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Human African trypanosomiasis in two historical foci of the estuaire province, gabon: A case report.

ABSTRACT: Human African Trypanosomiasis (HAT) is an infectious disease due to a protozoa parasite of the Trypanosoma genus. In West and Central Africa, this disease is caused by the subspecies Trypanosoma brucei gambiense. Several foci of this disease are currently active and causing the death of hundreds of people in endemic areas. In this article, we report two cases of gambiense HAT in one Indonesian and one Gabonese men in two historical foci of Gabon in 2019. Both patients had fever with temperatures above 38°C, an altered state of consciousness, cachexia, and multiple dermabrasions on the abdomen related to scratching lesions. The diagnostic revealed second-stage infection of both patients with T. b. gambiense; this result was confirmed by a polymerase chain reaction assay. Despite treatment with a combination of eflornithine and nifurtimox, as recommended by the World Health Organization for late-stage T. b. gambiense HAT, one of the two patients died. Thus, these cases highlight the importance of early HAT diagnosis and prompt patient care to fight effectively against this disease.

SUBMITTER: Iroungou BA

PROVIDER: S-EPMC7543151 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Human African trypanosomiasis in two historical foci of the estuaire province, gabon: A case report.

Iroungou Berthe Amélie BA Boundenga Larson L Guignali Mangouka Laurette L Bivigou-Mboumba Berthold B Nzenze Jean Raymond JR Maganga Gael Darren GD

SAGE open medical case reports 20201004

Human African Trypanosomiasis (HAT) is an infectious disease due to a protozoa parasite of the Trypanosoma genus. In West and Central Africa, this disease is caused by the subspecies <i>Trypanosoma brucei gambiense</i>. Several foci of this disease are currently active and causing the death of hundreds of people in endemic areas. In this article, we report two cases of <i>gambiense</i> HAT in one Indonesian and one Gabonese men in two historical foci of Gabon in 2019. Both patients had fever wit ...[more]

PMID: 33088570

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Project description:IntroductionHuman African Trypanosomiasis (HAT), a disease caused by protozoan parasites transmitted by tsetse flies, is an important neglected tropical disease endemic in remote regions of sub-Saharan Africa. Although the determination of the burden of HAT has been based on incidence, mortality and morbidity rates, the true burden of HAT goes beyond these metrics. This study sought to establish the socio-economic burden that households with HAT faced and the coping strategies they employed to deal with the increased burden.Materials and methodsA mixed methods approach was used and data were obtained through: review of hospital records; structured interviews (152); key informant interviews (11); case narratives (12) and focus group discussions (15) with participants drawn from sleeping sickness patients in the south western HAT foci in Kenya. Quantitative data were analysed using descriptive statistics while qualitative data was analysed based on emerging themes.ResultsSocio-economic impacts included, disruption of daily activities, food insecurity, neglect of homestead, poor academic performance/school drop-outs and death. Delayed diagnosis of HAT caused 93% of the affected households to experience an increase in financial expenditure (ranging from US$ 60-170) in seeking treatment. Out of these, 81.5% experienced difficulties in raising money for treatment resorting to various ways of raising it. The coping strategies employed to deal with the increased financial expenditure included: sale of agricultural produce (64%); seeking assistance from family and friends (54%); sale/lease of family assets (22%); seeking credit (22%) and use of personal savings (17%).Conclusion and recommendationCoping strategies outlined in this study impacted negatively on the affected households leading to further food insecurity and impoverishment. Calculation of the true burden of disease needs to go beyond incidence, mortality and morbidity rates to capture socio-economic variables entailed in seeking treatment and coping strategies of HAT affected households.

Project description:BackgroundThe Democratic Republic of the Congo (DRC) accounts for the majority of the reported gambiense human African trypanosomiasis (HAT) cases. Kongo Central province in the DRC reports a relatively low, yet steady number of cases, and forms a transboundary focus with Angola and the Republic of Congo. This paper describes an intervention aimed at reducing the case burden in Kongo Central by improving passive case detection, complemented with reactive screening.Methodology/principal findingsAt the initiation of this programme in August 2015, 620 health facilities were identified and equipped with Rapid Diagnostic Tests (RDTs) for HAT screening. Of these, 603 (97%) reported use of RDTs, and 584 (94%) that continued to use RDTs to the last quarter of 2016 were used in the analysis going forward. Among all health facilities involved, 23 were equipped to confirm HAT by microscopy, and 4 of the latter were equipped to perform molecular testing with loop-mediated isothermal amplification (LAMP). Patients clinically suspected of HAT were tested with an RDT and those with a positive RDT result were referred to the nearest microscopy facility for confirmatory testing. If RDT positive patients were negative by microscopy, they were tested by LAMP, either on fresh blood or blood that was dried on filter paper and transported to a facility performing LAMP. This network of diagnostic facilities reduced the median distance for a patient to travel to a screening facility from 13.7km when the classical card agglutination test for trypanosomiasis (CATT) was used as a screening test in the past, to 3.4km. As a consequence, passive case detection was improved by between 30% and 130% compared to the period before. Furthermore, the proportion of HAT cases detected in early stage disease by passive screening increased from 27% to 64%. Reactive screening took place in 20 villages where cases were reported by passive screening, and in 45 villages in the neighbourhood of these villages. Reactive screening was responsible for detection of 40% of cases, of which, 90% were in first stage of the disease.ConclusionsThis programme has demonstrated that it is possible to deploy passive screening for HAT at sub-country or country levels in the DRC, and this is made more effective when supplemented with reactive screening. Results and achievements showed an increase in the number of HAT cases detected, the majority of them in early disease, demonstrating that this strategy enables better population coverage and early detection of cases, which is critical in removing the HAT reservoir and interrupting transmission, and could contribute to HAT elimination in regions where it is implemented.

Dataset Information

Human African trypanosomiasis in two historical foci of the estuaire province, gabon: A case report.

Publications

Human African trypanosomiasis in two historical foci of the estuaire province, gabon: A case report.

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