Show simple item record

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.
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
refterms.dateFOA2019-03-04T09:20:52Z
html.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.


Files in this item

Thumbnail
Name:
balasegaraum apr 4 2.pdf
Size:
132.8Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record