The classical diagnosis of human African trypanosomiasis (HAT) is a 3-step approach:

  • Identification of suspects

  • Parasitological confirmation

  • Disease staging.

Identification of suspects is based on determining whether they have lived in or visited an endemic area, in combination with clinical signs and symptoms or with serological evidence (presence of trypanosome-specific antibodies in blood).

Parasite detection is considered as the confirmation of infection. It is relatively easy for T b rhodesiense HAT, but often difficult in T b gambiense HAT, where failure to demonstrate the parasite is not uncommon, even if concentration techniques are applied. For that reason, in some epidemiological situations, treatment decision is taken following serological and clinical evidence.[41]

Once parasites have been detected, or in case of a high index of suspicion such as an elevated card agglutination test for trypanosomiasis (CATT) end titre and/or neurological symptoms, a lumbar puncture and cerebrospinal fluid (CSF) examination should be performed for disease staging. The disease stage in combination with the infective agent (T b rhodesiense or gambiense) will determine the therapeutic choice.

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