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Neuro-inflammation in human West-African trypanosomiasis: a basis for improved stage determination

Veerle LEJON researcher laureate

°1971 Belgium
Master’s in science, biochemistry, Universiteit Antwerpen, Belgium, 1993

Neuro-inflammation in human West-African trypanosomiasis: a basis for improved stage determination

Trypanosomiasis or sleeping sickness is caused by the parasite Trypanosoma brucei gambiense. The spreading of the disease is limited to West and Central Africa, and is transmitted by tsetse flies (Glossina sp.) The flies become infected by taking in the parasite when sucking the blood of a sleeping sickness sufferer. After a maturation process in the fly’s intestine, the parasite ends up in its saliva glands, from where it can be transmitted to a new victim when the fly next bites. After the victim has been bitten, the injected trypanosomes firstly multiply on the skin, and later swarm into the blood and lymph (first disease stage). Most of the lymph glands become enlarged, especially in the neck area. Finally, the parasites penetrate the central nervous system (second disease stage), causing meningoencephalitis, which, if untreated, is almost always fatal.
The result of treatment with medicine is largely determined by the stage of the disease process at which the treatment starts. The medicines are divided in substances which are active during the first stage of the disease (e.g. Pentamidine) and those which work in the second stage, because they also penetrate the brain tissue (e.g. Melarsoprol). Medicines for the second stage of the disease are highly toxic. It is therefore very important to distinguish between both stages of the disease with a high degree of certainty. Until recently, this could only be done by investigating the lumbar fluid in well equipped laboratories; the number of cells and the protein concentration in the lumbar fluid was determined, and this was supplemented with a microscopic examination. The test also required well trained staff. In a large part of the endemic regions, these conditions for a proper diagnosis are not in place.
This thesis illustrates the development of a field test (LATEX/IgM) which is very easy to apply, requires no special equipment and is also easy to read. The test detects IgM antibodies against trypanosomes in the lumbar fluid. These are almost invariably present in patients in the second stage of the disease, and they can be detected with this card test even if the lumbar fluid is diluted 1:4. If the test has a positive outcome, it is advisable to treat the patient with the toxic medicines for the second stage of the disease. This work thus provides a clear contribution to the fight against sleeping sickness, which poses a severe threat to the population of many African countries.

report by Prof. J. Verhaegen, Department of Microbiology-Bacteriology, University Hospitals, Leuven, Belgium