[Diagnosis of human African trypanosomiasis in 2001]

Human African trypanosomiasis is characterized by a non-specific clinical presentation with no consistent, pathognomonic manifestations. However definite diagnosis is necessary to avoid unnecessary therapeutic risks with toxic drugs. Further complicating this situation is the frequent need to achieve field diagnosis in remote locations with limited facilities. Serological tests such as CATT (card agglutination trypanosomiasis test) are useful for initial population screening to identify suspects but are not sufficiently reliable for definitive diagnosis since the variations in sensitivity and specificity have been observed between countries and disease pockets. Parasitological examination is still the only method of definitive diagnosis. Thresholds of trypanosome detection differ from one technique to another, i.e., 10,000 trypanosomes per millilitre (T/ml) for fresh blood smears, 5,000 T/ml for thick drop specimens stained with Giemsa, 500 T/ml for centrifugation in capillary tubes, less than 500 T/ml for the QBC test, and 100 T/ml for the ion exchange minicolumn system. The possibility that the QBC test and minicolumn anion exchange system may go out of production could pose a serious problem for field diagnosis. Decisional algorithms are being developed to optimize use of remaining techniques.