Journal
INFECTION GENETICS AND EVOLUTION
Volume 30, Issue -, Pages 128-133Publisher
ELSEVIER
DOI: 10.1016/j.meegid.2014.12.017
Keywords
Trypanosoma brucei gambiense; Sleeping sickness; Population genetics; Treatment failure; Democratic Republic of the Congo
Categories
Funding
- PEERS (Programme d'Excellence pour l'Enseignement et la Recherche au Sud) TAO (Trypanosomes et tsetses en Afrique de l'Ouest: apport de la genetique des populations) of the AIRD (Agence Inter-etablissements de Recherche pour le Developpement)
- IRD (Institut de Recherche pour le Developpement)
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Human African trypanosomiasis (HAT) in the Democratic Republic of the Congo (DRC) is caused by the protozoan Trypanosoma brucei gambiense. Until recently, all patients in the second or neurological stage of the disease were treated with melarsoprol. At the end of the past and the beginning of the present century, alarmingly high relapse rates in patients treated with melarsoprol were reported in isolated HAT foci. In the Mbuji-Mayi focus of DRC, a particular mutation that confers cross resistance for pentamidine and melarsoprol was recently found for all strains studied. Nevertheless, treatment successfully cured a significant proportion of patients. To check for the existence of other possible genetic factors of the parasites, we genotyped trypanosomes isolated from patients before and after treatment (relapsing patients) with eight microsatellite markers. We found no evidence of any genetic correlation between parasite genotype and treatment outcome and we concluded that relapse or cure probably depend more on patients' factors such as disease progression, nutritional or immunological status or co-infections with other pathogens. The existence of a melarsoprol and pentamidine resistance associated mutation at such high rates highlights an increasing problem, even for other drugs, especially those using the same transporters as melarsoprol and pentamidine. (C) 2014 Elsevier B.V. All rights reserved.
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