Neuro-inflammatory risk factors for treatment failure in “early second stage” sleeping sickness patients treated with Pentamidine

In a clinical trial on efficacy of Pentamidine in second stage Trypanosoma brucei gambiense patients with ≤20 cells/μl in cerebrospinal fluid (CSF), 43% of treatment failures were observed. We hypothesised that unsuccessful treatment was caused by uncured brain infection. The relationship between tr...

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Bibliographic Details
Published in:Journal of neuroimmunology 2003-11, Vol.144 (1), p.132-138
Main Authors: Lejon, Veerle, Legros, Dominique, Savignoni, Alexia, Etchegorry, Marc Gastellu, Mbulamberi, Dawson, Büscher, Philippe
Format: Article
Language:English
Subjects:
Adolescent
Adult
Animals
Card agglutination
Cerebrospinal fluid
Cerebrospinal Fluid Proteins - biosynthesis
Cerebrospinal Fluid Proteins - blood
Cerebrospinal Fluid Proteins - cerebrospinal fluid
Child
Child, Preschool
Female
Humans
IgM
Immunoglobulin M - biosynthesis
Immunoglobulin M - blood
Immunoglobulin M - cerebrospinal fluid
Intrathecal humoral immune response
Latex Fixation Tests
Leukocyte Count
Male
Melarsoprol - therapeutic use
Middle Aged
Pentamidine
Pentamidine - therapeutic use
Recurrence
Risk Factors
Treatment Failure
Trypanosoma brucei gambiense
Trypanosoma brucei gambiense - drug effects
Trypanosoma brucei gambiense - growth & development
Trypanosoma brucei gambiense - immunology
Trypanosomiasis, African - cerebrospinal fluid
Trypanosomiasis, African - drug therapy
Trypanosomiasis, African - parasitology
Trypanosomiasis, African - pathology
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Summary:In a clinical trial on efficacy of Pentamidine in second stage Trypanosoma brucei gambiense patients with ≤20 cells/μl in cerebrospinal fluid (CSF), 43% of treatment failures were observed. We hypothesised that unsuccessful treatment was caused by uncured brain infection. The relationship between treatment outcome and CSF cell count, protein concentration, presence of trypanosomes, the intrathecal immune response, and CSF total IgM and trypanosome specific antibodies detected by LATEX/IgM and LATEX/ T.b. gambiense card agglutination tests was examined. Cell counts of 11–20 cells/μl, intrathecal IgM synthesis, CSF end-titres in LATEX/IgM ≥4 and LATEX/ T.b. gambiense positive CSF, were associated with treatment failure. Detection of intrathecal IgM synthesis is valuable for assessment of brain involvement and treatment decision.
ISSN:0165-5728
1872-8421
DOI:10.1016/j.jneuroim.2003.08.033