The challenging problem of disease staging in human African trypanosomiasis (sleeping sickness): a new approach to a circular question

Njamnshi, A. K., Gettinby, G. and Kennedy, P. G.E. (2017) The challenging problem of disease staging in human African trypanosomiasis (sleeping sickness): a new approach to a circular question. Transactions of the Royal Society of Tropical Medicine and Hygiene, 111(5), pp. 199-203. (doi: 10.1093/trstmh/trx034) (PMID:28957467)

Abstract

Human African trypanosomiasis (HAT), also known as sleeping sickness, puts millions of people at risk in sub-Saharan Africa and is a neglected parasitic disease that is almost always fatal if untreated or inadequately treated. HAT manifests itself in two stages that are difficult to distinguish clinically. The problem of staging in HAT is extremely important since treatment options, some of which are highly toxic, are directly linked to the disease stage. Several suggested investigations for disease staging have been problematic because of the lack of an existing gold standard with which to compare new clinical staging markers. The somewhat arbitrary current criteria based on the cerebrospinal fluid (CSF) white blood cell (WBC) count have been widely used, but the new potential biomarkers are generally compared with these, thereby making the problem somewhat circular in nature. We propose an alternative ‘reverse’ approach to address this problem, conceptualised as using appropriate statistical methods to test the performance of combinations of established laboratory variables as staging biomarkers to correlate with the CSF WBC/trypanosomes and clinical features of HAT. This approach could lead to the use of established laboratory staging markers, potentially leading to a gold standard for staging and clinical follow-up of HAT.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kennedy, Professor Peter
• Authors: Njamnshi, A. K., Gettinby, G., and Kennedy, P. G.E.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Transactions of the Royal Society of Tropical Medicine and Hygiene
• Publisher: Oxford University Press
• ISSN: 0035-9203
• ISSN (Online): 1878-3503
• Published Online: 14 July 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Transactions of the Royal Society of Tropical Medicine and Hygiene 111(5): 199-203
• Publisher Policy: Reproduced in accordance with the publisher copyright policy