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Biomedical subjects

J Jannin

Publications and source records attributed to J Jannin.

At least 19 recordsLinked to original sources
PubMed2006

Treatment and follow-up of the first case of human trypanosomiasis caused by Trypanosoma evansi in India.

The first reported human case of trypanosomiasis caused by Trypanosoma evansi was treated using suramin. Patient follow-up indicates that the drug and specific regimen used were well tolerated. Clinical, serological and parasitological investigations at 6 months indicate complete cure of the patient. Suramin should be considered in the treatment of other cases of human T. evansi infection, if they occur.

Follow-Up Studies↗
PubMed2006

Human African trypanosomiasis: Epidemiology and control.

Human African trypanosomiasis (HAT), or sleeping sickness, describes not one but two discrete diseases: that caused by Trypanosoma brucei rhodesiense and that caused by T. b. gambiense. The Gambian form is currently a major public health problem over vast areas of central and western Africa, while the zoonotic, Rhodesian form continues to present a serious health risk in eastern and southern Africa. The two parasites cause distinct clinical manifestations, and there are significant differences in the epidemiology of the diseases caused. We discuss the differences between the diseases caused by the two parasites, with an emphasis on disease burden, reservoir hosts, transmission, diagnosis, treatment and control. We analyse how these differences impacted on historical disease control trends and how they can inform contemporary treatment and control options. We consider the optimal ways in which to devise HAT control policies in light of the differing biology and epidemiology of the parasites, and emphasise, in particular, the wider aspects of control policy, outlining the responsibilities of individuals, governments and international organisations in control programmes.

Africa↗
PubMed2006

The elimination of Trypanosoma brucei gambiense sleeping sickness in the focus of Luba, Bioko Island, Equatorial Guinea.

After the resurgence of sleeping sickness in Luba, Equatorial Guinea, a major campaign to control the disease was established in 1985. The campaign comprised no vector control, but intensive active and passive surveillance using serology for screening, and treatment of all parasitological and suspected serological cases. Total prevalence was used to classify villages as endemic, at risk, anecdotal and non-endemic which also allowed defining the geographic extent of the focus. Active case-finding was implemented from 1985 to 2004. The frequency of surveys was based on parasitological prevalence: twice a year during intensified control, once a year during ordinary control and once every 2 years during the control consolidation phase, when the parasitological prevalence in the whole focus fell to 0.1%. From 1985 to 1999, the indirect immunofluorescent antibody test (IFAT) was used as an initial screening tool, followed by parasitological confirmation of IFAT positive cases, and the Card Agglutination Trypanosomiasis Test (CATT) if necessary. In 2000, the IFAT was replaced by the CATT. Serum-positive individuals without parasitological confirmation were subsequently tested on serial dilution. All cases underwent lumbar puncture to determine the stage of the disease. First-stage cases were treated with pentamidine and second-stage cases with melarsoprol. A few relapses and very advanced cases were treated with eflornithine. The last sleeping sickness case was identified and treated in 1995.

Agglutination Tests↗
PubMed2006

A rare case of human trypanosomiasis caused by Trypanosoma evansi.

Human trypanosoma infections like the ones seen in Africa and South America are unknown in India. The only exception in literature is of two documented cases of a self-limiting febrile illness, being attributed to Trypanosoma lewisi like parasites. We are reporting an unusual case of trypanosomiasis from the rural parts of Chandrapur district in Maharashtra. An adult male farmhand who used to practice veterinary medicine also, presented with history of febrile episodes on and off since five months and drowsiness before admission to this Institute. Though routine blood and other investigations were within normal limits, the peripheral smear showed a large number of trypanosomes which morphologically resembled the species Trypanosoma evansi, the aetiological agent of surra - a form of animal trypanosomiasis. A battery of assays covering the spectrum of parasitology, serology, and molecular biology confirmed the infecting parasite to be T. evansi. Failure to demonstrate the central nervous system (CNS) involvement, as evidenced by the absence of parasite in cerebrospinal fluid (CSF) advocated the use of suramin - the drug of choice in early stage African trypanosomiasis without any CNS involvement. Suramin achieved cure in our patient. The case is being reported because of its unique nature as the patient was not immunocompromised and showed infestation with a parasite which normally does not affect human beings.

Animals↗
PubMed2004

Treatment and control of human African trypanosomiasis.

PURPOSE OF REVIEW: Access to treatment is a multi-step process and little progress has been made to improve treatments for sleeping sickness over the past 50 years. The current strategy is based on diagnostic tools developed in the 1960s while available drugs are still the same as those developed in the middle of the last century. Strategic opportunities can only be based on two achievements: improved diagnosis and safer drugs. This paper reviews the development of new diagnostic tools and drugs and the opportunity offered by new technologies for their further improvement. RECENT FINDINGS: The prodrug DB289 shows excellent oral activity with low toxicity for the treatment of early-stage sleeping sickness; it has recently entered phase II(b) clinical trials. The recent ability to identify and test specific host and parasite biomarkers has allowed the development of new, more-specific and sensitive, diagnostic and stage-determination tools. The accurate diagnosis of an infection by use of proteomic signature analysis has been achieved. Urinary nitrites and nitrates follow closely the increase of brain nitric oxide associated with the penetration of trypanosomes in the brain. Sleep-onset rapid eye movement-like episodes have been shown to occur at onset of late-stage trypanosomiasis. This unique disturbance of the wake/sleep cycle seems to be the first pathognomonic sign in the occurrence of late-stage trypanosomiasis. SUMMARY: Following the description of the disease, and diagnostic tools and drugs that have been used, and are still in use today, the authors show how it has influenced over time the evolution of strategies for surveillance and control. Recent developments and prospects for new, more-specific and sensitive diagnostic tools and a safer drug will undoubtedly improve the accuracy of patient recruitment and facilitate treatment, and provide ways towards new strategic opportunities.

Animals↗
PubMed2003

The challenge of Trypanosoma brucei gambiense sleeping sickness diagnosis outside Africa.

Sleeping sickness is a lethal African disease caused by parasites of the Trypanosoma brucei subspecies, which is transmitted by tsetse flies. Occasionally, patients are reported outside Africa. Diagnosis of such imported cases can be problematic when the infection is due to Trypanosoma brucei gambiense, the chronic form of sleeping sickness found in west and central Africa. The low number of trypanosomes in the blood and the non-specific, variable symptoms make the diagnosis difficult, particularly when the index of suspicion is low. When the trypanosomes have penetrated into the central nervous system, neuropathological signs become apparent but even at this stage, misdiagnosis is frequent. Rapid and correct diagnosis of sleeping sickness can avoid inappropriate or delayed treatment and even death of the patient. In this article, an overview on diagnosis of imported cases of T b gambiense sleeping sickness is given, and possible pitfalls in the diagnostic process are highlighted. Bioclinical parameters that should raise the suspicion of sleeping sickness in a patient who has been in west or central Africa are discussed. Techniques for diagnosis are reviewed. A clinician suspecting sleeping sickness should contact a national reference centre for tropical medicine in his or her country, or the WHO, Geneva, Switzerland, or the Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA, for clinical consultation and provision of specific diagnostic tests. Appropriate drugs for sleeping sickness treatment are also provided by WHO and the CDC.

Animals↗
PubMed2003

[The concept of neglected disease].

"Neglected disease", "neglected population" and more generally "public health negligence" are emerging concepts being put forward by numerous humanitarian groups. Sleeping sickness provides a typical example to illustrate these concepts. After causing a major epidemic in the 1930s, sleeping sickness had been practically eradicated by the end of decolonization. Because of more urgent priorities, independent national governments relinquished control activities thus allowing the disease to return insidiously. By the beginning of the 1990s the situation was comparable to that prevailing in 1930 without inciting a response commensurate with the extent of the problem. Sleeping sickness is currently not a priority and, more simply, is not given proper attention because it affects only a few people living in regions presenting little economic interest. This point underlines the especially devastating combination of neglected disease and neglected population. As early as 1999 the World Health Organization with the determined support of Medecins Sans Frontieres launched a campaign not only to promote control measures for sleeping sickness at the international level but also to use initiatives in the domain to illustrate the enormous potential for progress against neglected disease. The effects of this campaign are now beginning to be felt.

Africa↗
PubMed2003

[Status of sleeping sickness in 2003].

On May 3, 2001, the World Health Organization signed a major agreement with the pharmaceutical industry for the supply of drugs necessary for treatment of sleeping sickness. At that time Dr. Gro Harlem Brutland, director of the WHO, announced, "We can now look forward to halting the spread of sleeping sickness...". The purpose of this article is to take a look at the situation two years later. A first assessment showed that most national programs for the control of human African trypanosomiasis (NPCHAT) had practically become inoperative. One of the first steps in the new eradication campaign consisted of reviving these NPCHAT teams. However this goal could be achieved only insofar as awareness of the severity of the disease and of the need to act was felt at every level of decision-making. In 2001 the Pan-African Tse-Tse Trypanosomiasis Eradication Campaign (PATTEC) initiative was launched by African State leaders to promote special attention at the ministerial level, high-level training, and international cooperation sometimes involving several NPCHAT teams. Actions in the field include trials using new strategies, expert assistance for personnel throughout the duration of prospection, and screening and immediate treatment of numerous patients in outbreak areas where the disease was thought to be extinct. Although progress has not always been measurable in concrete terms, the dynamics have shifted almost everywhere.

Africa↗
PubMed2003

[Sleeping sickness, forgotten illness: what are the consequences in the field?].

For nearly 25 years, sleeping sickness was forgotten and increasingly neglected. Research programs and control activities against human African trypanosomiasis were discontinued. Statistical studies show a constant decrease in the number of people screened and cases detected and little change in the ratios of actively versus passively diagnosed cases and of the early (blood and lymph involvement) versus late (cerebral involvement) stage cases. In the field neglect of the disease led to deterioration not only physical facilities but also human resources. As teams aged, senior members were often replaced by less than fully qualified people resulting in a decline in efficiency and organization. Many basic notions were lost and the albeit scarce innovations in diagnosis and therapy were often overlooked. When the fight against sleeping sickness was finally resumed, these factors had to be taken into account. Efforts in the field have been focused on four areas: renovation of equipment, didactic and practical training for health care personnel, development of a decision-making algorithm based on diagnostic findings, and implementation of new therapeutic protocols.

Algorithms↗
PubMed2003

[Human African trypanosomiasis in an urban area: an emerging problem?].

The human African trypanosomiasis is essentially a rural disease. The notification of cases in urban area has always been incidental; either a diagnosis made in town revealed a disease contracted in rural environment or it meant the preservation of a complete epidemiological cycle in a remaining urban micro-focus. In Kinshasa, in Democratic Republic of Congo, about forty cases have been notified each year. All of them came from the nearby foci of Bandundu, Lower Congo and Kasaï. In 1996 the number of cases reached suddenly 254 and today the average annual number comes up to 500 in spite of all the efforts undertaken to fight the disease. A study of cases in 1998 and 1999 shows that patients are essentially distributed in suburbs and that the most affected by the disease are the 15-49 year old ones whose job is related with agricultural or fishing activities. Two phenomena seem to explain this sudden increase: the massive inflow of refugees in outskirts of town coming from provinces where trypanosomiasis is endemic and a major economic crisis throwing out urban population in suburbs living on a subsistence micro-agriculture. These concomitant factors have contributed to the setting up of a trypanosomiasis belt around the capital. Today a strategy has to be reconsidered in order to fight against the disease in the capital itself and to make the medical staff aware of the diagnosis of a disease still unknown in their sanitary district.

Adolescent↗
PubMed2001

Sleeping sickness surveillance: an essential step towards elimination.

In the last decades, with little or no surveillance sleeping sickness has returned to alarming levels comparable to the early twentieth century. Sixty million people are considered at risk but only 3-4 million are under surveillance, yielding some 45 000 new cases annually. It is estimated that at least 300 000-500 000 people are presently infected. Despite the almost universal presence of the vector in sub-Saharan Africa and the existence of an animal parasite reservoir, it is technically feasible to control and eliminate the disease as a public health problem. The authors describe, step-by-step, a surveillance method based on the epidemiological status of the village and using several approaches ranging from passive to active surveillance. Co-ordinated by the WHO, such surveillance has been incepted in several countries. Epidemiological data is spatially linked to the village, whose geographical co-ordinates are collected using a Global Positioning Systems (GPS). Information is transmitted to WHO through internet. Data analysis and mapping is carried out using Geographical Information System (GIS) software and thematic maps are generated to illustrate epidemiological status. Examples from Central African Republic (CAR), Cameroon and Gabon illustrate the process and mapping.

Cameroon↗
PubMed2001

Availability and affordability of treatment for Human African Trypanosomiasis.

Human African Trypanosomiasis (HAT) is a re-emerging disease whose usual treatments are becoming less efficient because of the increasing parasite resistance. Availability of HAT drugs is poor and their production in danger because of technical, ecological and economic constraints. In view of this dramatic situation, a network involving experts from NGOs, WHO and pharmaceutical producers was commissioned with updating estimates of need for each HAT drug for the coming years; negotiations with potential producers of new drugs such as eflornithine; securing sustainable manufacturing of existing drugs; clinical research into new combinations of these drugs for first and second-line treatments; centralizing drug purchases and their distribution through a unique non-profit entity; and addressing regulatory and legal issues concerning new drugs.

Eflornithine↗
PubMed2001

[Monitoring human African trypanosomiasis in Central Africa in 2001 and cartography: results and perspectives].

Cases of human African trypanosomiasis are distributed in changing geographical "outbreak areas" that can be visualized over time and space. Because of these variations in distribution, cartography and spatial analysis provide powerful tools for planning surveillance and control strategies. In 1996, the WHO in collaboration with the 15 most endemic countries in Central Africa undertook a program to develop a standardized inter-regional map of trypanosomiasis. This article provides a brief overview of the value of geomatic tools in public health followed by a description of the WHO program and its preliminary results. Also presented in this article is the Trypinfo site being development on the internet to increase the surveillance response-time and improve the feedback system.

Africa, Central↗
PubMed2001

[Control of human African trypanosomiasis: back to square one].

The natural history of sleeping sickness is cyclic. The first epidemic outbreak in the 19th century devastated the population and resolved spontaneously for lack of victims. Intensive development during the colonial period and the movement of population that it spawned led to another epidemic in the early 1920s that reached such severe proportions that drastic steps had to be taken. At that time, Jamot was given complete political, administrative, and financial freedom to combat the disease. This program led to the development of the mobile team concept and so-called vertically structured vector control strategy and was so successful that sleeping sickness ceased to be considered as a major public health problem at the beginning of the 1960s. In the ensuing years sleeping sickness was largely neglected. Monitoring the disease required specialized teams that were no longer considered as cost-effective. One by one the measures that had been implemented to control the disease disappeared, thus setting the scene for a new outbreak grew. In 1995, the incidence of sleeping sickness reached the same levels as in the 1920s. The current situation is a classic example of a neglected disease with a paucity of competent specialists, diagnostic tests, effective drugs, and operational facilities. It was not until 2001 that new hope appeared thanks to a combined public- and private-sector initiative allowing restructuring of treatment teams, renovation of facilities, free distribution of drugs, and research to develop new therapeutic agents. Also thanks to the PATTEC initiative, the governments of the African affected nations are showing new in interest in sleeping sickness. However the battle is far from won and much effort will be required. Time is running out and the stakes are high.

Africa↗