These alterations of sleep patterns have been studied for a long time and in recent years the potential value of these manifestations as staging biomarkers has been highlighted [118]. Sleep patterns can in fact be monitored non-invasively using polysomnography. This consists of recording of an electroencephalogram (EEG), an electro-oculogram (EOG) and an electromyogram Selleck Ibrutinib (EMG) followed by an analysis of the recorded data [17]. In particular, it has been shown that late stage patients have a high number of SOREMPs during their sleep, which are not restricted to night time, but occur in the day time too. These disturbances tend to disappear after melarsoprol treatment [17]. Despite

the interesting data from polysomnography, its staging ability has only Entinostat been investigated on a small number of patients or in one-case studies, thus a complete evaluation of the approach has not been possible yet [17], [119] and [120]. Although it requires bulky, high-tech material, long periods of examination (24–48 h) and trained personnel, its major advantage is that it is non-invasive. In this review we have described the most interesting

biomarkers proposed so far for the diagnosis and the staging of HAT, with particular emphasis on their translation into field practice (Fig. 2). The nature of sleeping sickness – a neglected tropical disease – implies that for novel biomarkers to be useful, they should also have the potential to be translated into a cheap (i.e. <$1), easy to use and rapid (i.e. less than 15 min) field test. This step towards a realistic field test represents the bottleneck for the utility of new biomarkers. Furthermore, the ability to use the same biomarker (and thus the

same test) for multiple clinical applications to do with HAT (e.g. staging and follow-up) would mean significant cost savings in terms of production and personnel training. The introduction of the CATT for mass population screening probably represents the greatest success in the battle against sleeping sickness of the last 30 years, together with the introduction of eflornithine Endonuclease and NECT for the treatment of late stage patients. The use of the CATT and the application of a policy of proactive diagnostic testing, has contributed substantially to the reduction in the number of new cases and transmission of the disease. Due to its well-described limitations, the most important being the impossibility of using it for the serological screening of T. b. rhodesiense, a number of alternatives to the CATT have been proposed. However, very promising tests such as the Latex/T.b.g. did not show a real gain in terms of accuracy or applicability in the field compared to the CATT. Currently, the most promising alternative tools are represented by the rapid, new serological diagnostic tests, SD BIOLINE HAT (http://www.finddiagnostics.org/media/press/121206.