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The continuing problem of human African trypanosomiasis (sleeping sickness).
Ann Neurol. 2008 Aug; 64(2):116-26.AN

Abstract

Human African trypanosomiasis, also known as sleeping sickness, is a neglected disease, and it continues to pose a major threat to 60 million people in 36 countries in sub-Saharan Africa. Transmitted by the bite of the tsetse fly, the disease is caused by protozoan parasites of the genus Trypanosoma and comes in two types: East African human African trypanosomiasis caused by Trypanosoma brucei rhodesiense and the West African form caused by Trypanosoma brucei gambiense. There is an early or hemolymphatic stage and a late or encephalitic stage, when the parasites cross the blood-brain barrier to invade the central nervous system. Two critical current issues are disease staging and drug therapy, especially for late-stage disease. Lumbar puncture to analyze cerebrospinal fluid will remain the only method of disease staging until reliable noninvasive methods are developed, but there is no widespread consensus as to what exactly defines biologically central nervous system disease or what specific cerebrospinal fluid findings should justify drug therapy for late-stage involvement. All four main drugs used for human African trypanosomiasis are toxic, and melarsoprol, the only drug that is effective for both types of central nervous system disease, is so toxic that it kills 5% of patients who receive it. Eflornithine, alone or combined with nifurtimox, is being used increasingly as first-line therapy for gambiense disease. There is a pressing need for an effective, safe oral drug for both stages of the disease, but this will require a significant increase in investment for new drug discovery from Western governments and the pharmaceutical industry.

Authors+Show Affiliations

Department of Neurology, Division of Clinical Neurosciences, Faculty of Medicine, University of Glasgow Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK. p.g.kennedy@clinmed.gla.ac.uk

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18756506

Citation

Kennedy, Peter G E.. "The Continuing Problem of Human African Trypanosomiasis (sleeping Sickness)." Annals of Neurology, vol. 64, no. 2, 2008, pp. 116-26.
Kennedy PG. The continuing problem of human African trypanosomiasis (sleeping sickness). Ann Neurol. 2008;64(2):116-26.
Kennedy, P. G. (2008). The continuing problem of human African trypanosomiasis (sleeping sickness). Annals of Neurology, 64(2), 116-26. https://doi.org/10.1002/ana.21429
Kennedy PG. The Continuing Problem of Human African Trypanosomiasis (sleeping Sickness). Ann Neurol. 2008;64(2):116-26. PubMed PMID: 18756506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The continuing problem of human African trypanosomiasis (sleeping sickness). A1 - Kennedy,Peter G E, PY - 2008/8/30/pubmed PY - 2008/9/20/medline PY - 2008/8/30/entrez SP - 116 EP - 26 JF - Annals of neurology JO - Ann Neurol VL - 64 IS - 2 N2 - Human African trypanosomiasis, also known as sleeping sickness, is a neglected disease, and it continues to pose a major threat to 60 million people in 36 countries in sub-Saharan Africa. Transmitted by the bite of the tsetse fly, the disease is caused by protozoan parasites of the genus Trypanosoma and comes in two types: East African human African trypanosomiasis caused by Trypanosoma brucei rhodesiense and the West African form caused by Trypanosoma brucei gambiense. There is an early or hemolymphatic stage and a late or encephalitic stage, when the parasites cross the blood-brain barrier to invade the central nervous system. Two critical current issues are disease staging and drug therapy, especially for late-stage disease. Lumbar puncture to analyze cerebrospinal fluid will remain the only method of disease staging until reliable noninvasive methods are developed, but there is no widespread consensus as to what exactly defines biologically central nervous system disease or what specific cerebrospinal fluid findings should justify drug therapy for late-stage involvement. All four main drugs used for human African trypanosomiasis are toxic, and melarsoprol, the only drug that is effective for both types of central nervous system disease, is so toxic that it kills 5% of patients who receive it. Eflornithine, alone or combined with nifurtimox, is being used increasingly as first-line therapy for gambiense disease. There is a pressing need for an effective, safe oral drug for both stages of the disease, but this will require a significant increase in investment for new drug discovery from Western governments and the pharmaceutical industry. SN - 1531-8249 UR - https://www.unboundmedicine.com/medline/citation/18756506/The_continuing_problem_of_human_African_trypanosomiasis__sleeping_sickness__ L2 - https://doi.org/10.1002/ana.21429 DB - PRIME DP - Unbound Medicine ER -