Skip to main content

Latent Trypanosoma brucei gambiense foci in Uganda: a silent epidemic in children and adults?

  • S. L. WASTLING (a1), K. PICOZZI (a1), C. WAMBOGA (a2), B. VON WISSMANN (a1), C. AMONGI-ACCUP (a1) (a3), N. A. WARDROP (a1) (a4), J. R. STOTHARD (a5), A. KAKEMBO (a2) and S. C. WELBURN (a1)...

Trypanosoma brucei gambiense sleeping sickness follows a long asymptomatic phase and persists in ancient foci from which epidemic clinical disease arises. A putative focus of T. b. gambiense infections has been identified, initially in mothers and young children, on the Lake Albert shoreline of Western Uganda leading to mass screening of 6207 individuals in September 2008. T. b. gambiense infections were identified by Card Agglutination Test for Trypanosomiasis (CATT) and sub-species-specific PCR although parasitological methods failed to confirm any patent trypanosome infections. In April 2009, CATT positives were re-visited; diagnosis of individuals by CATT and PCR was unstable over the two time points and parasites remained undetected, even using mini Anion Exchange Centrifugation Technique (mAECT). These observations suggest the possibility of a silent focus of disease, where all infected individuals are in a latent stage, and highlight our limited understanding of the local natural history and disease progression of T. b. gambiense in children and adults.

Corresponding author
*Corresponding author: Professor Sue Welburn, Centre for Infectious Diseases, Division of Pathway Medicine, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Summerhall, Edinburgh, EH9 1QH. Tel: +44 131 650 6287; E-mail:
Hide All
Altman D. G. (1991). Practical Statistics for Medical Research. Chapman and Hall, London.
Brun R., Blum J., Chappuis F. and Burri C. (2010). Human African trypanosomiasis. Lancet 375, 148159.
Checchi F., Filipe J. A., Barrett M. P. and Chandramohan D. (2008). The natural progression of Gambiense sleeping sickness: what is the evidence? PLoS Neglected Tropical Diseases 2: e303.
Cox A. P., Tosas O., Tilley A., Picozzi K., Coleman P., Hide G. and Welburn S. C. (2010). Constraints to estimating the prevalence of trypanosome infections in East African zebu cattle. Parasites and Vectors 3, 82.
Deborggraeve S., Boelaert M., Rijal S., Doncker S., Dujardin J. C., Herdewijn P. and Buscher P. (2008). Diagnostic accuracy of a new Leishmania PCR for clinical visceral leishmaniasis in Nepal and its role in diagnosis of disease. Tropical Medicine and International Health 13, 13781383.
Deborggraeve S. and Buscher P. (2010). Molecular diagnostics for sleeping sickness: what is the benefit for the patient? Lancet Infectious Diseases 10, 433439.
Dukes P., Gibson W. C., Gashumba J. K., Hudson K. M., Bromidge T. J., Kaukus A., Asonganyi T. and Magnus E. (1992). Absence of the LiTat 1.3 (CATT antigen) gene in Trypanosoma brucei gambiense stocks from Cameroon. Acta Tropica 51, 123134.
Enyaru J. C. K., Matovu E., Akol M., Sebikali C., Kyambadde J., Schmidt C., Brun R., Kaminsky R., Ogwal L. M. and Kansiime F. (1998). Parasitological detection of Trypanosoma brucei gambiense in serologically negative sleeping-sickness suspects from north-western Uganda. Annals of Tropical Medicine and Parasitology 92, 845850.
Garcia A., Jamonneau V., Magnus E., Laveissiere C., Lejon V., N'Guessan P., N'Dri L., Meirvenne N. V. and Buscher P. (2000). Follow-up of Card Agglutination Trypanosomiasis Test (CATT) positive but apparently aparasitaemic individuals in Cote d'Ivoire: evidence for a complex and heterogeneous population. Tropical Medicine and International Health 5, 786793.
Kanmogne G. D., Asonganyi T. and Gibson W. C. (1996). Detection of Trypanosoma brucei gambiense, in serologically positive but aparasitaemic sleeping-sickness suspects in Cameroon, by PCR. Annals of Tropical Medicine and Parasitology 90, 475483.
Koffi M., Solano P., Denizot M., Courtin D., Garcia A., Lejon V., Buscher P., Cuny G. and Jamonneau V. (2006). Aparasitaemic serological suspects in Trypanosoma brucei gambiense human African trypanosomiasis: a potential human reservoir of parasites? Acta Tropica 98, 183188.
Kuboki N., Inoue N., Sakurai T., Di Cello F., Grab D. J., Suzuki H., Sugimoto C. and Igarashi I. (2003). Loop-mediated isothermal amplification for detection of African trypanosomes. Journal of Clinical Microbiology 41, 55175524.
Kyambadde J. W., Enyaru J. C., Matovu E., Odiit M. and Carasco J. F. (2000). Detection of trypanosomes in suspected sleeping sickness patients in Uganda using the polymerase chain reaction. Bulletin of the World Health Organisation 78, 119124.
Lejon V., Ngoyi D. M., Boelaert M. and Buscher P. (2010). A CATT negative result after treatment for human African trypanosomiasis is no indication for cure. PLoS Neglected Tropical Diseases 4, e590.
Lindner A. K. and Priotto G. (2010). The unknown risk of vertical transmission in sleeping sickness - a literature review. PLoS Neglected Tropical Diseases 4, e 783.
Lumsden W. H., Kimber C. D., Evans D. A. and Doig S. J. (1979). Trypanosoma brucei: Miniature anion-exchange centrifugation technique for detection of low parasitaemias: Adaptation for field use. Transactions of the Royal Society of Tropical Medicine and Hygiene 73, 312317.
Magez S. and Radwanska M. (2009). African trypanosomiasis and antibodies: implications for vaccination, therapy and diagnosis. Future Microbiology 4, 10751087.
Magnus E., Van Meirvenne N. and Vervoort T. (1978). Card-Agglutination Test with stained trypanosomes (CATT) for serological diagnosis of T. b. gambiense trypanosomiasis. Annales De La Societe Belge De Medecine Tropicale 58, 169176.
Masiga D. K., Smyth A. J., Hayes P., Bromidge T. J. and Gibson W. C. (1992). Sensitive detection of trypanosomes in tsetse flies by DNA amplification. International Journal for Parasitology 22, 909918.
Matovu E., Kuepfer I., Boobo A., Kibona S. and Burri C. (2010 a). Comparative detection of trypanosomal DNA by loop-mediated isothermal amplification and PCR from flinders technology associates cards spotted with patient blood. Journal of Clinical Microbiology 48, 20872090.
Matovu E., Mugasa C. M., Ekangu R. A., Deborggraeve S., Lubega G. W., Laurent T., Schoone G. J., Schallig H. D. and Buscher P. (2010 b). Phase II evaluation of sensitivity and specificity of PCR and NASBA followed by oligochromatography for diagnosis of human African trypanosomiasis in clinical samples from D. R. Congo and Uganda. PLoS Neglected Tropical Diseases 4, e737.
Miezan T. W., Meda A. H., Doua F. and Cattand P. (1994). Evaluation of parasitological techniques in the diagnosis of Trypanosoma brucei gambiense human trypanosomiasis in the Côte d'Ivoire. Bulletin de la Societe de Pathologie Exotique 87, 101104.
Moser D. R., Cook G. A., Ochs D. E., Bailey C. P., McKane M. R. and Donelson J. E. (1989). Detection of Trypanosoma congolense and Trypanosoma brucei subspecies by DNA amplification using the polymerase chain reaction. Parasitology 99, 5766.
Mugasa C. M., Schoone G. J., Ekangu R. A., Lubega G. W., Kager P. A. and Schallig H. D. F. H. (2008). Detection of Trypanosoma brucei parasites in blood samples using real-time nucleic acid sequence-based amplification. Diagnostic Microbiology and Infectious Disease 61, 440445.
Mugasa C. M., Laurent T., Schoone G. J., Kager P. A., Lubega G. W. and Schallig H. D. F. H. (2009). Nucleic acid sequence-based amplification with oligochromatography for detection of Trypanosoma brucei in clinical samples. Journal of Clinical Microbiology 47, 630635.
Njiru Z. K., Mikosza A. S. J., Armstrong T., Enyaru J. C., Ndung'u J. M. and Thompson A. R. C. (2008 b). Loop-Mediated Isothermal Amplification (LAMP) method for rapid detection of Trypanosoma brucei rhodesiense. PLoS Neglected Tropical Diseases 2, e147.
Njiru Z. K., Mikosza A. S., Matovu E., Enyaru J. C., Ouma J. O., Kibona S. N., Thompson R. C. A. and Ndung'u J. M. (2008 a). African trypanosomiasis: sensitive and rapid detection of the sub-genus Trypanozoon by loop-mediated isothermal amplification (LAMP) of parasite DNA. International Journal for Parasitology 38, 589599.
Paquet C., Ancelle T., Gastelluetchegorry M., Castilla J. and Harndt I. (1992). Persistence of antibodies to Trypanosoma brucei gambiense after treatment of human trypanosomiasis in Uganda. Lancet 340, 250250.
Pansaerts R., Van Meirvenne N., Magnus E. and Verhelst L. (1998). Increased sensitivity of the card agglutination test CATT/Trypanosoma brucei gambiense by inhibition of complement. Acta Tropica 70, 349354.
Penchenier L., Simo G., Grebaut P., Nkinin S., Laveissiere C. and Herder S. (2000). Diagnosis of human trypanosomiasis, due to Trypanosoma brucei gambiense in central Africa, by the polymerase chain reaction. Transactions of the Royal Society of Tropical Medicine and Hygiene 94, 392394.
Picozzi K., Fevre E. M., Odiit M., Carrington M., Eisler M. C., Maudlin I. and Welburn S. C. (2005). Sleeping sickness in Uganda: a thin line between two fatal diseases. British Medical Journal 331, 12381241.
Radwanska M., Claes F., Magez S., Magnus E., Perez-Morga D., Pays E. and Buscher P. (2002). Novel primer sequences for polymerase chain reaction-based detection of Trypanosoma brucei gambiense. American Journal of Tropical Medicine and Hygiene 67, 289295.
Rocha G., Martins A., Gama G., Brandae F. and Atougia J. (2004). Possible cases of sexual and congenital transmission of sleeping sickness. Lancet 363, 247.
Simo G., Asonganyi T., Nkinin S. W., Njiokou F. and Herder S. (2006). High prevalence of Trypanosoma brucei gambiense group 1 in pigs from the Fontem sleeping sickness focus in Cameroon. Veterinary Parasitology 139, 5766.
Welburn S., Fevre E. M., Coleman P. G., Odiit M. and Maudlin I. (2001). Sleeping sickness: a tale of two diseases. Trends in Parasitology 17, 1924.
Welburn S. C., Coleman P. G., Maudlin I., Fevre E. M., Odiit M. and Eisler M. (2006). Crisis, what crisis? Control of Rhodesian sleeping sickness. Trends in Parasitology 22, 123128.
Welburn S. C., Maudlin I. and Simarro P. P. (2009). Sleeping Sickness. In Encyclopedia of Microbiology, Third Edition (ed. Schaechter M.) pp. 706720. Elsevier, Oxford.
Woo P. T. (1970). The haematocrit centrifuge technique for the diagnosis of African trypanosomiasis. Acta Tropica 27, 384386.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

  • ISSN: 0031-1820
  • EISSN: 1469-8161
  • URL: /core/journals/parasitology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 18 *
Loading metrics...

Abstract views

Total abstract views: 145 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd February 2018. This data will be updated every 24 hours.