PATHOLOGY OF HUMAN AFRICAN TRYPANOSOMIASIS WITH REFERENCE TO EXPERIMENTAL AFRICAN TRYPANOSOMIASIS AND INFECTIONS OF THE CENTRAL NERVOUS SYSTEM

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Abstract
The pathology of African trypanosomiasis in man is reviewed in a sequential approach. The overview is complicated by the very large number of publications, most of them dealing with only one aspect of the disease. Despite this prolific research, no single explanation for the pathogenesis of this complex disease has emerged. Trypanosomes, with their antigenic variation, have topographical preferences within the host and within particular organs. The lymphatic system is an important site for multiplication and provides a way of escaping host defences and trypanocides. The host defence—only partially specific and often out of phase—results in a vasculitis which is most likely immune-complex-mediated. The inflammatory cell response is complex and results in immune suppression. Metabolic alterations at the interstitial level and changes within the circulating blood constituents further contribute to tissue damage. The role of autoimmunity is not clearly assessed. Interstitial trypanosomes render chemotheraphy difficult. Side-effects of melarsoprol are most likely immunologic and toxic in origin. Because of relapses in long-term follow-ups in experimental infections, the author cautions against premature declaration of cure in the absence of trypanosome detection in the brain, which was shown to be the source of persisting trypanosomes.

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