1. Resolving the apparent transmission paradox of African sleeping sickness
- Author
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Caroline Clucas, Dieudonné Mumba Ngoyi, Annette MacLeod, William Weir, Katie Atkins, Paul Garside, Brice Rotureau, Paul Capewell, Vincent Jamonneau, Nono Raymond Kuispond Swar, Mamadou Camara, Bruno Bucheton, Alison P. Galvani, College of Medical, Veterinary and Life Sciences [Glasgow], Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, London School of Hygiene and Tropical Medicine (LSHTM), University of Edinburgh, Interactions hôtes-vecteurs-parasites-environnement dans les maladies tropicales négligées dues aux trypanosomatides (UMR INTERTRYP), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université de Bordeaux (UB), Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Ministère Guinéen de la Santé, University of Kinshasa (UNIKIN), Biologie cellulaire des Trypanosomes - Trypanosome Cell Biology, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Yale School of Public Health (YSPH), The authors received no specific funding for this work., Université de Bordeaux (UB)-Institut de Recherche pour le Développement (IRD)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], College of Medical, Veterinary and Life Sciences, London School of Hygiene and Tropical Medicine ( LSHTM ), Usher Institute of Population Health Sciences and Informatics [Edinburgh, U.K.], Interactions hôtes-vecteurs-parasites-environnement dans les maladies tropicales négligées dues aux trypanosomatides ( UMR INTERTRYP ), Centre de Coopération Internationale en Recherche Agronomique pour le Développement ( CIRAD ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut de Recherche pour le Développement ( IRD ) -Université de Bordeaux ( UB ), Programme National de Lutte contre la Trypanosomiase Humaine Africaine ( PNLTHA ), University of Kinshasa ( UNIKIN ), Biologie cellulaire des Trypanosomes, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Yale School of Public Health ( YSPH )
- Subjects
0301 basic medicine ,Physiology ,[SDV]Life Sciences [q-bio] ,Disease ,Disease Vectors ,0302 clinical medicine ,[ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology ,Zoonoses ,Medicine and Health Sciences ,African trypanosomiasis ,Biology (General) ,Asymptomatic Infections ,Skin ,Protozoans ,biology ,Transmission (medicine) ,Tsetse fly ,General Neuroscience ,Neglected Diseases ,Eukaryota ,Parasitic diseases ,3. Good health ,Body Fluids ,Insects ,Infectious Diseases ,Skin infections ,Blood ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Carrier State ,Fatal disease ,medicine.symptom ,Anatomy ,Integumentary System ,General Agricultural and Biological Sciences ,Neglected Tropical Diseases ,medicine.medical_specialty ,[ SDV.MP.PAR ] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Trypanosoma ,Glossina ,Arthropoda ,QH301-705.5 ,Essay ,Dermatology ,Asymptomatic ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Trypanosomiasis ,Infectious disease control ,parasitic diseases ,medicine ,Animals ,Humans ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Intensive care medicine ,Africa South of the Sahara ,Protozoan Infections ,General Immunology and Microbiology ,[ SDV ] Life Sciences [q-bio] ,Organisms ,Biology and Life Sciences ,biology.organism_classification ,medicine.disease ,Tropical Diseases ,Skin anatomy ,Invertebrates ,Parasitic Protozoans ,Insect Vectors ,Species Interactions ,030104 developmental biology ,Trypanosomiasis, African ,030217 neurology & neurosurgery - Abstract
Human African trypanosomiasis (HAT), or African sleeping sickness, is a fatal disease found throughout sub-Saharan Africa. The disease is close to elimination in many areas, although it was similarly close to elimination once before and subsequently reemerged, despite seemingly low rates of transmission. Determining how these foci persisted and overcame an apparent transmission paradox is key to finally eliminating HAT. By assessing clinical, laboratory, and mathematical data, we propose that asymptomatic infections contribute to transmission through the presence of an overlooked reservoir of skin-dwelling parasites. Our assessment suggests that a combination of asymptomatic and parasitaemic cases is sufficient to maintain transmission at foci without animal reservoirs, and we argue that the current policy not to treat asymptomatic HAT should be reconsidered., African sleeping sickness is an important disease of sub-Saharan Africa that is approaching elimination, but this Essay maintains that an overlooked anatomical reservoir — human skin — may impact control efforts.
- Published
- 2019