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      Description of the first sleeping sickness case diagnosed in Burkina Faso since two decades

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          Abstract

          Burkina Faso belongs to a group of countries in which human African trypanosomiasis (HAT), caused by Trypanosoma brucei gambiense, is no longer considered to be a public health problem. Although no native cases have been detected since 1993, there is still the risk of HAT re-emergence due to significant population movements between Burkina Faso and active HAT foci in Côte d’Ivoire. Since 2014, Burkina Faso receives support from the WHO to implement a passive surveillance program. This resulted in the detection in 2015 of the first putative native HAT case since two decades. However, epidemiological entomological and molecular biology investigations have not been able to identify with certainty the origin of this infection or to confirm that it was due to T. b. gambiense. This case emphasises the need to strengthen passive surveillance of the disease for sustained elimination of HAT as a public health problem in Burkina Faso.

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          In 2012, the roadmap for the Control of Neglected Tropical Diseases (NTD) of the World Health Organization (WHO) included human African trypanosomiasis (HAT) to be eliminated as a public health problem by 2020. To reach this ambitious objective in Burkina Faso, where the vector (and consequently a risk of HAT re-emergence) is still present, a passive surveillance system based on sentinel sites was established in the southwestern part of the country, considered to be the most at-risk area. The implementation of this system recently resulted in the diagnosis of the first putative native sleeping sickness case since two decades. Although the origin of this infection and how the patient was infected could not be identified, the detection of this native case confirms that HAT re-emergence in Burkina Faso is still a risk. This demonstrates the importance of implementing, maintaining and reinforcing passive surveillance programs in at-risk areas.

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          The Atlas of human African trypanosomiasis: a contribution to global mapping of neglected tropical diseases

          Background Following World Health Assembly resolutions 50.36 in 1997 and 56.7 in 2003, the World Health Organization (WHO) committed itself to supporting human African trypanosomiasis (HAT)-endemic countries in their efforts to remove the disease as a public health problem. Mapping the distribution of HAT in time and space has a pivotal role to play if this objective is to be met. For this reason WHO launched the HAT Atlas initiative, jointly implemented with the Food and Agriculture Organization of the United Nations, in the framework of the Programme Against African Trypanosomosis. Results The distribution of HAT is presented for 23 out of 25 sub-Saharan countries having reported on the status of sleeping sickness in the period 2000 - 2009. For the two remaining countries, i.e. Angola and the Democratic Republic of the Congo, data processing is ongoing. Reports by National Sleeping Sickness Control Programmes (NSSCPs), Non-Governmental Organizations (NGOs) and Research Institutes were collated and the relevant epidemiological data were entered in a database, thus incorporating (i) the results of active screening of over 2.2 million people, and (ii) cases detected in health care facilities engaged in passive surveillance. A total of over 42 000 cases of HAT and 6 000 different localities were included in the database. Various sources of geographic coordinates were used to locate the villages of epidemiological interest. The resulting average mapping accuracy is estimated at 900 m. Conclusions Full involvement of NSSCPs, NGOs and Research Institutes in building the Atlas of HAT contributes to the efficiency of the mapping process and it assures both the quality of the collated information and the accuracy of the outputs. Although efforts are still needed to reduce the number of undetected and unreported cases, the comprehensive, village-level mapping of HAT control activities over a ten-year period ensures a detailed and reliable representation of the known geographic distribution of the disease. Not only does the Atlas serve research and advocacy, but, more importantly, it provides crucial evidence and a valuable tool for making informed decisions to plan and monitor the control of sleeping sickness.
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            Detection of Trypanosoma congolense and Trypanosoma brucei subspecies by DNA amplification using the polymerase chain reaction.

            The nuclear DNA of Trypanosoma congolense contains a family of highly conserved 369 base pair (bp) repeats. The sequences of three cloned copies of these repeats were determined. An unrelated family of 177 bp repeats has previously been shown to occur in the nuclear DNA of Trypanosoma brucei brucei (Sloof et al. 1983a). Oligonucleotides were synthesized which prime the specific amplification of each of these repetitive DNAs by the polymerase chain reaction (PCR). Amplification of 10% of the DNA in a single parasite of T. congolense or T. brucei spp. produced sufficient amplified product to be visible as a band in an agarose gel stained with ethidium bromide. This level of detection, which does not depend on the use of radioactivity, is about 100 times more sensitive than previous detection methods based on radioactive DNA probes. The oligonucleotides did not prime the amplification of DNA sequences in other trypanosome species nor in Leishmania, mouse or human DNAs. Amplification of DNA from the blood of animals infected with T. congolense and/or T. brucei spp. permitted the identification of parasite levels far below that detectable by microscopic inspection. Since PCR amplification can be conducted on a large number of samples simultaneously, it is ideally suited for large-scale studies on the prevalence of African trypanosomes in both mammalian blood and insect vectors.
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              Atypical Human Infections by Animal Trypanosomes

              The two classical forms of human trypanosomoses are sleeping sickness due to Trypanosoma brucei gambiense or T. brucei rhodesiense, and Chagas disease due to T. cruzi. However, a number of atypical human infections caused by other T. species (or sub-species) have been reported, namely due to T. brucei brucei, T. vivax, T. congolense, T. evansi, T. lewisi, and T. lewisi-like. These cases are reviewed here. Some infections were transient in nature, while others required treatments that were successful in most cases, although two cases were fatal. A recent case of infection due to T. evansi was related to a lack of apolipoprotein L-I, but T. lewisi infections were not related to immunosuppression or specific human genetic profiles. Out of 19 patients, eight were confirmed between 1974 and 2010, thanks to improved molecular techniques. However, the number of cases of atypical human trypanosomoses might be underestimated. Thus, improvement, evaluation of new diagnostic tests, and field investigations are required for detection and confirmation of these atypical cases.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draft
                Role: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draft
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: ValidationRole: Writing – original draft
                Role: ConceptualizationRole: Investigation
                Role: Formal analysisRole: InvestigationRole: Writing – original draft
                Role: Formal analysisRole: Project administration
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Methodology
                Role: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: MethodologyRole: Supervision
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                20 August 2018
                August 2018
                : 12
                : 8
                : e0006677
                Affiliations
                [1 ] Université Nazi Boni, Unité de Formation et de Recherche Sciences et Techniques, Bobo-Dioulasso, Burkina Faso
                [2 ] Centre International de Recherche-Développement sur l’Elevage en zones Subhumides, Unité de recherches sur les bases biologiques de la lutte intégrée, Bobo-Dioulasso, Burkina Faso
                [3 ] Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
                [4 ] Programme National de Lutte contre les Maladies Tropicales Négligées, Ouagadougou, Burkina Faso
                [5 ] Institut Pierre Richet, Unité de Recherche “Trypanosomoses”, Bouaké, Côte d’Ivoire
                [6 ] Institut de Recherche pour le Développement, INTERTRYP, Université de Montpellier-IRD-CIRAD, Montpellier, France
                Institute of Tropical Medicine, BELGIUM
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-1008-233X
                Article
                PNTD-D-18-00390
                10.1371/journal.pntd.0006677
                6124770
                30125276
                632bab70-cb24-4081-aa7c-ef856cdd97bb
                © 2018 Dama et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 March 2018
                : 10 July 2018
                Page count
                Figures: 1, Tables: 0, Pages: 9
                Funding
                The World Health Organisation (WHO) supported the establishment of the HAT passive surveillance, and the active medical survey. The epidemiological data collection was supported by Institut de Recherche pour le développement (IRD). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Organisms
                Eukaryota
                Protozoans
                Parasitic Protozoans
                Trypanosoma
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                African Trypanosomiasis
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                Parasitic Diseases
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                Custom metadata
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                2018-09-05
                All relevant data are within the paper.

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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