title: Cerebrospinal fluid neopterin as marker of the meningo-encephalitic stage of Trypanosoma brucei gambiense sleeping sickness.
abstract: BACKGROUND
  Sleeping sickness, or human African trypanosomiasis (HAT), is a protozoan disease that affects rural communities in sub-Saharan Africa. Determination of the disease stage, essential for correct treatment, represents a key issue in the management of patients. In the present study we evaluated the potential of CXCL10, CXCL13, ICAM-1, VCAM-1, MMP-9, B2MG, neopterin and IgM to complement current methods for staging Trypanosoma brucei gambiense patients.
  
  
  RESULTS
  Five hundred and twelve T. b. gambiense HAT patients originated from Angola, Chad and the Democratic Republic of the Congo (D.R.C.). Their classification as stage 2 (S2) was based on the number of white blood cells (WBC) (>5/µL) or presence of parasites in the cerebrospinal fluid (CSF). The CSF concentration of the eight markers was first measured on a training cohort encompassing 100 patients (44 S1 and 56 S2). IgM and neopterin were the best in discriminating between the two stages of disease with 86.4% and 84.1% specificity respectively, at 100% sensitivity. When a validation cohort (412 patients) was tested, neopterin (14.3 nmol/L) correctly classified 88% of S1 and S2 patients, confirming its high staging power. On this second cohort, neopterin also predicted both the presence of parasites, and of neurological signs, with the same ability as IgM and WBC, the current reference for staging.
  
  
  CONCLUSIONS
  This study has demonstrated that neopterin is an excellent biomarker for staging T. b. gambiense HAT patients. A rapid diagnostic test for detecting this metabolite in CSF could help in more accurate stage determination.
authors: Biomedical Proteomics Research Group, Department of Human Protein Sciences, University of Geneva, Geneva, Switzerland.
authors: Natalia
authors: N
authors: Tiberti
authors: Alexandre
authors: A
authors: Hainard
authors: Veerle
authors: V
authors: Lejon
authors: Bertrand
authors: B
authors: Courtioux
authors: Enock
authors: E
authors: Matovu
authors: John Charles
authors: JC
authors: Enyaru
authors: Xavier
authors: X
authors: Robin
authors: Natacha
authors: N
authors: Turck
authors: Krister
authors: K
authors: Kristensson
authors: Dieudonné Mumba
authors: DM
authors: Ngoyi
authors: Gedeão M L
authors: GM
authors: Vatunga
authors: Sanjeev
authors: S
authors: Krishna
authors: Philippe
authors: P
authors: Büscher
authors: Sylvie
authors: S
authors: Bisser
authors: Joseph Mathu
authors: JM
authors: Ndung'u
authors: Jean-Charles
authors: JC
authors: Sanchez
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid; D007958:Leukocyte Count; D008297:Male; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid* / Q000469:parasitology*; D019798:Neopterin / Q000134:cerebrospinal fluid*; D015203:Reproducibility of Results; D014347:Trypanosoma brucei gambiense / Q000502:physiology*; D014353:Trypanosomiasis, African / Q000097:blood / Q000134:cerebrospinal fluid* / Q000469:parasitology*
chemical_list: D015415:Biomarkers; D007075:Immunoglobulin M; D019798:Neopterin