ABSTRACT
Introducción: La tripanosomiasis africana humana es producida por protozoos del género Trypanosoma y transmitida fundamentalmente por la picadura de la mosca tse-tsé. En el último siglo ha habido varias epidemias en el África, pero dado que el número de nuevos casos notificados había disminuido, la hoja de ruta de la OMS para las enfermedades tropicales desatendidas fijó el objetivo de su eliminación como problema de salud pública para 2020. Muchos de los países donde Cuba presta colaboración internacionalista son endémicos, por lo que los colaboradores están expuestos al riesgo de padecer y enfrentar esta enfermedad. Objetivo: Realizar una actualización clínica y epidemiológica de la entidad para alertar sobre la posibilidad de la aparición en áreas endémicas y la presencia de casos importados en Cuba. Métodos: Se realizó una revisión bibliográfica en la base de datos Medline/PubMed y en artículos relevantes relacionados con el tema, de los últimos años; también hemos tomado como referencia las notas descriptivas de tripanosomiasis africana de la OMS en el 2020, así como textos clásicos de medicina interna y la plataforma búsqueda ClinicalKey. Información, análisis y síntesis: Se hizo una detallada exposición de la enfermedad y la conducta terapéutica; una breve reseña de los casos importados y del país de procedencia, además del peligro que presenta la aparición de casos importados para Cuba. Conclusiones: La enfermedad es una entidad potencialmente mortal, endémica en países donde existe colaboración cubana. Es necesario tener presente el diagnóstico de esta enfermedad para un abordaje terapéutico adecuado(AU)
Introduction: Human African trypanosomiasis is produced by protozoa of the genus Trypanosoma and transmitted mainly by the bite of the tsetse fly. There have been several epidemics in Africa in the last century, but as the number of new reported trypanosomiasis cases has decreased, the WHO roadmap for neglected tropical diseases had targeted their elimination as a public health problem by 2020. Many of the countries where Cuba provides internationalist collaboration are endemic, so the collaborators are exposed to the risk of suffering and facing this disease. Objectives: To carry out a clinical and epidemiological update of the entity and warn about the possibility of the appearance in endemic areas and the presence of imported cases in Cuba. Methods: a bibliographic review was carried out in the Medline / Pub Med database and in relevant articles related to the subject, from recent years; we have taken the 2020 WHO African Trypanosomiasis descriptive notes as a reference, as well as classic internal medicine texts and the ClinicalKey search platform. Information, Analysis and Synthesis: A detailed exposition of the disease and the therapeutic behavior was made; a brief review of imported cases and the country of origin, in addition to the danger posed by the appearance of imported cases for Cuba. Conclusions: This is a potentially fatal entity, endemic in countries where there is Cuban collaboration. It is necessary to bear in mind the diagnosis of this disease for an adequate therapeutic approach(AU)
Subject(s)
Humans , Male , Female , CubaABSTRACT
Objective To investigate the prognosis of two rare imported patients with human African trypanosomias (HAT) after treatment in a follow-up study, and to evaluate the therapeutic efficacy, so as to provide insights into the treatment of imported HAT patients. Methods The white blood cells in cerebrospinal fluid samples and the trypomastigotes in cerebrospinal fluid and blood samples were monitored in an imported case with Trypanosoma brucei rhodesiense infection 1, 3, 11 and 25 months post-treatment and in an imported case with T. brucei gambiense infection 1, 3, 8 and 12 months post-treatment to evaluate the therapeutic efficacy and prognosis. Results There were 1, 1, 4 and 2 white blood cells in per μL of cerebrospinal fluid in the case with T. brucei rhodesiense infection 1, 3, 11 and 25 months post-treatment, and there were 3, 6, 4 and 3 white blood cells in per μL of cerebrospinal fluid in the case with T. brucei gambiense infection 1, 3, 8 and 12 months post-treatment. In addition, no trypomastigotes were identified in the cerebrospinal fluid or blood samples of either case with T. brucei rhodesiense or T. brucei gambiense infection. Conclusion Following standardized treatment, two imported cases with human African trypanosomiasis cases recover satisfactorily, without any signs of relapse.
ABSTRACT
Serum resistance associated (SRA) gene has been found to confer resistance to the innate trypanolytic factor (TLF) found in normal human serum; thus allowing Trypanosoma brucei brucei to survive exposure to normal human serum. This study was carried out to examine the presence of SRA gene and identify the origin of T. b. rhodesiense isolates from three districts in Tanzania, namely Kibondo, Kasulu and Urambo. Twenty-six T. b. rhodesiense isolates and two references T. b. rhodesiense isolates from Kenya were examined for SRA gene using simple Polymerase Chain Reaction technique. The gene was found to be present in all 26 T. b. rhodesiense isolates including the two references isolates from Kenya. The SRA gene was confirmed to be specific to T. b. rhodesiense since it could not be amplified from all other Trypanozoon including T. b. gambiense; and gave an amplified fragment of the expected size (3.9kb), confirming that all these isolates were T. b. rhodesiense of the northern variant. Although the geographic distributions of T. b. gambiense and T. b. rhodesiense are clearly localized to west/central Africa and eastern Africa, respectively, natural movement of people and recent influx of large number of refugees into Tanzania from the Democratic Republic of Congo, could have brought T. b. gambiense in western Tanzania. The overlap in distribution of both of these pathogenic sub-species could result in erroneous diagnoses since both trypanosome sub-species are morphologically identical, and currently serologic methods have low specificity. Both the susceptible and resistant T.b. rhodesiense isolates possessed the SRA gene suggesting that there is no correlation between drug resistance and presence of SRA gene. The use of SRA gene helps to confirm the identity and diversity of some of the isolates resistant to various drugs.