title: Polysomnography as a diagnosis and post-treatment follow-up tool in human African trypanosomiasis: a case study in an infant.
abstract: Gambian (Trypanosoma brucei gambiense) human African trypanosomiasis (HAT) evolves from the hemolymphatic stage 1, treated with pentamidine, to the meningoencephalitic stage 2, often treated with melarsoprol. This arseniate may provoke a deadly reactive encephalopathy. It is therefore crucial to diagnose precisely the stages of HAT, especially when clinical and biological examinations are doubtful. We present here the case of a 30-month old girl (E20 KOLNG) diagnosed with stage 1 HAT during a field survey in June 2007 in Congo. She was followed-up every six months for 18 months in a village dispensary facility at Mpouya. Her health status deteriorated in December 2008, although cerebrospinal fluid (CSF) white blood cell (WBC) count was normal. The child was hospitalized at Brazzaville and a daytime polysomnographic recording (electroencephalogram, electrooculogram, and electromyogram) was performed (Temec Vitaport 3® portable recorder) to avoid a new lumbar puncture. The child presented a complete polysomnographic syndrome of HAT with a major disturbance of the distribution of sleep and wake episodes and the occurrence of sleep onset REM periods (SOREMPs). The relapse at stage 2 was confirmed by a new CSF examination that showed an elevated WBC count (23cells·μL(-1)) with the presence of B lymphocytes. Melarsoprol treatment was undertaken. A post-treatment recording was immediately performed, showing the resolution of sleepwake pattern abnormalities. Another polysomnography, taken four months later, confirmed the normalization of sleep-wake patterns indicating healing. We therefore propose that polysomnography, being a non-invasive technique, should be used in children to alleviate burden caused by HAT staging procedures, especially regarding lumbar punctures in remote African villages.
authors.affiliation: Service de neurologie, CHU de Brazzaville, boulevard Maréchal Lyautey n° 13, B.P. 32, Brazzaville, Congo.
authors.forename: Ghislain
authors.initials: G
authors.lastname: Mpandzou
authors.forename: Raymond
authors.initials: R
authors.lastname: Cespuglio
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ngampo
authors.forename: Bébène
authors.initials: B
authors.lastname: Bandzouzi
authors.forename: Bernard
authors.initials: B
authors.lastname: Bouteille
authors.forename: Philippe
authors.initials: P
authors.lastname: Vincendeau
authors.forename: Alain
authors.initials: A
authors.lastname: Buguet
mesh_terms: D020261:Arsenic Poisoning / Q000175:diagnosis* / Q000469:parasitology / Q000517:prevention & control; D002675:Child, Preschool; D003223:Congo; D005260:Female; D006801:Humans; D008549:Melarsoprol / Q000008:administration & dosage / Q000009:adverse effects; D017286:Polysomnography / Q000379:methods*; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000469:parasitology*; D014344:Trypanocidal Agents / Q000008:administration & dosage / Q000009:adverse effects; D014347:Trypanosoma brucei gambiense / Q000187:drug effects* / Q000254:growth & development; D014353:Trypanosomiasis, African / Q000150:complications / Q000188:drug therapy* / Q000469:parasitology
chemical_list: D014344:Trypanocidal Agents; D008549:Melarsoprol