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    Mar 04, 2021
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    Treatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo.

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    Authors
    Balasegaram, M
    Harris, S
    Checchi, F
    Hamel, C
    Karunakara, U
    Affiliation
    Medecins Sans Frontieres, London, England. manica.balasigaram@london.msf.org
    Issue Date
    2006-10
    
    Metadata
    Show full item record
    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.
    Publisher
    Published by WHO
    URI
    http://hdl.handle.net/10144/18281
    PubMed ID
    17128357
    Additional Links
    http://www.who.int/bulletin/en
    Language
    en
    ISSN
    0042-9686
    Collections
    Trypanosomiasis/Sleeping Sickness

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