title: Latent Trypanosoma brucei gambiense foci in Uganda: a silent epidemic in children and adults?
abstract: Trypanosoma brucei gambiense sleeping sickness follows a long asymptomatic phase and persists in ancient foci from which epidemic clinical disease arises. A putative focus of T. b. gambiense infections has been identified, initially in mothers and young children, on the Lake Albert shoreline of Western Uganda leading to mass screening of 6207 individuals in September 2008. T. b. gambiense infections were identified by Card Agglutination Test for Trypanosomiasis (CATT) and sub-species-specific PCR although parasitological methods failed to confirm any patent trypanosome infections. In April 2009, CATT positives were re-visited; diagnosis of individuals by CATT and PCR was unstable over the two time points and parasites remained undetected, even using mini Anion Exchange Centrifugation Technique (mAECT). These observations suggest the possibility of a silent focus of disease, where all infected individuals are in a latent stage, and highlight our limited understanding of the local natural history and disease progression of T. b. gambiense in children and adults.
authors.affiliation: Centre for Infectious Diseases, Division of Pathway Medicine, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Summerhall, Edinburgh, EH9 1QH.
authors.forename: S L
authors.initials: SL
authors.lastname: Wastling
authors.forename: K
authors.initials: K
authors.lastname: Picozzi
authors.forename: C
authors.initials: C
authors.lastname: Wamboga
authors.forename: B
authors.initials: B
authors.lastname: VON Wissmann
authors.forename: C
authors.initials: C
authors.lastname: Amongi-Accup
authors.forename: N A
authors.initials: NA
authors.lastname: Wardrop
authors.forename: J R
authors.initials: JR
authors.lastname: Stothard
authors.forename: A
authors.initials: A
authors.lastname: Kakembo
authors.forename: S C
authors.initials: SC
authors.lastname: Welburn
mesh_terms: D000328:Adult; D000372:Agglutination Tests; D058070:Asymptomatic Diseases; D002648:Child; D016054:DNA, Protozoan / Q000302:isolation & purification; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D060106:Lakes; D008403:Mass Screening; D016133:Polymerase Chain Reaction; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000453:epidemiology* / Q000469:parasitology; D014454:Uganda / Q000453:epidemiology
chemical_list: D016054:DNA, Protozoan