title: Clinical profiles, disease outcome and co-morbidities among T. b. rhodesiense sleeping sickness patients in Uganda.
abstract: BACKGROUND
  The acute form of Human African Trypanosomiasis (HAT, also known as Sleeping sickness) caused by Trypanosoma brucei rhodesiense has been shown to have a wide spectrum of focus specific clinical presentation and severity in East and Southern Africa. Indeed HAT occurs in regions endemic for other tropical diseases, however data on how these co-morbidities might complicate the clinical picture and affect disease outcome remains largely scanty. We here describe the clinical presentation, presence of co-infections, and how the latter impact on HAT prognosis.
  
  
  RESULTS
  We carried out a retrospective analysis of clinical data from 258 sleeping sickness patients reporting to Lwala hospital between 2005 and 2012. The mean patient age was 28.6 years with a significant number of cases below 18 years (p< 0.0001). About 93.4% of the cases were diagnosed as late stage (p< 0.0001). The case fatality rate was 10.5% with post treatment reactive encephalopathys reported in 7.9% of the cases, of whom 36.8% eventually died. Fever was significantly (p = 0.045) higher in patients under 18 years. Of the early stage patients, 26.7% and 6.7% presented with late stage signs of sleep disorder and mental confusion respectively. Among the co-infections, malaria was significantly more prevalent (28.9%; p< 0.0001) followed by urinary tract infections (4.2%). Co-infections were present in 14.3% of in-hospital deaths, 38.5% of which were recorded as Malaria. Malaria was significantly more common in patients under 18 years (45.5%; p< 0.02), and was reported in 60% of the fatal cases in this age group.
  
  
  CONCLUSIONS
  We show a wide spectrum of sleeping sickness clinical presentation and disease outcome that was apparently not significantly influenced by concurrent infections. It would thus be interesting to determine the host and/or parasite factors that might be responsible for the observed diverse clinical presentation.
authors.affiliation: School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, Kampala Uganda.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Kato
authors.affiliation: School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, Kampala Uganda.
authors.forename: Ann
authors.initials: A
authors.lastname: Nanteza
authors.affiliation: School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, Kampala Uganda.
authors.forename: Claire
authors.initials: C
authors.lastname: Mugasa
authors.affiliation: Lwala Hospital, Kaberamaido Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Edyelu
authors.affiliation: School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, Kampala Uganda.
authors.forename: Enock
authors.initials: E
authors.lastname: Matovu
authors.affiliation: College of Natural Sciences, Makerere University, Kampala Uganda.
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Alibu
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D016833:Trypanosoma brucei rhodesiense; D014353:Trypanosomiasis, African / Q000175:diagnosis / Q000453:epidemiology*; D014454:Uganda; D014552:Urinary Tract Infections / Q000453:epidemiology