Neopterin and CXCL-13 in Diagnosis and Follow-Up of Trypanosoma brucei gambiense Sleeping Sickness: Lessons from the Field in Angola

Biomed Res Int. 2019 Nov 23;2019:6070176. doi: 10.1155/2019/6070176. eCollection 2019.


Human African Trypanosomiasis may become manageable in the next decade with fexinidazole. However, currently stage diagnosis remains difficult to implement in the field and requires a lumbar puncture. Our study of an Angolan cohort of T. b. gambiense-infected patients used other staging criteria than those recommended by the WHO. We compared WHO criteria (cell count and parasite identification in the CSF) with two biomarkers (neopterin and CXCL-13) which have proven potential to diagnose disease stage or relapse. Biological, clinical, and neurological data were analysed from a cohort of 83 patients. A neopterin concentration below 15.5 nmol/L in the CSF denoted patients with stage 1 disease, and a concentration above 60.31 nmol/L characterized patients with advanced stage 2 (trypanosomes in CSF and/or cytorachia higher than 20 cells) disease. CXCL-13 levels below 91.208 pg/mL denoted patients with stage 1 disease, and levels of CXCL-13 above 395.45 pg/mL denoted patients with advanced stage 2 disease. Values between these cut-offs may represent patients with intermediate stage disease. Our work supports the existence of an intermediate stage in HAT, and CXCL-13 and neopterin levels may help to characterize it.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Angola
  • Biomarkers / cerebrospinal fluid
  • Chemokine CXCL13 / cerebrospinal fluid*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neopterin / cerebrospinal fluid*
  • ROC Curve
  • Trypanosomiasis, African* / cerebrospinal fluid
  • Trypanosomiasis, African* / classification
  • Trypanosomiasis, African* / diagnosis
  • Young Adult


  • Biomarkers
  • CXCL13 protein, human
  • Chemokine CXCL13
  • Neopterin