The evolving spectrum of human African trypanosomiasis

Kennedy, P. G. E. (2023) The evolving spectrum of human African trypanosomiasis. QJM: An International Journal of Medicine, (doi: 10.1093/qjmed/hcad273) (PMID:38065835) (Early Online Publication)

Abstract

Summary: Human African trypanosomiasis (HAT), or sleeping sickness, continues to be a major threat to human health in 36 countries throughout sub-Saharan Africa with up to 60 million people at risk. Over the last decade, there have been several advances in this area, some of which are discussed in this overview. Due to the concerted efforts of several bodies, including better identification and treatment of cases and improved tsetse fly vector control, the number of cases of HAT has declined dramatically. The clinical heterogeneity of HAT has also been increasingly recognized, and the disease, while usually fatal if untreated or inadequately treated, does not always have a uniformly fatal outcome. Improved methods of HAT diagnosis have now been developed including rapid diagnostic tests. Novel drug treatment of HAT has also been developed, notably nifurtimox–eflornithine combination therapy (NECT) for late-stage Trypanosoma brucei gambiense, oral fexinidazole for early and the early component of the late-stage of T.b. gambiense, and the new oral compounds of the oxaborole group, which have shown considerable promise in field trials. Advances in HAT neuropathogenesis have been steady, though largely incremental, with a particular focus on the role of the blood–brain barrier in parasite entry into the central nervous system and the relevant importance of both innate and adaptive immunity. While the World Health Organization goal of elimination of HAT as a public health problem by 2020 has probably been achieved, it remains to be seen whether the second more ambitious goal of interruption of transmission of HAT by 2030 will be attained.

• Item Type: Articles
• Keywords: human African trypanosomiasis, sleeping sickness, trypanosome, diagnostic staging, tsetse fly, vector, reservoirs, cytokines, blood-brain barrier.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kennedy, Professor Peter
• Authors: Kennedy, P. G. E.
• College/School: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: QJM: An International Journal of Medicine
• Publisher: Oxford University Press
• ISSN: 1460-2725
• ISSN (Online): 1460-2393
• Copyright Holders: Copyright © 2023 The Author
• First Published: First published in QJM: An International Journal of Medicine 2023
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher