title: Clinical presentation of T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda.
abstract: BACKGROUND
  A wide spectrum of disease severity has been described for Human African Trypanosomiasis (HAT) due to Trypanosoma brucei rhodesiense (T.b. rhodesiense), ranging from chronic disease patterns in southern countries of East Africa to an increase in virulence towards the north. However, only limited data on the clinical presentation of T.b. rhodesiense HAT is available. From 2006-2009 we conducted the first clinical trial program (Impamel III) in T.b. rhodesiense endemic areas of Tanzania and Uganda in accordance with international standards (ICH-GCP). The primary and secondary outcome measures were safety and efficacy of an abridged melarsoprol schedule for treatment of second stage disease. Based on diagnostic findings and clinical examinations at baseline we describe the clinical presentation of T.b. rhodesiense HAT in second stage patients from two distinct geographical settings in East Africa.
  
  
  RESULTS
  138 second stage patients from Tanzania and Uganda were enrolled. Blood samples were collected for diagnosis and molecular identification of the infective trypanosomes, and T.b. rhodesiense infection was confirmed in all trial subjects. Significant differences in diagnostic parameters and clinical signs and symptoms were observed: the median white blood cell (WBC) count in the cerebrospinal fluid (CSF) was significantly higher in Tanzania (134 cells/mm(3)) than in Uganda (20 cells/mm(3); p<0.0001). Unspecific signs of infection were more commonly seen in Uganda, whereas neurological signs and symptoms specific for HAT dominated the clinical presentation of the disease in Tanzania. Co-infections with malaria and HIV did not influence the clinical presentation nor treatment outcomes in the Tanzanian study population.
  
  
  CONCLUSIONS
  We describe a different clinical presentation of second stage T.b. rhodesiense HAT in two distinct geographical settings in East Africa. In the ongoing absence of sensitive diagnostic tools and safe drugs to diagnose and treat second stage T.b. rhodesiense HAT an early identification of the disease is essential. A detailed understanding of the clinical presentation of T.b. rhodesiense HAT among health personnel and affected communities is vital, and awareness of regional characteristics, as well as implications of co-infections, can support decision making and differential diagnosis.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. irene.kuepfer@unibas.ch
authors.forename: Irene
authors.initials: I
authors.lastname: Kuepfer
authors.forename: Emma Peter
authors.initials: EP
authors.lastname: Hhary
authors.forename: Mpairwe
authors.initials: M
authors.lastname: Allan
authors.forename: Andrew
authors.initials: A
authors.lastname: Edielu
authors.forename: Christian
authors.initials: C
authors.lastname: Burri
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Blum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000469:parasitology; D002555:Cerebrospinal Fluid / Q000166:cytology; D002648:Child; D002986:Clinical Trials as Topic; D005260:Female; D005843:Geography; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D013636:Tanzania; D016833:Trypanosoma brucei rhodesiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology*; D014454:Uganda; D055815:Young Adult