Sleeping sickness in Uganda: a thin line between two fatal diseases.
OBJECTIVE
To determine, through the use of molecular diagnostic tools, whether the two species of parasite that cause human African trypanosomiasis have become sympatric.


METHODS
Blood sampling of all available patients between June 2001 and June 2005 in central Uganda and between July and September 2003 in northwest Uganda and analysis of subcounty sleeping sickness records in Uganda between 1985 and 2005.


METHODS
Sleeping sickness treatment centres in central and northwest Uganda and in south Sudan.


METHODS
Patients presenting at the treatment centres and diagnosed as having sleeping sickness.


METHODS
Classification of parasites from patients from each disease focus as either Trypanosoma brucei rhodesiense (acute form) or T b gambiense (chronic form).


RESULTS
Blood from 231 patients with sleeping sickness in central Uganda and from 91 patients with sleeping sickness in northwest Uganda and south Sudan were screened for T b rhodesiense (detection of SRA gene) and T b gambiense (detection of TgsGP gene). All samples from central Uganda were classified as T b rhodesiense, and all samples from northwest Uganda and south Sudan were identified as T b gambiense.


CONCLUSIONS
The two focuses of human African trypanosomiasis remain discrete, but the area of Uganda affected by the acute form of human sleeping sickness has increased 2.5-fold since 1985, spreading to three new districts within the past five years through movement of infected livestock. Without preventive action targeted at the livestock reservoir of this zoonotic disease, it is likely that the two disease focuses will converge. This will have a major impact on diagnosis and treatment of this neglected disease. Real time monitoring is recommended, using molecular diagnostic tools (at a regional surveillance centre, for example) targeted at both livestock and human patients.
Picozzi
Kim
K
Centre for Infectious Diseases, Royal (Dick) School of Veterinary Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH25 9RG.
Fèvre
Eric M
EM
Odiit
Martin
M
Carrington
Mark
M
Eisler
Mark C
MC
Maudlin
Ian
I
Welburn
Susan C
SC
D000818:Animals; D006801:Humans; D016133:Polymerase Chain Reaction / Q000379:methods; D012307:Risk Factors; D014347:Trypanosoma brucei gambiense / Q000145:classification / Q000235:genetics*; D016833:Trypanosoma brucei rhodesiense / Q000145:classification / Q000235:genetics*; D014353:Trypanosomiasis, African / Q000453:epidemiology / Q000235:genetics* / Q000469:parasitology; D014454:Uganda / Q000453:epidemiology