disturbances and neuro-psychiatric disorders in the second stage. Recent descriptions of the clinical presentation of T.b. rhodesiense in endemic populations show a high variability in different foci. The symptomatology of travellers is markedly different from the usual textbook descriptions of African HAT patients. The onset of both infections is almost invariably an acute and febrile disease. Diagnosis and treatment are difficult and rely mostly on old methods and drugs. However, new molecular diagnostic technologies are under development. A promising new drug combination is currently evaluated in a phase 3 b study and further new drugs are under evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. WHO (2006) Human African trypanosomiais (sleeping sickness): epidemiological update. Weekly Epidemiological Record 8:71–80. WHO, Geneva

    Google Scholar 

  2. Simarro PP, Jannin J, Cattand P (2008) Eliminating human African trypanosomiasis: where do we stand and what comes next? PLoS Med 5:e55

    Article  PubMed  Google Scholar 

  3. Robays J, Ebeja Kadima A, Lutumba P, Miaka mia Bilenge C, Kande Betu Ku Mesu V, De Deken R, Makabuza J, Deguerry M, Van der Stuyft P, Boelaert M (2004) Human African trypanosomiasis amongst urban residents in Kinshasa: a case-control study. Trop Med Int Health 9:869–875

    Article  PubMed  CAS  Google Scholar 

  4. Bisoffi Z, Beltrame A, Monteiro G, Arzese A, Marocco S, Rorato G, Anselmi M, Viale P (2005) African trypanosomiasis gambiense, Italy. Emerg Infect Dis 11:1745–1747

    Article  PubMed  Google Scholar 

  5. Iborra C, Danis M, Bricaire F, Caumes E (1999) A traveler returning from Central Africa with fever and a skin lesion. Clin Infect Dis 28:679–680

    Article  PubMed  CAS  Google Scholar 

  6. Ezzedine K, Darie H, Le Bras M, Malvy D (2007) Skin features accompanying imported human African trypanosomiasis: hemolymphatic Trypanosoma gambiense infection among two French expatriates with dermatologic manifestations. J Travel Med 14:192–196

    Article  PubMed  Google Scholar 

  7. Jelinek T, Bisoffi Z, Bonazzi L, van Thiel P, Bronner U, de Frey A, Gundersen SG, McWhinney P, Ripamonti D (2002) Cluster of African trypanosomiasis in travelers to Tanzanian national parks. Emerg Infect Dis 8:634–635

    PubMed  Google Scholar 

  8. Urech K, Neumayr A, Blum J (2011) Sleeping sickness in travelers; do they really sleep? PLoS Negl Trop Dis

  9. Mendonca MM, Rasica M, van Thiel PP, Richter C, Kager PA, Wismans PJ (2002) Three patients with African sleeping sickness following a visit to Tanzania. Ned Tijdschr Geneeskd 146:2552–2556

    Google Scholar 

  10. Moore AC, Ryan ET, Waldron MA (2002) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20–2002. A 37-year-old man with fever, hepatosplenomegaly, and a cutaneous foot lesion after a trip to Africa. N Engl J Med 346:2069–2076

    Article  PubMed  Google Scholar 

  11. Moore DA, Edwards M, Escombe R, Agranoff D, Bailey JW, Squire SB, Chiodini PL (2002) African trypanosomiasis in travelers returning to the United Kingdom. Emerg Infect Dis 8:74–76

    Article  PubMed  Google Scholar 

  12. Checchi F, Filipe JA, Haydon DT, Chandramohan D, Chappuis F (2008) Estimates of the duration of the early and late stage of gambiense sleeping sickness. BMC Infect Dis 8:16

    Article  PubMed  Google Scholar 

  13. Blum J, Schmid C, Burri C (2006) Clinical aspects of 2541 patients with second stage human African trypanosomiasis. Acta Trop 97:55–64

    Article  PubMed  Google Scholar 

  14. Blum J, Burri C (2002) Treatment of late stage sleeping sickness caused by T.b. gambiense: a new approach to the use of an old drug. Swiss Med Wkly 132:51–56

    PubMed  CAS  Google Scholar 

  15. Buguet A, Bourdon L, Bisser S, Chapotot F, Radomski MW, Dumas M (2001) Sleeping sickness: major disorders of circadian rhythm. Med Trop (Mars) 61:328–339

    CAS  Google Scholar 

  16. Lundkvist GB, Kristensson K, Bentivoglio M (2004) Why trypanosomes cause sleeping sickness. Physiology (Bethesda) 19:198–206

    Article  Google Scholar 

  17. Kennedy PG (2006) Human African trypanosomiasis—neurological aspects. J Neurol 253:411–416

    Article  PubMed  Google Scholar 

  18. Blum JA, Schmid C, Burri C, Hatz C, Olson C, Fungula B, Kazumba L, Mangoni P, Mbo F, Deo K, Mpanya A, Dala A, Franco JR, Pohlig G, Zellweger MJ (2009) Cardiac alterations in human African trypanosomiasis (T.b. gambiense) with respect to the disease stage and antiparasitic treatment. PLoS Negl Trop Dis 3:e383

    Article  PubMed  Google Scholar 

  19. Blum JA, Burri C, Hatz C, Kazumba L, Mangoni P, Zellweger MJ (2007) Sleeping hearts: the role of the heart in sleeping sickness (human African trypanosomiasis). Trop Med Int Health 12:1422–1432

    Article  PubMed  CAS  Google Scholar 

  20. Blum JA, Zellweger MJ, Burri C, Hatz C (2008) Cardiac involvement in African and American trypanosomiasis. Lancet Infect Dis 8:631–641

    Article  PubMed  Google Scholar 

  21. Collomb H, Bartoli D (1967) The heart in human African trypanosomiasis caused by Trypanosoma gambiense. Bull Soc Pathol Exot Filiales 60:142–156

    PubMed  CAS  Google Scholar 

  22. Poltera AA, Cox JN, Owor R (1976) Pancarditis affecting the conducting system and all valves in human African trypanosomiasis. Br Heart J 38:827–837

    Article  PubMed  CAS  Google Scholar 

  23. Poltera AA, Hochmann A, Lambert PH (1980) A model for cardiopathy induced by Trypanosoma brucei brucei in mice. A histologic and immunopathologic study. Am J Pathol 99:325–351

    PubMed  CAS  Google Scholar 

  24. Bertrand E, Serie F, Rive J, Compaore P, Sentilhes L, Baudin L, Renambot J, Chauvet J, Ekra A, Assamoi MO (1974) Current aspects of the cardiac symptoms in African human trypanosomiasis due to Trypanosoma gambiense (apropos of 194 cases). Acta Cardiol 29:363–381

    PubMed  CAS  Google Scholar 

  25. Blum JA, Schmid C, Hatz C, Kazumba L, Mangoni P, Rutishauser J, la Torre A, Burri C (2007) Sleeping glands? The role of endocrine disorders in sleeping sickness (T.b. gambiense human African trypanosomiasis). Acta Trop 104:16–24

    Article  PubMed  CAS  Google Scholar 

  26. Odiit M, Kansiime F, Enyaru JC (1997) Duration of symptoms and case fatality of sleeping sickness caused by Trypanosoma brucei rhodesiense in Tororo, Uganda. East Afr Med J 74:792–795

    PubMed  CAS  Google Scholar 

  27. MacLean LM, Odiit M, Chisi JE, Kennedy PG, Sternberg JM (2010) Focus-specific clinical profiles in human African trypanosomiasis caused by Trypanosoma brucei rhodesiense. PLoS Negl Trop Dis 4:e906

    Article  PubMed  Google Scholar 

  28. Boatin BA, Wyatt GB, Wurapa FK, Bulsara MK (1986) Use of symptoms and signs for diagnosis of Trypanosoma brucei rhodesiense trypanosomiasis by rural health personnel. Bull World Health Organ 64:389–395

    PubMed  CAS  Google Scholar 

  29. Buyst H (1977) The epidemiology of sleeping sickness in the historical Luangwa valley. Ann Soc Belg Med Trop 57:349–359

    PubMed  CAS  Google Scholar 

  30. Wellde BT, Chumo DA, Reardon MJ, Mwangi J, Asenti A, Mbwabi D, Abinya A, Wanyama L, Smith DH (1989) Presenting features of Rhodesian sleeping sickness patients in the Lambwe Valley, Kenya. Ann Trop Med Parasitol 83(Suppl 1):73–89

    PubMed  Google Scholar 

  31. Mbulamberi DB (1987) A clinical analysis of 3151 cases of Rhodesian sleeping sickness treated in the South Eastern Uganda, during the year 1985. Proceedings of the International Scientific Council for Trypanosomiasis Research and Control 19th Meeting, Lomé, Togo, pp 188–195

  32. Foulkes JR (1981) The six diseases WHO. Human trypanosomiasis in Africa. Br Med J (Clin Res Ed) 283:1172–1174

    Article  CAS  Google Scholar 

  33. Kuepfer I, Hhary EP, Allan M, Edielu A, Burri C, Blum JA (2011) Clinical presentation of T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda. PLoS Negl Trop Dis 5:e968

    Article  PubMed  Google Scholar 

  34. MacLean L, Chisi JE, Odiit M, Gibson WC, Ferris V, Picozzi K, Sternberg JM (2004) Severity of human african trypanosomiasis in East Africa is associated with geographic location, parasite genotype, and host inflammatory cytokine response profile. Infect Immun 72:7040–7044

    Article  PubMed  CAS  Google Scholar 

  35. Reincke M, Arlt W, Heppner C, Petzke F, Chrousos GP, Allolio B (1998) Neuroendocrine dysfunction in African trypanosomiasis. The role of cytokines. Ann NY Acad Sci 840:809–821

    Article  PubMed  CAS  Google Scholar 

  36. Jones IG, Lowenthal MN, Buyst H (1975) Electrocardiographic changes in African trypanosomiasis caused by Trypanosoma brucei rhodesiense. Trans R Soc Trop Med Hyg 69:388–395

    Article  PubMed  CAS  Google Scholar 

  37. Koten JW, De Raadt P (1969) Myocarditis in Trypanosoma rhodesiense infections. Trans R Soc Trop Med Hyg 63:485–489

    Article  PubMed  CAS  Google Scholar 

  38. Kouchner G, Bouree P, Lowenthal M (1979) Hepatic involvement in Trypanosoma rhodesiense trypanosomiasis. Bull Soc Pathol Exot Filiales 72:131–135

    PubMed  CAS  Google Scholar 

  39. Blum J, Beck BR, Brun R, Hatz C (2005) Clinical and serologic responses to human ‘apathogenic’ trypanosomes. Trans R Soc Trop Med Hyg 99:795–797

    Article  PubMed  CAS  Google Scholar 

  40. Jamonneau V, Ravel S, Garcia A, Koffi M, Truc P, Laveissiere C, Herder S, Grebaut P, Cuny G, Solano P (2004) Characterization of Trypanosoma brucei s.l. infecting asymptomatic sleeping-sickness patients in Cote d'Ivoire: a new genetic group? Ann Trop Med Parasitol 98:329–337

    Article  PubMed  CAS  Google Scholar 

  41. Duggan AJ, Hutchinson MP (1966) Sleeping sickness in Europeans: a review of 109 cases. J Trop Med Hyg 69:124–131

    PubMed  CAS  Google Scholar 

  42. Sinha A, Grace C, Alston WK, Westenfeld F, Maguire JH (1999) African trypanosomiasis in two travelers from the United States. Clin Infect Dis 29:840–844

    Article  PubMed  CAS  Google Scholar 

  43. Apted FJ, Smyly DP, Ormero WE, Stronach BW (1963) A comparative study of the epidemiology of endemic Rhodesian sleeping sickness in different parts of Africa. J Trop Med Hyg 66:1–16

    PubMed  CAS  Google Scholar 

  44. Ripamonti D, Massari M, Arici C, Gabbi E, Farina C, Brini M, Capatti C, Suter F (2002) African sleeping sickness in tourists returning from Tanzania: the first 2 Italian cases from a small outbreak among European travelers. Clin Infect Dis 34:E18–E22

    Article  PubMed  Google Scholar 

  45. Braendli B, Dankwa E, Junghanss T (1990) East African sleeping sickness (Trypanosoma rhodesiense infection) in 2 Swiss travelers to the tropics. Schweiz Med Wochenschr 120:1348–1352

    PubMed  CAS  Google Scholar 

  46. Sanner BM, Doberauer C, Tepel M, Zidek W (2000) Fulminant disease simulating bacterial sepsis with disseminated intravascular coagulation after a trip to East Africa. Intensive Care Med 26:646–647

    Article  PubMed  CAS  Google Scholar 

  47. Oscherwitz SL (2003) East African trypanosomiasis. J Travel Med 10:141–143

    Article  PubMed  Google Scholar 

  48. Quinn TC, Hill CD (1983) African trypanosomiasis in an American hunter in East Africa. Arch Intern Med 143:1021–1023

    Article  PubMed  CAS  Google Scholar 

  49. Croft AM, Jackson CJ, Friend HM, Minton EJ (2006) African trypanosomiasis in a British soldier. J R Army Med Corps 152:156–160

    PubMed  CAS  Google Scholar 

  50. Damian MS, Dorndorf W, Burkardt H, Singer I, Leinweber B, Schachenmayr W (1994) Polyneuritis and myositis in Trypanosoma gambiense infection. Dtsch Med Wochenschr 119:1690–1693

    Article  PubMed  CAS  Google Scholar 

  51. Chappuis F, Loutan L, Simarro P, Lejon V, Buscher P (2005) Options for field diagnosis of human african trypanosomiasis. Clin Microbiol Rev 18:133–146

    Article  PubMed  Google Scholar 

  52. Camara M, Camara O, Ilboudo H, Sakande H, Kabore J, N'Dri L, Jamonneau V, Bucheton B (2010) Sleeping sickness diagnosis: use of buffy coats improves the sensitivity of the mini anion exchange centrifugation test. Trop Med Int Health 15:796–799

    Article  PubMed  Google Scholar 

  53. Deborggraeve S, Lejon V, Ekangu RA, Mumba ND, Pati PP, Ilunga M, Mulunda JP, Buscher P (2011) Diagnostic accuracy of PCR in gambiense sleeping sickness diagnosis, staging and post-treatment follow-up: a 2-year longitudinal study. PLoS Negl Trop Dis 5:e972

    Article  PubMed  Google Scholar 

  54. WHO (1998) Control and surveillance of African trypanosomiasis. WHO Technical report, WHO, Geneva

  55. Lejon V, Robays J, N'Siesi FX, Mumba D, Hoogstoel A, Bisser S, Reiber H, Boelaert M, Buscher P (2007) Treatment failure related to intrathecal immunoglobulin M (IgM) synthesis, cerebrospinal fluid IgM, and interleukin-10 in patients with hemolymphatic-stage sleeping sickness. Clin Vaccine Immunol 14:732–737

    Article  PubMed  CAS  Google Scholar 

  56. Lejon V, Buscher P (2005) Review article: cerebrospinal fluid in human African trypanosomiasis: a key to diagnosis, therapeutic decision and post-treatment follow-up. Trop Med Int Health 10:395–403

    Article  PubMed  CAS  Google Scholar 

  57. Kennedy PG (2010) Novel biomarkers for late-stage human African trypanosomiasis—the search goes on. Am J Trop Med Hyg 82:981–982

    Article  PubMed  Google Scholar 

  58. Hainard A, Tiberti N, Robin X, Lejon V, Ngoyi DM, Matovu E, Enyaru JC, Fouda C, Ndung'u JM, Lisacek F, Muller M, Turck N, Sanchez JC (2009) A combined CXCL10, CXCL8 and H-FABP panel for the staging of human African trypanosomiasis patients. PLoS Negl Trop Dis 3:e459

    Article  PubMed  Google Scholar 

  59. Amin DN, Ngoyi DM, Nhkwachi GM, Palomba M, Rottenberg M, Buscher P, Kristensson K, Masocha W (2010) Identification of stage biomarkers for human African trypanosomiasis. Am J Trop Med Hyg 82:983–990

    Article  PubMed  CAS  Google Scholar 

  60. Mumba ND, Lejon V, N'Siesi FX, Boelaert M, Buscher P (2009) Comparison of operational criteria for treatment outcome in gambiense human African trypanosomiasis. Trop Med Int Health 14:438–444

    Article  Google Scholar 

  61. Mumba ND, Lejon V, Pyana P, Boelaert M, Ilunga M, Menten J, Mulunda JP, Van Nieuwenhove S, Muyembe Tamfum JJ, Buscher P (2010) How to shorten patient follow-up after treatment for Trypanosoma brucei gambiense sleeping sickness. J Infect Dis 201:453–463

    Article  Google Scholar 

  62. Deborggraeve S, Buscher P (2010) Molecular diagnostics for sleeping sickness: what is the benefit for the patient? Lancet Infect Dis 10:433–439

    Article  PubMed  Google Scholar 

  63. Becker S, Franco JR, Simarro PP, Stich A, Abel PM, Steverding D (2004) Real-time PCR for detection of Trypanosoma brucei in human blood samples. Diagn Microbiol Infect Dis 50:193–199

    Article  PubMed  CAS  Google Scholar 

  64. Truc P, Lejon V, Magnus E, Jamonneau V, Nangouma A, Verloo D, Penchenier L, Buscher P (2002) Evaluation of the micro-CATT, CATT/Trypanosoma brucei gambiense, and LATEX/T b gambiense methods for serodiagnosis and surveillance of human African trypanosomiasis in West and Central Africa. Bull World Health Organ 80:882–886

    PubMed  Google Scholar 

  65. Louis FJ, Buscher P, Lejon V (2001) Diagnosis of human African trypanosomiasis in 2001. Med Trop (Mars) 61:340–346

    CAS  Google Scholar 

  66. Bisser S, Bouteille B, Sarda J, Stanghellini A, Ricard D, Jauberteau MO, Marchan F, Dumas M, Breton JC (1997) Contribution of biochemical tests in the diagnosis of the nervous phase of human African trypanosomiasis. Bull Soc Pathol Exot 90:321–326

    PubMed  CAS  Google Scholar 

  67. Sabbah P, Brosset C, Imbert P, Bonardel G, Jeandel P, Briant JF (1997) Human African trypanosomiasis: MRI. Neuroradiology 39:708–710

    Article  PubMed  CAS  Google Scholar 

  68. Gill DS, Chatha DS, Carpio-O'Donovan R (2003) MR imaging findings in African trypansomiasis. AJNR Am J Neuroradiol 24:1383–1385

    PubMed  Google Scholar 

  69. Braakman HM, van de Molengraft FJ, Hubert WW, Boerman DH (2006) Lethal African trypanosomiasis in a traveler: MRI and neuropathology. Neurology 66:1094–1096

    Article  PubMed  Google Scholar 

  70. Serrano-Gonzalez C, Velilla I, Fortuno B, Guelbenzu S, Portoles A (1996) Neuroimaging and efficacy of treatment in advanced African trypanosomiasis. Rev Neurol 24:1554–1557

    PubMed  CAS  Google Scholar 

  71. Bedat-Millet AL, Charpentier S, Monge-Strauss MF, Woimant F (2000) Psychiatric presentation of human African trypanosomiasis: overview of diagnostic pitfalls, interest of difluoromethylornithine treatment and contribution of magnetic resonance imaging. Rev Neurol (Paris) 156:505–509

    CAS  Google Scholar 

  72. Dorlo TP, Kager PA (2008) Pentamidine dosage: a base/salt confusion. PLoS Negl Trop Dis 2:e225

    Article  PubMed  Google Scholar 

  73. Blum JA, Hatz CF (2009) Treatment of cutaneous leishmaniasis in travelers. J Travel Med 16:123–131

    Article  PubMed  Google Scholar 

  74. Burri C (2010) Chemotherapy against human African trypanosomiasis: Is there a road to success? Parasitology 137:1987–1994

    Article  PubMed  CAS  Google Scholar 

  75. Blum J, Nkunku S, Burri C (2001) Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis. Trop Med Int Health 6:390–400

    Article  PubMed  CAS  Google Scholar 

  76. Balasegaram M, Young H, Chappuis F, Priotto G, Raguenaud ME, Checchi F (2009) Effectiveness of melarsoprol and eflornithine as first-line regimens for gambiense sleeping sickness in nine Medecins Sans Frontieres programmes. Trans R Soc Trop Med Hyg 103:280–290

    Article  PubMed  CAS  Google Scholar 

  77. Robays J, Nyamowala G, Sese C, Betu Ku MKV, Lutumba P, Van der V, Boelaert M (2008) High failure rates of melarsoprol for sleeping sickness, Democratic Republic of Congo. Emerg Infect Dis 14:966–967

    Article  PubMed  Google Scholar 

  78. Seixas J (2004) Investigations of the encephalopathic syndrome during melarsoprol treatment of human African trypanosomiasis. Dissertation, The Swiss Tropicla and Health Institute, Switzerland and the Universidade Nova de Lisboa, Portugal

  79. Pepin J, Milord F, Khonde AN, Niyonsenga T, Loko L, Mpia B, De Wals P (1995) Risk factors for encephalopathy and mortality during melarsoprol treatment of Trypanosoma brucei gambiense sleeping sickness. Trans R Soc Trop Med Hyg 89:92–97

    Article  PubMed  CAS  Google Scholar 

  80. Pepin J, Tetreault L, Gervais C (1985) The use of oral corticosteroids in the treatment of human African trypanosomiasis: a retrospective survey in Nioki, Zaire. Ann Soc Belg Med Trop 65:17–29

    PubMed  CAS  Google Scholar 

  81. Burri C, Nkunku S, Merolle A, Smith T, Blum J, Brun R (2000) Efficacy of new, concise schedule for melarsoprol in treatment of sleeping sickness caused by Trypanosoma brucei gambiense: a randomised trial. Lancet 355:1419–1425

    Article  PubMed  CAS  Google Scholar 

  82. Schmid C, Richer M, Bilenge CM, Josenando T, Chappuis F, Manthelot CR, Nangouma A, Doua F, Asumu PN, Simarro PP, Burri C (2005) Effectiveness of a 10-day Melarsoprol schedule for the treatment of late-stage human African trypanosomiasis: confirmation from a multinational study (Impamel II). J Infect Dis 191:1922–1931

    Article  PubMed  CAS  Google Scholar 

  83. Pepin J, Mpia B (2006) Randomized controlled trial of three regimens of melarsoprol in the treatment of Trypanosoma brucei gambiense trypanosomiasis. Trans R Soc Trop Med Hyg 100:437–441

    Article  PubMed  CAS  Google Scholar 

  84. Burri C, Blum J, Brun R (1995) Alternative application of melarsoprol for treatment of T.B. gambiense sleeping sickness. Preliminary results. Ann Soc Belg Med Trop 75:65–71

    PubMed  CAS  Google Scholar 

  85. Chappuis F, Udayraj N, Stietenroth K, Meussen A, Bovier PA (2005) Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis. Clin Infect Dis 41:748–751

    Article  PubMed  CAS  Google Scholar 

  86. Iten M, Mett H, Evans A, Enyaru JC, Brun R, Kaminsky R (1997) Alterations in ornithine decarboxylase characteristics account for tolerance of Trypanosoma brucei rhodesiense to D, L-alpha-difluoromethylornithine. Antimicrob Agents Chemother 41:1922–1925

    PubMed  CAS  Google Scholar 

  87. Burri C, Brun R (2003) Eflornithine for the treatment of human African trypanosomiasis. Parasitol Res 90(Supp 1):S49–S52

    PubMed  Google Scholar 

  88. Priotto G, Kasparian S, Ngouama D, Ghorashian S, Arnold U, Ghabri S, Karunakara U (2007) Nifurtimox-eflornithine combination therapy for second-stage Trypanosoma brucei gambiense sleeping sickness: a randomized clinical trial in Congo. Clin Infect Dis 45:1435–1442

    Article  PubMed  CAS  Google Scholar 

  89. Priotto G, Pinoges L, Fursa IB, Burke B, Nicolay N, Grillet G, Hewison C, Balasegaram M (2008) Safety and effectiveness of first line eflornithine for Trypanosoma brucei gambiense sleeping sickness in Sudan: cohort study. BMJ 336:705–708

    Article  PubMed  CAS  Google Scholar 

  90. Priotto G, Kasparian S, Mutombo W, Ngouama D, Ghorashian S, Arnold U, Ghabri S, Baudin E, Buard V, Kazadi-Kyanza S, Ilunga M, Mutangala W, Pohlig G, Schmid C, Karunakara U, Torreele E, Kande V (2009) Nifurtimox-eflornithine combination therapy for second-stage African Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomised, phase III, non-inferiority trial. Lancet 374:56–64

    Article  PubMed  CAS  Google Scholar 

  91. Schmid C, Kande V, Mutombo W, Ilunga M, Lumpungu I, Mutanda S, Tete D, Nganzobo P, Mubwa N, Blum J, Balasegaram M, Valverde O (2010) NECT-FIELD: Clinical trial to evaluate the tolerability, feasibility, and effectiveness of NECT treatment in "real-life" conditions for late stage sleeping sickness. LB-2253, Annual Meeting, American Society of Tropiclal Medicine and Hygine, Poster Session C Presentations, 31-1-2010

  92. Adams JH, Haller L, Boa FY, Doua F, Dago A, Konian K (1986) Human African trypanosomiasis (T.b. gambiense): a study of 16 fatal cases of sleeping sickness with some observations on acute reactive arsenical encephalopathy. Neuropathol Appl Neurobiol 12:81–94

    Article  PubMed  CAS  Google Scholar 

  93. Haller L, Adams H, Merouze F, Dago A (1986) Clinical and pathological aspects of human African trypanosomiasis (T.b. gambiense) with particular reference to reactive arsenical encephalopathy. Am J Trop Med Hyg 35:94–99

    PubMed  CAS  Google Scholar 

  94. Pepin J, Milord F (1991) African trypanosomiasis and drug-induced encephalopathy: risk factors and pathogenesis. Trans R Soc Trop Med Hyg 85:222–224

    Article  PubMed  CAS  Google Scholar 

  95. Le Bras J, Sina G, Triolo N, Trova P (1977) Symptomatology générale de la trypanosomiase humaine africaine de l'enfant. Med Trop (Mars) 37:51–61

    Google Scholar 

  96. Boa YF, Traore MA, Doua F, Kouassi-Traore MT, Kouassi BE, Giordano C (1988) The different present-day clinical picture of human African trypanosomiasis caused by T.b. gambiense. Analysis of 300 cases from a focus in Daloa, Ivory Coast. Bull Soc Pathol Exot Filiales 81:427–444

    PubMed  CAS  Google Scholar 

  97. Bertrand E, Serie F, Kone I, Rive J, Campaore P, Sentilhes L, Philippe J (1973) Symptomatologie générale de la trypanosomiase humaine africaine au moment du dépistage. Médecine d'Afrique Noire 20:303–314

    Google Scholar 

  98. Debroise A, Debroise-Ballereau C, Satge P, Rey M (1968) African trypanosomiasis in young children. Arch Fr Pediatr 25:703–720

    PubMed  CAS  Google Scholar 

  99. Ngandu-Kabeya G (1976) Study of the symptomatology of African trypanosomiasis in children (apropos of 24 cases). Ann Soc Belg Med Trop 56:85–93

    PubMed  CAS  Google Scholar 

  100. Edan G (1979) Clinical and biological symptoms of T. gambiense tryponosomiasis in the meningo-encephalitic period (author's transl). Med Trop (Mars) 39:499–507

    CAS  Google Scholar 

  101. Ginoux PY, Frezil JL, Alary JC (1982) Symptoms of human trypanosomiasis at the first diagnostic phase in the People Republic of Congo (author's transl). Med Trop (Mars) 42:281–287

    CAS  Google Scholar 

  102. Antoine P (1977) Neurological and psychological studies of patients with sleeping sickness and their course. Ann Soc Belg Med Trop 57:227–248

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. A. Blum.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 109 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blum, J.A., Neumayr, A.L. & Hatz, C.F. Human African trypanosomiasis in endemic populations and travellers. Eur J Clin Microbiol Infect Dis 31, 905–913 (2012). https://doi.org/10.1007/s10096-011-1403-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-011-1403-y

Keywords

Navigation