Human African Trypanosomiasis in South Sudan: How Can We Prevent a New Epidemic?

Postigo, Jorge; Franco, José R.; Lado, Mounir

doi:10.1371/journal.pntd.0001541

Cited by 37 publications

(39 citation statements)

References 32 publications

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“…These findings highlight the need for continued surveillance in this country [27]. In neighbouring Uganda, the area at risk of T. b. gambiense infection (≈17 thousand km 2 ) is located in the North-west of the country.…”

Section: Resultsmentioning

confidence: 91%

Estimating and Mapping the Population at Risk of Sleeping Sickness

et al. 2012

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BackgroundHuman African trypanosomiasis (HAT), also known as sleeping sickness, persists as a public health problem in several sub-Saharan countries. Evidence-based, spatially explicit estimates of population at risk are needed to inform planning and implementation of field interventions, monitor disease trends, raise awareness and support advocacy. Comprehensive, geo-referenced epidemiological records from HAT-affected countries were combined with human population layers to map five categories of risk, ranging from “very high” to “very low,” and to estimate the corresponding at-risk population.ResultsApproximately 70 million people distributed over a surface of 1.55 million km2 are estimated to be at different levels of risk of contracting HAT. Trypanosoma brucei gambiense accounts for 82.2% of the population at risk, the remaining 17.8% being at risk of infection from T. b. rhodesiense. Twenty-one million people live in areas classified as moderate to very high risk, where more than 1 HAT case per 10,000 inhabitants per annum is reported.DiscussionUpdated estimates of the population at risk of sleeping sickness were made, based on quantitative information on the reported cases and the geographic distribution of human population. Due to substantial methodological differences, it is not possible to make direct comparisons with previous figures for at-risk population. By contrast, it will be possible to explore trends in the future. The presented maps of different HAT risk levels will help to develop site-specific strategies for control and surveillance, and to monitor progress achieved by ongoing efforts aimed at the elimination of sleeping sickness.

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Section: Resultsmentioning

confidence: 91%

Estimating and Mapping the Population at Risk of Sleeping Sickness

et al. 2012

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“…Untreated patients become progressively less responsive before coma and death supervene. [80][81][82][83] While children with Nodding Syndrome may exhibit blank, staring facies perhaps attributable to absence seizures, the overall clinical pattern of the syndrome is distinct from African trypanosomiasis. Additionally, infection with T. brucei gambiense among cases and controls was similar.…”

Section: Parasitesmentioning

confidence: 99%

Nodding syndrome in Mundri county, South Sudan: Environmental, nutritional and infectious factors

Spencer¹,

Vandemaele

Richer³

et al. 2013

Afr H. Sci.

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Background: Nodding Syndrome is a seizure disorder of children in Mundri County, Western Equatoria, South Sudan. The disorder is reported to be spreading in South Sudan and northern Uganda. Results: Nodding Syndrome was associated with Onchocerca volvulus and Mansonella perstans infections, with food use of a variety of sorghum (serena) introduced as part of an emergency relief program, and was inversely associated with a history of measles infection. There was no evidence to suggest exposure to a manmade neurotoxic pollutant or chemical agent, other than chemically dressed seed intended for planting but used for food. Food use of cyanogenic plants was documented, and exposure to fungal contaminants could not be excluded. Conclusion: Nodding Syndrome in South Sudan has an unknown etiology. Further research is recommended on the association of Nodding Syndrome with onchocerciasis/mansonelliasis and neurotoxins in plant materials used for food.

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“…It is also important to consider that there is a lengthy lag in outbreaks of the disease after periods of conflict or socio-political instability [6]. Concern is currently raised by outbreaks in the Ivory Coast [7] and South Sudan [8], by the discovery of the presence of asymptomatic carriers [9, 10], and by the resurgence of an old focus in Zambia [11]. …”

Section: Introductionmentioning

confidence: 99%

Trypanosoma brucei Invasion and T-Cell Infiltration of the Brain Parenchyma in Experimental Sleeping Sickness: Timing and Correlation with Functional Changes

et al. 2016

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BackgroundThe timing of Trypanosoma brucei entry into the brain parenchyma to initiate the second, meningoencephalitic stage of human African trypanosomiasis or sleeping sickness is currently debated and even parasite invasion of the neuropil has been recently questioned. Furthermore, the relationship between neurological features and disease stage are unclear, despite the important diagnostic and therapeutic implications.MethodologyUsing a rat model of chronic Trypanosoma brucei brucei infection we determined the timing of parasite and T-cell neuropil infiltration and its correlation with functional changes. Parasite DNA was detected using trypanosome-specific PCR. Body weight and sleep structure alterations represented by sleep-onset rapid eye movement (SOREM) periods, reported in human and experimental African trypanosomiasis were monitored. The presence of parasites, as well as CD4+ and CD8+ T-cells in the neuropil was assessed over time in the brain of the same animals by immunocytochemistry and quantitative analyses.Principal findingsTrypanosome DNA was present in the brain at day 6 post-infection and increased more than 15-fold by day 21. Parasites and T-cells were observed in the parenchyma from day 9 onwards. Parasites traversing blood vessel walls were observed in the hypothalamus and other brain regions. Body weight gain was reduced from day 7 onwards. SOREM episodes started in most cases early after infection, with an increase in number and duration after parasite neuroinvasion.ConclusionThese findings demonstrate invasion of the neuropil over time, after an initial interval, by parasites and lymphocytes crossing the blood-brain barrier, and show that neurological features can precede this event. The data thus challenge the current clinical and cerebrospinal fluid criteria of disease staging.

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Human African Trypanosomiasis in South Sudan: How Can We Prevent a New Epidemic?

Cited by 37 publications

References 32 publications

Estimating and Mapping the Population at Risk of Sleeping Sickness

Estimating and Mapping the Population at Risk of Sleeping Sickness

Nodding syndrome in Mundri county, South Sudan: Environmental, nutritional and infectious factors

Trypanosoma brucei Invasion and T-Cell Infiltration of the Brain Parenchyma in Experimental Sleeping Sickness: Timing and Correlation with Functional Changes

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