Sleeping sickness: end of the epidemic outbreak?

• Published in: Revue neurologique 2012-03, Vol.168 (3), p.230-238
• Main Authors: Bisser, S, Courtioux, B
• Format: Article
• Language: fre
• Subjects: Africa; Africa - epidemiology; Animals; Epidemics; Humans; Life Sciences; Polymerase Chain Reaction; Santé publique et épidémiologie; Trypanosoma brucei gambiense; Trypanosoma brucei gambiense - genetics; Trypanosoma brucei gambiense - physiology; Trypanosoma brucei rhodesiense; Trypanosoma brucei rhodesiense - genetics; Trypanosoma brucei rhodesiense - physiology; Trypanosomiasis, African; Trypanosomiasis, African - diagnosis; Trypanosomiasis, African - epidemiology; Trypanosomiasis, African - parasitology; Trypanosomiasis, African - pathology; Trypanosomiasis, African - therapy
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2011.12.004

Sleeping sickness or human African trypanosomiasis is a parasitic disease transmitted by tsetse flies and therefore confined to its habitat, the central part of the African continent. Two disease forms are linked to two different parasites: T. b. gambiense and T. b. rhodesiense. Actual epidemiological data and precise and dynamic mapping of foci are in favor of a real decrease of the disease. Not all areas are under control and resurgence can still not be avoided from the remote areas where the disease is endemic. However, recent advances in knowledge in parasite genetics are giving hope of control. In 2009, for the first time since 50 years, less than 10,000 cases were declared to the World Health Organization. Clinical trials allowed revising some clinical concepts and linking them with parasite genetics: both disease forms can show variations from asymptomatic, chronic to acute and are linked to genetic differences in the host or the parasite. Parasitological diagnosis may be facilitated by the introduction of individual rapid tests and PCR-based field tests. Knowledge in mechanisms of brain invasion and screenings of inflammatory molecules allow new marker combinations for staging but they do not avoid lumbar puncture. Therapeutic options remain limited but there is hope to develop a new drug orally available in a near future.