Camara M, Kaba D, KagbaDouno M, Sanon J R, Ouendeno F F, Solano P
Programme National de Lutte contre la Trypanosomose Humaine Africaine, Conakry, Guinée.
Med Trop (Mars). 2005;65(2):155-61.
The purpose of this study carried out in two adjacent areas of the coastal mangrove forest of Guinea (Dubreka and Boffa) was to screen the population for disease, provide information on human African trypanosomiasis (HAT, a.k.a. sleeping sickness) and compare the epidemiologic and clinical features with those of outbreak areas in the Ivory Coast where more data is currently available. Cases of HAT were confirmed by parasitological testing after active medical work-up (91 of 9637 patients examined). Five cases were confirmed in patients in treatment centers. Of the first 57 cases admitted for treatment in the Dubreka and Boffa centers, 29 were responded to a clinical and epidemiological questionnaire and underwent thorough clinical examination. Disease stage was determined by cytochemical testing of cerebrospinal fluid. As in outbreak areas of the Ivory Coast, sleeping sickness in Dubreka and Boffa is a rural disease mainly affecting the working population. Most cases identified in Guinea involved men and women working in farming, fishing, or salt extraction. However unlike Ivory Coast outbreak areas where ethnic diversity related to share cropping is considered to play a major role in maintaining endemicity, almost all patients in our study (98%) were from the native Soussou population that is self employed and lives in villages with no immigrant population. While clinical symptoms observed in these patients were not different from those reported elsewhere, there was a high frequency of cervical adenopathy (93%). This finding could provide a useful diagnostic sign for screening populations living in these mangrove forest regions and as a source for parasitological diagnosis as shown by the fact that 88.5% of patients were screened on the basis of lymph node fluid specimens. Most patients including among those identified by active work-up (5%) were in the meningo-encephalitis phase of the disease (98%). The findings of this study underline the need not only to continue surveillance in these regions but also to extend surveillance throughout the country as a means of avoiding recrudescence and extension of the disease.
本研究在几内亚沿海红树林的两个相邻地区（杜布雷卡和博法）开展，目的是对人群进行疾病筛查，提供有关人类非洲锥虫病（HAT，又称昏睡病）的信息，并将流行病学和临床特征与目前有更多数据的科特迪瓦爆发地区进行比较。在积极的医学检查后，通过寄生虫学检测确诊了HAT病例（9637名受检患者中的91例）。在治疗中心的患者中确诊了5例。在杜布雷卡和博法中心收治的首批57例接受治疗的病例中，29例对临床和流行病学问卷作出了回应，并接受了全面的临床检查。通过脑脊液的细胞化学检测确定疾病阶段。与科特迪瓦的爆发地区一样，杜布雷卡和博法的昏睡病是一种主要影响劳动人口的农村疾病。在几内亚发现的大多数病例涉及从事农业、渔业或盐开采的男性和女性。然而，与科特迪瓦爆发地区不同，那里与作物分成相关的种族多样性被认为在维持地方病方面起主要作用，我们研究中的几乎所有患者（98%）都来自当地的苏苏族，他们自营职业，生活在没有移民人口的村庄。虽然在这些患者中观察到的临床症状与其他地方报告的症状没有差异，但颈淋巴结病的发生率很高（93%）。这一发现可为筛查生活在这些红树林地区的人群提供有用的诊断体征，并作为寄生虫学诊断的来源，事实表明，88.5%的患者是根据淋巴结液标本进行筛查的。大多数患者，包括通过积极检查发现的患者（5%），处于疾病的脑膜脑炎阶段（98%）。本研究结果强调，不仅需要在这些地区继续进行监测，而且需要在全国范围内扩大监测，以避免疾病复发和蔓延。
