The evolving spectrum of human African trypanosomiasis

Area of Science:

• * Neglected tropical diseases
• * Parasitology
• * Public health

Background:

• * Human African trypanosomiasis (HAT), or sleeping sickness, remains a significant health threat in sub-Saharan Africa, risking up to 60 million lives.
• * Recent years have seen substantial progress in combating HAT through coordinated global health initiatives.

Purpose of the Study:

• * To provide an overview of recent advances in the diagnosis, treatment, and understanding of HAT.
• * To highlight progress towards the World Health Organization's elimination goals for HAT.

Main Methods:

• * Review of recent developments in HAT diagnosis, including rapid diagnostic tests.
• * Examination of novel therapeutic strategies for HAT, such as nifurtimox-eflornithine combination therapy (NECT), oral fexinidazole, and oxaborole compounds.
• * Analysis of advancements in understanding HAT neuropathogenesis, focusing on the blood-brain barrier and immune responses.

Main Results:

• * Significant decline in HAT cases attributed to enhanced case identification, treatment, and tsetse fly control.
• * Development and validation of improved diagnostic tools and novel drug regimens for both early and late-stage HAT.
• * Growing recognition of HAT's clinical heterogeneity and the complex interplay of host immunity and parasite invasion of the central nervous system.

Conclusions:

• * The World Health Organization's goal to eliminate HAT as a public health problem by 2020 has likely been met.
• * Achieving the ambitious goal of interrupting HAT transmission by 2030 requires sustained and intensified efforts.
• * Ongoing research into neuropathogenesis and the development of new treatments are vital for the ultimate eradication of HAT.