Cerebrospinal fluid B lymphocyte identification for diagnosis and follow-up in human African trypanosomiasis in the field.
OBJECTIVE
In human African trypanosomiasis (HAT, sleeping sickness), staging of disease and treatment follow-up relies on white cell count in the cerebrospinal fluid (CSF). As B lymphocytes (CD19 positive cells) are not found in the CSF of healthy individuals but occur in neurological disorders such as multiple sclerosis, B lymphocyte count may be useful for field diagnosis/staging and therapeutic follow-up in HAT.


METHODS
Seventy-one HAT patients were diagnosed and 50 were followed-up 6-24 months after treatment. White cell counts were used for conventional staging (stage 1, < or =5 cells/microl CSF, n = 42; stage 2, > or =20 cells/microl, n = 16) and intermediate stage (6-19 cells/microl, n = 13). Slides containing 1 microl of CSF mixed with Dynabeads CD19 pan B were examined microscopically to detect B cell rosettes (bound to at least four beads).


RESULTS
Stage 1 patients exhibited zero (n = 37) or one CSF rosette/microl (n = 5), contrary to most stage 2 patients (14/16: > or =2 rosettes/microl). Intermediate stage patients expressed 0 (n = 9), 1 (n = 3) or 2 (n = 1) rosettes/microl of CSF. During follow-up, rosette counts correlated with white cell count staging but were much easier to read.


CONCLUSIONS
B cell rosettes being easily detected in the CSF in field conditions may be proposed to replace white cell count for defining HAT stages 1 and 2 and limit uncertainty in treatment decision in patients with intermediate stage.
Bouteille
Bernard
B
University of Limoges, France. bouteille@unilim.fr <bouteille@unilim.fr>
Mpandzou
Ghislain
G
Cespuglio
Raymond
R
Ngampo
Stéphane
S
Peeling
Rosanna W
RW
Vincendeau
Philippe
P
Buguet
Alain
A
D000913:Antibodies, Protozoan / Q000134:cerebrospinal fluid; D018941:Antigens, CD19 / Q000276:immunology; D001402:B-Lymphocytes / Q000166:cytology*; D015415:Biomarkers / Q000134:cerebrospinal fluid; D005500:Follow-Up Studies; D006801:Humans; D018655:Lymphocyte Count / Q000379:methods; D012044:Regression Analysis; D012397:Rosette Formation / Q000379:methods; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification; D014353:Trypanosomiasis, African / Q000134:cerebrospinal fluid* / Q000145:classification / Q000175:diagnosis* / Q000276:immunology
D000913:Antibodies, Protozoan; D018941:Antigens, CD19; D015415:Biomarkers