Tshimungu K, Okenge L N, Mukeba J N, Kande V B K, De Mol P
Laboratoire de microbiologie médicale, Université de Liège, CHU Sart-Tilman (B23), 4000 Liège, Belgique.
Sante. 2009 Apr-Jun;19(2):73-80. doi: 10.1684/san.2009.0154.
Despite efforts to control human African trypanosomiasis (HAT) in the field, this infection remains prevalent in endemic or epidemic form in most of its traditional habitats. In the Democratic Republic of Congo (DRC), HAT has extended beyond rural areas to reach large cities such as Kinshasa. The objective of this study was to analyse the characteristics of trypanosomiasis patients (cases) in Kinshasa and to compare them to those of healthy controls. METHODS AND POPULATION OF STUDY: This case-control study allowed us to compare case patients and controls for some epidemiologic, clinical and sociodemographic characteristics. In all, 1764 people (588 case-patients and 1176 controls) were interviewed according to a structured questionnaire. Case-patients were infected with trypanosomiasis and entered the National Human African Trypanosomiasis Program (PNLTHA-DRC) from January 2004 through December 2005. Controls were matched for sex, age and residence to the corresponding case-patient, but had negative results from the Card Agglutination Trypanosomiasis Test (CATT-Test) whole-blood serologic analysis. Each patient was matched with two controls.
Cases were identified in all 24 districts of Kinshasa, but were concentrated in the outskirts (outlying areas and southern expansion) and in rural areas. Overall, 25% (144/588) of case-patients lived in urbanized areas. People in the labour market (aged 20-49 years) were affected more often than others. HAT affected men and women equally. It also affected at higher rates people who moved around a lot and those who worked in rural or domestic activities, especially those in close contact with watercourses. Sleep disorders were the primary clinical sign (85%). Cervical adenopathies were observed frequently (66%). Fever was reported in 68% of case-patients. Most (73.5%) were diagnosed at a very advanced stage of infection (meningoencephalitic or neurological stage).
These results highlight several modifiable or avoidable characteristics associated with HAT. Interventions on them might make it possible to reduce the morbidity and mortality rates associated with HAT and prevent wider extension of this disease.
尽管在实地努力控制人类非洲锥虫病（HAT），但在其大多数传统栖息地，这种感染仍以地方病或流行病形式普遍存在。在刚果民主共和国（DRC），HAT已从农村地区蔓延至金沙萨等大城市。本研究的目的是分析金沙萨锥虫病患者（病例）的特征，并将其与健康对照者的特征进行比较。
这项病例对照研究使我们能够比较病例患者和对照者的一些流行病学、临床和社会人口学特征。总共1764人（588例病例患者和1176名对照者）根据结构化问卷接受了访谈。病例患者感染了锥虫病，并于2004年1月至2005年12月进入国家人类非洲锥虫病项目（PNLTHA-DRC）。对照者在性别、年龄和居住地方面与相应的病例患者匹配，但卡片凝集锥虫病试验（CATT试验）全血血清学分析结果为阴性。每名患者与两名对照者匹配。
金沙萨的所有24个区均发现了病例，但病例集中在郊区（边远地区和南部扩展区）以及农村地区。总体而言，25%（144/588）的病例患者居住在城市化地区。劳动力市场上的人（年龄在20至49岁之间）比其他人更容易受到影响。HAT对男性和女性的影响相同。它对经常流动的人和从事农村或家务活动的人影响也更大，尤其是那些与水道密切接触的人。睡眠障碍是主要临床症状（85%）。颈部淋巴结病经常出现（66%）。68%的病例患者报告有发热症状。大多数（73.5%）在感染的非常晚期（脑膜脑炎或神经期）被诊断出来。
这些结果突出了与HAT相关的几个可改变或可避免的特征。对这些特征进行干预可能会降低与HAT相关的发病率和死亡率，并防止这种疾病的进一步广泛传播。
