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CARD AGGLUTINATION TEST FOR TRYPANOSOMIASIS (CATT) END-DILUTION TITER AND CEREBROSPINAL FLUID CELL COUNT AS PREDICTORS OF HUMAN AFRICAN TRYPANOSOMIASIS (TRYPANOSOMA BRUCEI GAMBIENSE) AMONG SEROLOGICALLY SUSPECTED INDIVIDUALS IN SOUTHERN SUDAN

The diagnosis of human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense relies on an initial serologic screening with the card agglutination test for trypanosomiasis (CATT) for T. b. gambiense, followed by parasitologic confirmation in most endemic areas. Unfortunately, field parasitologic methods lack sensitivity and the management of serologically suspected individuals (i.e., individuals with a positive CATT result but negative parasitology) remains controversial. In Kajo-Keji County in southern Sudan, we prospectively collected sociodemographic and laboratory data of a cohort of 2,274 serologically suspected individuals. Thirty-three percent (n = 749) attended at least one follow-up visit and HAT was confirmed in 64 (9%) cases. Individuals with lower initial CATT-plasma (CATT-P) end-dilution titers had lowest risks (10.4 and 13.8/100 person-years for 1:4 and 1:8 titers, respectively) that significantly increased for higher dilutions: relative risks = 5.1 (95% confidence interval [CI] = 2.6–9.5) and 4.6 (95% CI = 2.8–9.8) for 1:16 and 1:32 titers, respectively. The cumulative yearly risk was also high (76%) in individuals found with 11–20 cells in the cerebrospinal fluid, but this involved only eight patients. Adjustment for potential confounders did not affect the results. In conclusion, treatment with pentamidine should be considered for all serologically suspected individuals with a CATT-P end-dilution titer 1:16 in areas of a moderate to high prevalence of HAT.

Received February 10, 2004. Accepted for publication April 5, 2004.

Acknowledgments: We thank the Sudanese medical and non-medical staff of the Kajo-Keji Sleeping Sickness Control Program for their dedicated work.

Financial support: This study was supported by Médecins Sans Frontières, Swiss Section.

Authors’ addresses: François Chappuis, Médecins Sans Frontières, Swiss Section, Rue de Lausanne 78, 1203 Geneva, Switzerland and Travel and Migration Medicine Unit, Department of Community Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva, Switzerland, Telephone: 41-22-3729620, Fax: 41-22-3729626, E-mail: francois.chappuis{at}hcuge.ch. Elisa Stivanello, Karen Adams, Solon Kidane, and Anne Pittet, Médecins Sans Frontières, Swiss Section, Rue de Lausanne 78, 1203 Geneva, Switzerland, Telephone: 41-22-8498484, Fax: 41-22-8498488. Patrick A. Bovier, Department of Community Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland, Telephone: 41-22-3723311, Fax: 41-22-3729626.

Reprint requests: François Chappuis, Travel and Migration Medicine Unit, Department of Community Medicine, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva, Switzerland. Médecins Sans Frontières, Swiss Section, Geneva, Switzerland; Department of Community Medicine, Geneva University Hospital, Geneva, Switzerland

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