Treatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo.

Hdl Handle:
http://hdl.handle.net/10144/18281
Title:
Treatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo.
Authors:
Balasegaram, M; Harris, S; Checchi, F; Hamel, C; Karunakara, U
Journal:
Bulletin of the World Health Organization
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.
Affiliation:
Medecins Sans Frontieres, London, England. manica.balasigaram@london.msf.org
Publisher:
Published by WHO
Issue Date:
Oct-2006
URI:
http://hdl.handle.net/10144/18281
PubMed ID:
17128357
Additional Links:
http://www.who.int/bulletin/en
Language:
en
ISSN:
0042-9686
Appears in Collections:
Trypanosomiasis/Sleeping Sickness

Full metadata record

DC FieldValue Language
dc.contributor.authorBalasegaram, M-
dc.contributor.authorHarris, S-
dc.contributor.authorChecchi, F-
dc.contributor.authorHamel, C-
dc.contributor.authorKarunakara, U-
dc.date.accessioned2008-02-14T11:44:17Z-
dc.date.available2008-02-14T11:44:17Z-
dc.date.issued2006-10-
dc.identifier.citationTreatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo. 2006, 84 (10):777-82 Bull. World Health Organ.en
dc.identifier.issn0042-9686-
dc.identifier.pmid17128357-
dc.identifier.urihttp://hdl.handle.net/10144/18281-
dc.description.abstractOBJECTIVE: 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.en
dc.language.isoenen
dc.publisherPublished by WHO-
dc.relation.urlhttp://www.who.int/bulletin/en-
dc.rightsArchived on this site with permission of WHOen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAnimalsen
dc.subject.meshChilden
dc.subject.meshCohort Studiesen
dc.subject.meshDemocratic Republic of the Congoen
dc.subject.meshDisease Progressionen
dc.subject.meshEflornithineen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshPentamidineen
dc.subject.meshRecurrenceen
dc.subject.meshRetrospective Studiesen
dc.subject.meshRisk Assessmenten
dc.subject.meshRisk Factorsen
dc.subject.meshTreatment Failureen
dc.subject.meshTreatment Outcomeen
dc.subject.meshTrypanocidal Agentsen
dc.subject.meshTrypanosoma brucei gambienseen
dc.subject.meshTrypanosomiasis, Africanen
dc.titleTreatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo.en
dc.contributor.departmentMedecins Sans Frontieres, London, England. manica.balasigaram@london.msf.orgen
dc.identifier.journalBulletin of the World Health Organizationen

Related articles on PubMed

All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.