[Sleeping sickness in the region of the town of Kinshasa: a retrospective analysis during the surveillance period 1996-2000]. / La maladie de sommeil dans la région Ville de Kinshasa: une analyse rétrospective des données de surveillance sur la période 1996-2000.

In the Democratic Republic of Congo, the re-emergence of sleeping sickness is no longer limited to rural areas. Over the course of the past decade, more and more cases have been reported from urban centres such as Kinshasa, Mbuji-mayi, Matadi and Boma. This paper presents a retrospective analysis on the region of Kinshasa over the period 1996-2000, using epidemiological surveillance, individual case files and available entomological data. There are 22 health districts in total; they were classified as urban when the population exceeded 5000 per square kilometre. The Human African Trypanosomiasis (HAT) control programme reported 2451 parasitologically confirmed new cases between 1996 and 2000, in the entire region of Kinshasa. Affected people (66%) were aged 15-49 years. Cases occurred in every health district, and 956 (39%) occurred in urban residents. Glossina captures in 1999 established the presence of Trypanosoma spp. Local HAT transmission is plausible but not proven. The high number of urban cases necessitates development of control strategies adapted to cities.

[Control of Trypanosoma gambiense trypanosomiasis. Evaluation of a strategy based on the treatment of serologically suspected cases with a single dose of diminazene]. / Contrôle de la trypanosomiase à T. b. gambiense. Evaluation d'une strategie basée sur le traitement des suspects sérologiques par une dose unique de diminazène.

A novel method for the control of T.b. gambiense trypanosomiasis was evaluated in an endemic focus of Zaïre where a high incidence had persisted despite massive participation in active case-finding surveys based on lymph node puncture. All inhabitants of 3 villages were examined with a card agglutination serological test (CATT), and parasitological examinations were performed on those who were CATT+. Individuals in whom we detected trypanosomes were treated as usual. A lumbar puncture was carried out on CATT+/parasitology- subjects; those whose cerebrospinal fluid showed more than 3 white blood cell (WBC) per mm3 were treated with a full course of melarsoprol while those with a CSF WBC count between 1 and 3 per mm3 were given a single injection of diminazene (7 mg/kg). Three such surveys were performed, with a 6-month interval, during which 282 "serological suspects" received diminazene, 39 "clinical cases" were given melarsoprol and 82 "parasitological cases" were treated according to standard protocols. The annual incidence of trypanosomiasis decreased rapidly from 10.4-41.1/1.000 inhabitants (mean: 17.6/1.000) during the 10 years before the intervention to 1.1-2.6/1.000 (mean: 1.7/1.000) in the 3 years following the intervention. No major adverse effect was seen with diminazene. Among the 282 serological suspects, an elevated CSF WBC count was later documented in 12 individuals, who were all cured with melarsoprol. The incidence increased 5 years after the intervention (7.1/1.000 in 1992), which may have been avoided had we carried out similar interventions in adjacent foci.

[Animal reservoir hosts of Trypanosoma brucei gambiense in Zaire: trypanosome infections in two foci in Bas-Zaire]. / Le réservoir animal de Trypanosoma brucei gambiense au Zaire: infections trypanosomiennes dans deux foyers du Bas-Zaire.

The prevalence of Trypanosoma spp. infections in domestic animals was estimated in a forest (Boma) and a savanna (Kimpese) sleeping focus in Bas-Zaire. The miniature anion-exchange centrifugation technique was used to determine the infection rates with T. congolense, T. vivax and T. brucei spp. in 505 animals. T. congolense predominated in both foci with the highest prevalence in pigs (76.2%), followed by sheep (31.3%), dogs (30.6%) and goats (7.4%). T. vivax was seen only on two occasions. In the forest zone, T. brucei spp. infections were frequent (pigs 16.5%, sheep 6.2%, dogs 3.4%, goats 1.1%) in contrast to the savanna area where only one T. brucei spp. infection was diagnosed. Twenty five primary isolations of T. brucei were done using different isolation and stabilization approaches. Isolates and stocks await behavioural, biochemical and molecular biological identification to discriminate T. b. brucei and T. b. gambiense of domestic animal origin.