Sawadogo Patindoilba Marcel, Kabore Jean Axel T, Guiguemde Kiswendsida Thierry, Soulama Issiaka, Zida Adama
Région du Centre, Université Joseph Ki-Zerbo, Rue Thomas Sankara, O3 BP 7021, Ouagadougou, Burkina Faso.
Région du Centre, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
Acta Parasitol. 2025 Sep 9;70(5):193. doi: 10.1007/s11686-025-01128-6.
The objective of the World Health Organization is to achieve the interruption of human African trypanosomiasis (HAT) transmission by 2030.
This review aims to update knowledge on HAT, through a synthesis on the epidemiology, diagnostic tools and drugs of HAT.
From 1960 to 2024 approximately 132,063 cases of HAT have been reported across Africa. The majority of HAT patients live in the Democratic Republic of Congo (DRC). The Card Agglutination Test for Trypanosomiasis (CATT) remained for a long time the reference serology test for field screening. The immune trypanolysis test (ITL) test is an accurate serodiagnostic tool increasingly used for medical surveillance of sleeping sickness, but it is reserved for reference laboratories. Prototypes of TDRs such as SD BIOLINE HAT and, HAT Sero-K-SeT have been developed to respond to constraints posed with CATT and ITL, but lack specificity. Parasitological diagnosis techniques such as the mini-Anion Exchange by Centrifugation technique (mAECT) are used for mandatory confirmation of the disease before the initiation of treatment, but their sensitivity is low. To date, the active molecules against HAT are: pentamidine, suramin, melarsoprol, eflornithine and nifurtimox. The use of these molecules does not guarantee healing and generates many side effects. A new molecule has appeared in the therapeutic arsenal. This is fexinidazole, which was approved by the WHO in 2019 for the treatment of HAT due to T.b. gambiense. The WHO recommends the oral administration of this molecule in the first stage of the disease and in the second stage for non-severe cases. Since 2024, this molecule has also been approved by the WHO for the treatment of HAT due to T. b. rhodesiense.
All these difficulties raised raise questions about the need to develop new diagnostic tools that are more specific, more sensitive and better suited to field screening. They also call out the urgency of finding new drugs that are less toxic, easy to administer and more effective.
世界卫生组织的目标是到2030年实现人类非洲锥虫病（HAT）传播的中断。
本综述旨在通过综合人类非洲锥虫病的流行病学、诊断工具和药物来更新相关知识。
1960年至2024年期间，非洲各地报告了约132,063例人类非洲锥虫病病例。大多数人类非洲锥虫病患者生活在刚果民主共和国（DRC）。锥虫病卡片凝集试验（CATT）长期以来一直是现场筛查的参考血清学检测方法。免疫锥虫溶解试验（ITL）是一种准确的血清学诊断工具，越来越多地用于昏睡病的医学监测，但仅限于参考实验室使用。诸如SD BIOLINE HAT和HAT Sero-K-SeT等TDR原型已被开发出来，以应对CATT和ITL带来的限制，但缺乏特异性。诸如微型阴离子交换离心技术（mAECT）等寄生虫学诊断技术用于在开始治疗前对疾病进行强制确认，但其敏感性较低。迄今为止，针对人类非洲锥虫病的活性分子有：喷他脒、苏拉明、美拉胂醇、依氟鸟氨酸和硝呋替莫。使用这些分子并不能保证治愈，且会产生许多副作用。治疗药物库中出现了一种新分子。这就是非昔硝唑，它于2019年被世界卫生组织批准用于治疗冈比亚布氏锥虫引起的人类非洲锥虫病。世界卫生组织建议在疾病的第一阶段口服该分子，对于非严重病例在第二阶段也可使用。自2024年以来，该分子也已被世界卫生组织批准用于治疗罗德西亚布氏锥虫引起的人类非洲锥虫病。
所有这些提出的困难引发了关于开发更特异、更敏感且更适合现场筛查的新诊断工具的必要性的问题。它们还凸显了寻找毒性更低、易于给药且更有效的新药物的紧迫性。
