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A multi-centre evaluation of the card indirect agglutination test for trypanosomiasis (TrypTect CIATT)
T Asonganyi1, F Doua, S N Kibona
1Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon.
Insights
The TrypTect card indirect agglutination test (CIATT) offers high sensitivity and specificity for diagnosing sleeping sickness caused by Trypanosoma brucei gambiense and T. b. rhodesiense. This antigen-detection method identifies infections missed by traditional diagnostics and can monitor treatment effectiveness.
Area of Science:
- Medical Parasitology
- Tropical Medicine
- Infectious Diseases
Background:
- Human African Trypanosomiasis (HAT), or sleeping sickness, is a severe parasitic disease caused by Trypanosoma brucei.
- Current diagnostic methods, primarily parasitological, often fail to detect early or non-patent infections, leading to underdiagnosis.
- Accurate and sensitive diagnostic tools are crucial for effective HAT control and management.
Purpose of the Study:
- To evaluate the diagnostic performance of the TrypTect card indirect agglutination test (CIATT) for Trypanosoma brucei gambiense and T. b. rhodesiense sleeping sickness.
- To compare the prevalence detected by TrypTect CIATT with parasitological diagnosis in endemic populations.
- To assess the utility of TrypTect CIATT in diagnosing non-patent infections and evaluating treatment efficacy.
Main Methods:
- Evaluation of TrypTect CIATT, an antigen-detection test, against parasitological diagnosis for HAT.
- Assessment of infection prevalence in endemic foci using TrypTect CIATT.
- Follow-up studies on suspected cases, including PCR and ELISA for trypanosome DNA and antibodies.
- Monitoring of patients post-melarsoprol treatment using TrypTect CIATT to assess cure.
Main Results:
- TrypTect CIATT demonstrated high relative sensitivity (99.3%) and specificity (99.4%).
- Prevalence rates detected by TrypTect CIATT were significantly higher (27.9% for T. b. gambiense, 21.8% for T. b. rhodesiense) than parasitological methods (1.6%, 1.1%).
- The test identified non-patent infections and showed positive antigen detection in 69.0% of treated patients by 9 months post-therapy.
Conclusions:
- TrypTect CIATT is a highly sensitive and specific diagnostic tool for sleeping sickness, outperforming traditional parasitological methods.
- The test effectively detects non-patent infections and can be used for monitoring therapeutic response to treatment.
- Implementation of TrypTect CIATT can improve HAT diagnosis, leading to better disease control in endemic regions.
Abstract:
A version of the card indirect agglutination test for trypanosomiasis, the TrypTect CIATT, was evaluated for the diagnosis of Trypanosoma brucei gambiense and T. b. rhodesiense sleeping sickness. The results of this antigen-detection test indicated high relative sensitivity (99.3%) and specificity (99.4%), and also much higher prevalences of infection in the general population of endemic foci (27.9% for T. b. gambiense and 21.8% for T. b. rhodesiense) than detected by parasitological diagnosis (1.6% and 1.1%, respectively). TrypTect CIATT detected (and could therefore be used for the diagnosis of) non-patent infections. Among the suspected cases (i.e. those initially found to be parasite-negative but to be antigen-positive), trypanosomes were detected in 29 (4.2%) of those checked at a 3-month follow-up, and 17 more such suspects when they were followed up at 6-18 months. Moreover, a high proportion of blood samples from a random sample of the rest of the suspects tested positive for trypanosome-specific DNA by PCR (79.9% for T. b. gambiense and 13.9% for T. b. rhodesiense). ELISA also demonstrated the presence of anti-trypanosome antibodies in many of the suspects tested (63%, 38%, 24% and 66.9% of those in Cameroon, Côte d'Ivoire, Tanzania, and Malawi, respectively). A follow-up of 164 patients treated with melarsoprol revealed that, by 9 months post-treatment, 113 (69.0%) had no detectable trypanosome antigens in their peripheral blood. The test could therefore be used for evaluating chemotherapeutic cure, as well as for diagnosis.