title: A Clinical and Epidemiological Investigation of the First Reported Human Infection With the Zoonotic Parasite Trypanosoma evansi in Southeast Asia.
abstract: BACKGROUND
  Trypanosomais a genus of unicellular parasitic flagellate protozoa.Trypanosoma bruceispecies and Trypanosoma cruziare the major agents of human trypanosomiasis; other Trypanosomaspecies can cause human disease, but are rare. In March 2015, a 38-year-old woman presented to a healthcare facility in southern Vietnam with fever, headache, and arthralgia. Microscopic examination of blood revealed infection with Trypanosoma
  
  
  METHODS
  Microscopic observation, polymerase chain reaction (PCR) amplification of blood samples, and serological testing were performed to identify the infecting species. The patient's blood was screened for the trypanocidal protein apolipoprotein L1 (APOL1), and a field investigation was performed to identify the zoonotic source.
  
  
  RESULTS
  PCR amplification and serological testing identified the infecting species as Trypanosoma evansi.Despite relapsing 6 weeks after completing amphotericin B therapy, the patient made a complete recovery after 5 weeks of suramin. The patient was found to have 2 wild-type APOL1 alleles and a normal serum APOL1 concentration. After responsive animal sampling in the presumed location of exposure, cattle and/or buffalo were determined to be the most likely source of the infection, with 14 of 30 (47%) animal blood samples testing PCR positive forT. evansi.
  
  
  CONCLUSIONS
  We report the first laboratory-confirmed case ofT. evansiin a previously healthy individual without APOL1 deficiency, potentially contracted via a wound while butchering raw beef, and successfully treated with suramin. A linked epidemiological investigation revealed widespread and previously unidentified burden ofT. evansiin local cattle, highlighting the need for surveillance of this infection in animals and the possibility of further human cases.
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Vinh Chau
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Le
authors.initials: L
authors.lastname: Buu Chau
authors.affiliation: Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD), UMR Intertryp, Montpellier, France.|Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.
authors.forename: Marc
authors.initials: M
authors.lastname: Desquesnes
authors.affiliation: Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.|UMR 177 Intertryp IRD/CIRAD, Montpellier, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Herder
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Phu Huong Lan
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Cuong
authors.affiliation: Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.
authors.forename: Benjarat
authors.initials: B
authors.lastname: Yimming
authors.affiliation: Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.
authors.forename: Piangjai
authors.initials: P
authors.lastname: Chalermwong
authors.affiliation: Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.
authors.forename: Sathaporn
authors.initials: S
authors.lastname: Jittapalapong
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Jose
authors.initials: J
authors.lastname: Ramon Franco
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
authors.forename: Ngo
authors.initials: N
authors.lastname: Tri Tue
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Maia A
authors.initials: MA
authors.lastname: Rabaa
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Juan
authors.initials: J
authors.lastname: Carrique-Mas
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
authors.forename: Tam
authors.initials: T
authors.lastname: Pham Thi Thanh
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
authors.forename: Nga
authors.initials: N
authors.lastname: Tran Vu Thieu
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Berto
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Ngo
authors.initials: N
authors.lastname: Thi Hoa
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Minh Hoang
authors.affiliation: Regional Animal Health Laboratory 5.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Canh Tu
authors.affiliation: Subdepartment of Animal Health, Buon Ma Thuot, Dak Lak, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Khac Chuyen
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Bridget
authors.initials: B
authors.lastname: Wills
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Tran
authors.initials: T
authors.lastname: Tinh Hien
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Thwaites
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Department of Medicine, Imperial College London, Hammersmith Campus.
authors.forename: Sophie
authors.initials: S
authors.lastname: Yacoub
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom.|Department of Pathogen and Molecular Biology, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: D000328:Adult; D000818:Animals; D000075944:Apolipoprotein L1; D001053:Apolipoproteins / Q000097:blood / Q000235:genetics; D001210:Asia, Southeastern / Q000453:epidemiology; D001769:Blood / Q000469:parasitology; D002020:Buffaloes / Q000469:parasitology; D002417:Cattle; D021821:Communicable Diseases, Emerging / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology / Q000635:transmission; D016054:DNA, Protozoan / Q000032:analysis; D005260:Female; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood / Q000235:genetics; D008853:Microscopy; D016133:Polymerase Chain Reaction; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014345:Trypanosoma / Q000145:classification / Q000302:isolation & purification* / Q000648:ultrastructure; D014352:Trypanosomiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology* / Q000635:transmission; D014744:Vietnam / Q000453:epidemiology; D015047:Zoonoses / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission
chemical_list: C108666:APOL1 protein, human; D000075944:Apolipoprotein L1; D001053:Apolipoproteins; D016054:DNA, Protozoan; D008075:Lipoproteins, HDL; D014344:Trypanocidal Agents
keywords: Trypanosoma evansi; Vietnam; case investigation; emerging infections; zoonosis