Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1456 Trypanosomiasis, African

specific therapy

Indications

■All patients with both forms.

Treatment Options

■T.b. rhodiensewithout CNS involvement: Suramin (obtainable from

CDC)

■T.b. gambiensewithout CNS involvement: pentamidine IV or IM

■T.b. rhodiensewith CNS involvement (trypanosomes in CSF): melar-

soprol, given in graduated dosage

■T.b. gambiensewith CNS involvement: melarsoprol; Eflornithine is

more effective, but not available in US.

Side Effects & Complications

■Suramin: fever, malaise, proteinuria, urticaria, paresthesias.

■Melarsoprol: reactive encephalopathy (considered autoimmune) in

4–8%, sometimes fatal, treated with steroids. Also peripheral neu-

ropathy – can be severe

■Pentamidine: hypotension, hypoglycemia, renal failure, hypocal-

cemia, hyperkalemia, neutropenia.

■Contraindications to treatment: absolute: none, except allergy to

intended agent.

■Contraindications to treatment: relative: same.

follow-up

During Treatment

■In both forms, drugs are toxic, and close clinical follow needed, usu-

ally in a hospital. CSF examination to assess presence of parasites.

Routine

■Good nutrition, general care, treatment of coexisting illness.

complications and prognosis

■T.b. rhodiensis: in early stage, before CNS invasion and treated

promptly, prognosis is good. If CNS invasion has occurred, prog-

nosis is more guarded and melarsoprol can be very toxic and result

in encephalopathy or death.

■T.b. gambiense: early stage: some hazard with pentamidine, other-

wise good prognosis. In late stage, there is not complete reversal of

brain damage, and without eflornithine treatment melarsoprol must

be used which is very toxic (see T.b. rhodesiense).