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Cerebrospinal fluid B lymphocyte identification for diagnosis and follow‐up in human African trypanosomiasis in the field
Authors:Bernard Bouteille  Ghislain Mpandzou  Raymond Cespuglio  Stéphane Ngampo  Rosanna W. Peeling  Philippe Vincendeau  Alain Buguet
Affiliation:1. Laboratory of Parasitology, EA 3174, Faculty of Medicine, University of Limoges, France;2. Neurology Ward, University Hospital of Brazzaville, Republic of Congo;3. Free Radicals Energy Substrates and Cerebral Physiopathology, EA 4170, Claude‐Bernard Lyon 1 University, France;4. National Control Programme for Human African Trypanosomiasis, Brazzaville, Republic of Congo;5. UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, Geneva, Switzerland;6. Laboratory of Parasitology, Bordeaux 2 University, France
Abstract:
Objectives In human African trypanosomiasis (HAT, sleeping sickness), staging of disease and treatment follow‐up relies on white cell count in the cerebrospinal fluid (CSF). As B lymphocytes (CD19 positive cells) are not found in the CSF of healthy individuals but occur in neurological disorders such as multiple sclerosis, B lymphocyte count may be useful for field diagnosis/staging and therapeutic follow‐up in HAT. Methods Seventy‐one HAT patients were diagnosed and 50 were followed‐up 6–24 months after treatment. White cell counts were used for conventional staging (stage 1, ≤5 cells/μl CSF, n = 42; stage 2, ≥20 cells/μl, n = 16) and intermediate stage (6–19 cells/μl, n = 13). Slides containing 1 μl of CSF mixed with Dynabeads® CD19 pan B were examined microscopically to detect B cell rosettes (bound to at least four beads). Results Stage 1 patients exhibited zero (n = 37) or one CSF rosette/μl (n = 5), contrary to most stage 2 patients (14/16: ≥2 rosettes/μl). Intermediate stage patients expressed 0 (n = 9), 1 (n = 3) or 2 (n = 1) rosettes/μl of CSF. During follow‐up, rosette counts correlated with white cell count staging but were much easier to read. Conclusion B cell rosettes being easily detected in the CSF in field conditions may be proposed to replace white cell count for defining HAT stages 1 and 2 and limit uncertainty in treatment decision in patients with intermediate stage.
Keywords:B lymphocytes  sleeping sickness  human African trypanosomiasis  cerebrospinal fluid  staging  follow‐up  lymphocytes B  maladie du sommeil  trypanosomiase humaine africaine  liquide cé  phalo‐rachidien  classification  suivi  linfocitos B  enfermedad del sueñ  o  tripanosomiasis humana Africana    quido cefalorraquí  deo  estadí  o  seguimiento
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