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Article

Clinical Study on the Melarsoprol-Related Encephalopathic Syndrome: Risk Factors and HLA Association

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Institute of Hygiene and Tropical Medicine, NOVA University, 1349-008 Lisbon, Portugal
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Global Health and Tropical Medicine R&D Center, NOVA University, 1349-008 Lisbon, Portugal
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Instituto de Combate e Controlo das Tripanossomíases, Luanda, Angola
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Hospital Geral de Luanda, Luanda, Angola
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Instituto Superior Politécnico Kalandula de Angola, Luanda, Angola
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Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo
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Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
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University of Basel, 4001 Basel, Switzerland
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Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2020, 5(1), 5; https://doi.org/10.3390/tropicalmed5010005
Received: 26 November 2019 / Revised: 23 December 2019 / Accepted: 25 December 2019 / Published: 1 January 2020
Melarsoprol administration for the treatment of late-stage human African trypanosomiasis (HAT) is associated with the development of an unpredictable and badly characterized encephalopathic syndrome (ES), probably of immune origin, that kills approximately 50% of those affected. We investigated the characteristics and clinical risk factors for ES, as well as the association between the Human Leukocyte Antigen (HLA) complex and the risk for ES in a case-control study. Late-stage Gambiense HAT patients treated with melarsoprol and developing ES (69 cases) were compared to patients not suffering from the syndrome (207 controls). Patients were enrolled in six HAT treatment centres in Angola and in the Democratic Republic of Congo. Standardized clinical data was obtained from all participants before melarsoprol was initiated. Class I (HLA-A, HLA-B, HLA-Cw) and II (HLA-DR) alleles were determined by PCR-SSOP methods in 62 ES cases and 189 controls. The principal ES pattern consisted in convulsions followed by a coma, whereas ES with exclusively mental changes was not observed. Oedema, bone pain, apathy, and a depressed humour were associated with a higher risk of ES, while abdominal pain, coma, respiratory distress, and a Babinski sign were associated with higher ES-associated mortality. Haplotype C*14/B*15 was associated with an elevated risk for ES (OR: 6.64; p-value: 0.008). Haplotypes A*23/C*14, A*23/B*15 and DR*07/B*58 also showed a weaker association with ES. This result supports the hypothesis that a genetically determined peculiar type of immune response confers susceptibility for ES. View Full-Text
Keywords: human African trypanosomiasis; treatment; melarsoprol; adverse event; encephalopathy; human leukocyte antigen; association study human African trypanosomiasis; treatment; melarsoprol; adverse event; encephalopathy; human leukocyte antigen; association study
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MDPI and ACS Style

Seixas, J.; Atouguia, J.; Josenando, T.; Vatunga, G.; Miaka Mia Bilenge, C.; Lutumba, P.; Burri, C. Clinical Study on the Melarsoprol-Related Encephalopathic Syndrome: Risk Factors and HLA Association. Trop. Med. Infect. Dis. 2020, 5, 5. https://doi.org/10.3390/tropicalmed5010005

AMA Style

Seixas J, Atouguia J, Josenando T, Vatunga G, Miaka Mia Bilenge C, Lutumba P, Burri C. Clinical Study on the Melarsoprol-Related Encephalopathic Syndrome: Risk Factors and HLA Association. Tropical Medicine and Infectious Disease. 2020; 5(1):5. https://doi.org/10.3390/tropicalmed5010005

Chicago/Turabian Style

Seixas, Jorge, Jorge Atouguia, Teófilo Josenando, Gedeão Vatunga, Constantin Miaka Mia Bilenge, Pascal Lutumba, and Christian Burri. 2020. "Clinical Study on the Melarsoprol-Related Encephalopathic Syndrome: Risk Factors and HLA Association" Tropical Medicine and Infectious Disease 5, no. 1: 5. https://doi.org/10.3390/tropicalmed5010005

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