Treatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo.
dc.contributor.author | Balasegaram, M | |
dc.contributor.author | Harris, S | |
dc.contributor.author | Checchi, F | |
dc.contributor.author | Hamel, C | |
dc.contributor.author | Karunakara, U | |
dc.date.accessioned | 2008-02-14T11:44:17Z | |
dc.date.available | 2008-02-14T11:44:17Z | |
dc.date.issued | 2006-10 | |
dc.identifier.citation | Treatment 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.issn | 0042-9686 | |
dc.identifier.pmid | 17128357 | |
dc.identifier.uri | http://hdl.handle.net/10144/18281 | |
dc.description.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. | |
dc.language.iso | en | en |
dc.publisher | Published by WHO | |
dc.relation.url | http://www.who.int/bulletin/en | |
dc.rights | Archived on this site with permission of WHO | en |
dc.subject.mesh | Adolescent | en |
dc.subject.mesh | Adult | en |
dc.subject.mesh | Animals | en |
dc.subject.mesh | Child | en |
dc.subject.mesh | Cohort Studies | en |
dc.subject.mesh | Democratic Republic of the Congo | en |
dc.subject.mesh | Disease Progression | en |
dc.subject.mesh | Eflornithine | en |
dc.subject.mesh | Female | en |
dc.subject.mesh | Humans | en |
dc.subject.mesh | Male | en |
dc.subject.mesh | Pentamidine | en |
dc.subject.mesh | Recurrence | en |
dc.subject.mesh | Retrospective Studies | en |
dc.subject.mesh | Risk Assessment | en |
dc.subject.mesh | Risk Factors | en |
dc.subject.mesh | Treatment Failure | en |
dc.subject.mesh | Treatment Outcome | en |
dc.subject.mesh | Trypanocidal Agents | en |
dc.subject.mesh | Trypanosoma brucei gambiense | en |
dc.subject.mesh | Trypanosomiasis, African | en |
dc.title | Treatment Outcomes and Risk Factors for Relapse in Patients with Early-stage Human African Trypanosomiasis (HAT) in the Republic of the Congo. | en |
dc.contributor.department | Medecins Sans Frontieres, London, England. manica.balasigaram@london.msf.org | en |
dc.identifier.journal | Bulletin of the World Health Organization | en |
refterms.dateFOA | 2019-03-04T09:20:52Z | |
html.description.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. |