Immunoassay of circulating trypanosomal antigens in sleeping sickness patients undergoing treatment.

Sera from 99 patients infected with Trypanosoma brucei rhodesiense and undergoing treatment, were analyzed for circulating trypanosomal antigens using a sandwich antigen-trapping enzyme-linked immunosorbent assay (ELISA). Trypanosomal antigens were detected in 83 (84%) of the patients. Post-treatment antigen profile in 67 patients showed five distinct patterns: in 48% of the patients antigen levels remained elevated throughout the time of hospitalisation and follow-up; in 31%, antigens dropped to the negative value by the second month; in 7.5%, antigens dropped to the negative level and became elevated afterwards; in 7.5%, antigen levels were negative initially, but later, became elevated and remained so throughout the observation period; in 6%, antigen levels remained below the negative value throughout. All patients who relapsed on follow-up had earlier shown evidence of elevated antigen profile. There were no cases of relapses among 21 patients whose antigen levels dropped subsequent to treatment. This ELISA trypanosome antigen detection test could be useful in evaluating treatment success, when used together with parasitological diagnostic techniques.

Evaluation of Procyclic Agglutination Trypanosomiasis Test (PATT) for the immunodiagnosis of Trypanosoma brucei rhodesiense sleeping sickness in Kenya.

Documented sera from 156 patients admitted to Alupe Sleeping Sickness Hospital in Western Kenya were tested to determine the potential usefulness of Procclic Agglutination Trypanosomiasis Test (PATT) for the diagnosis of Trypanosoma brucei rhodesiense African sleeping sickness. A total of 490 serum samples were tested, including 42 controls. Anti-trypanosome antibodies were detected in 99% of the sera taken prior to trypanocidal drug therapy. Antibody levels remained high during course of treatment. In cured cases antibodies declined to negative or low levels 4 months to one year after treatment. High antibody levels persisted in patients who relapsed. Although the results showed a high sensitivity and specificity, confirming the potential usefulness of the test for serodiagnosis of African sleeping sickness, PATT, in its present form is unsuitable for routine diagnosis. This is due to difficulties inherent in the use of live trypanosomes as detector antigen.

Circurating trypanosomal antigen levels in sleeping sickness patients under going treatment at Alupe

Sera from 99 sleeping sickness patients admitted to Alupe Hospital were analyzed for circulating trypanosomal antigens using a sandwich antigen-trapping enzyme immunosorbent assay. Trypanosomal antigens were detected in 83 (84) of the patients. Post-treatment antigen profile in 67 patients showed five distinct patterns: in 48 of the patients antigen levels remained elevated thoughout; in 31 of the patients antigens dropped to the; negative value; and became elevated afterward; in 6.0 of the patients antigen levels were negative initially; but became elevated later; in 7.5 of the patients antigen levels remained below the negative value thoughout. The significance of these observations in the clinical management of sleeping sickness is discussed

Treatment of arsenical refractory Rhodesian sleeping sickness in Kenya.

Case histories of three Rhodesian sleeping sickness patients who relapsed after Mel-B therapy are presented. Repeated Mel-B therapy was clinically effective but not curative, and all three patients subsequently relapsed again and required further treatment.

Presenting features of Rhodesian sleeping sickness patients in the Lambwe Valley, Kenya.

During a recent outbreak of Rhodesian sleeping sickness in the Lambwe Valley no asymptomatic Rhodesian sleeping sickness patients were found although 54% of the primary patients had mild symptoms and 9% were stuporous or comatose at presentation. The duration of symptoms was three months or less in 90% of the patients. Headache, weakness, joint and back pains and weight loss were claimed by at least 75% of the patients, while 82% of the females reported amenorrhoea and 70% of the males claimed impotency. Physical examination revealed lymphadenopathy in 86% but fever in only 36% of the patients, while chancres were found in only 16%. Patients had significantly lower levels of haemoglobin and thrombocytes than controls and their erythrocyte sedimentation rates were elevated. A comparison of both blood group and haemoglobin type between patients and controls yielded no significant differences. Fifty-seven per cent of the primary patients reporting mild symptoms had abnormal levels of leucocytes in their CSF. All relapse patients had abnormal CSF parameters. Levels of serum urea nitrogen were significantly elevated in patients, but SGOT, SGPT and total bilirubin were not. Levels of albumin and beta-globulin in patients were significantly lower than controls while gamma-globulin was elevated. Mean serum IgM levels in patients were elevated to nearly three-fold those of controls, but 35% of the individual patient values fell within the 95% range of control values. Some patients had extended prothrombin and thrombin times while fibrinogen levels were significantly elevated. No patients reported haemorrhage, and none was seen.

Treatment of Rhodesian sleeping sickness in Kenya.

In a study of 269 sleeping sickness patients treated with Mel-B, 14 (5.2%) died during treatment. With total dosages of at least 30 ml (1.08 g), 1.4% relapsed and another 6.4% died, mostly of unknown causes, within three years of treatment, giving a success rate of 92.1% over the three years. Mel-B was used to treat 55 relapses after suramin therapy with 1.8% deaths during treatment, 3.6% relapses, and 92.7% success over at least three years. Apparent drug resistance to Mel-B was found in three patients who continued to relapse after repeated treatments. During 1980, 51 patients were treated with suramin on the basis of clinical condition without benefit of cerebrospinal fluid (CSF) analysis. Subsequently 49% of these patients relapsed within three years of treatment. When 29 patients were treated on the basis of CSF evaluation only two (7%) relapsed.