Resolving the apparent transmission paradox of African sleeping sickness
Resolving the apparent transmission paradox of African sleeping sickness
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DOI：
10.1371/journal.pbio.3000105
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发表时间：
2019-01-01
期刊：
影响因子：
9.8
通讯作者：
MacLeod, Annette
中科院分区：
文献类型：
--
作者：
Capewell, Paul;Atkins, Katie;MacLeod, Annette
人类非洲锥虫病（HAT），或非洲昏睡病，是一种在撒哈拉以南非洲发现的致命疾病。这种疾病在许多地区已接近消灭，虽然它以前也曾接近消灭，但后来又重新出现，尽管传播率似乎很低。确定这些病灶如何持续存在并克服明显的传播悖论是最终消除HAT的关键。通过评估临床，实验室和数学数据，我们提出，无症状感染有助于通过存在被忽视的皮肤寄生虫的传播。我们的评估表明，无症状和寄生虫血症病例的组合足以维持在没有动物宿主的疫源地的传播，我们认为，应重新考虑目前不治疗无症状HAT的政策。
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.