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

Publisher: World Health Organization Country of Publication: Switzerland NLM ID: 7507052 Publication Model: Print Cited Medium: Print ISSN: 0042-9686 (Print) Linking ISSN: 00429686 NLM ISO Abbreviation: Bull World Health Organ Subsets: MEDLINE

Original Publication: Geneva : World Health Organization,

Treatment Outcome*; Eflornithine/*therapeutic use ; Pentamidine/*therapeutic use ; Trypanocidal Agents/*therapeutic use ; Trypanosoma brucei gambiense/*drug effects ; Trypanosomiasis, African/*drug therapy; Adolescent ; Adult ; Animals ; Child ; Cohort Studies ; Democratic Republic of the Congo/epidemiology ; Disease Progression ; Eflornithine/administration & dosage ; Female ; Humans ; Male ; Pentamidine/administration & dosage ; Recurrence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Failure ; Trypanocidal Agents/administration & dosage ; Trypanosomiasis, African/epidemiology ; Trypanosomiasis, African/parasitology

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.

Comment in: Bull World Health Organ. 2006 Oct;84(10):766. (PMID: 17128348)

0 (Trypanocidal Agents)
673LC5J4LQ (Pentamidine)
ZQN1G5V6SR (Eflornithine)

Date Created: 20061128 Date Completed: 20061227 Latest Revision: 20190608

20221213

PMC2627495

10.2471/blt.05.028399

17128357