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an african trypanosomiasis
– D iag nostic confirm ation: presence of trypanosom es in lym ph nod e aspirates or in blood
using concentration tech niques: capillary tube centrifug ation tech nique ( W oo test) ,
quantitativ e buffy coat (Q B C ), m ini-anion exch ang e centrifug ation tech nique (m A E C ).
– Stag e d eterm ination: d etection of trypanosom es (after centrifug ation) and w h ite cell
count in th e cerebrospinal fluid (lum bar puncture):
• H aem olym ph atic stag e: no trypanosom es A N D ≤ 5 w h i3te cells/ m m
• M ening oenceph alitic stag e: ev id ence of trypanosom es O R > 5 w h ite3cells/ m m
Treatment (except in pregnant women)
– D ue to th e toxicity of trypanocid es, d etection of th e parasite is essential before
initiating treatm ent. I n th e absence of parasitolog ical confirm ation, treatm ent m ay
nev erth eless be justified in certain cases: v ery strong clinical suspicion, patients in
life- th reatening cond ition, strong serolog ical suspicion ( C A T T 1 :1 6 positiv e) in a
population w h ere th e d isease is h ig h ly prev alent (> 2 % ).
– Sev eral treatm ent reg im ens exist. C h eck national recom m end ations and local
resistance lev els.
– T reatm ent m ust be ad m inistered und er close m ed ical superv ision. P atients receiv ing
pentam id ine can be treated as outpatients but th ose receiv ing suram in, eflornith ine
(w ith or w ith out nifurtim ox) or m elarsoprol sh ould be h ospitalised .
– A fter treatm ent, patients sh ould be ch ecked ev ery 6 m onth s (clinical exam ination,
lum bar
puncture and exam ination for trypanosom es) ov er 2 4 m onth s, to look for relapse.
Haemolymphatic stage (Stage I)
Gambiense HAT
pentamidine isetionate d eep IM
C h ild ren and ad ults: 4 m g / kg once d aily for 7 to 1 0 d ays
P atients sh ould receiv e a source of g lucose (m eal, sw eet tea) one h our before injection
( risk of h ypog lycaem ia) ; th ey sh ould rem ain supine d uring ad m inistration and one
h our after injection (risk of h ypotension).
Rhodesiense HAT
suramin slow I V
C h ild ren and ad ults: D 1 : test d ose of 4 to 5 m g / kg
D 3 , D 1 0 , D 1 7 , D 2 4 , D 3 1 : 2 0 m g / kg w ith out exceed ing 1
g / injection
Suram in m ay cause anaph ylactic reactions, a test d ose is recom m end ed prior to starting
treatm ent. I n th e ev ent of an anaph ylactic reaction after th e test d ose, th e patients m ust
not be g iv en suram in ag ain.
Meningoencephalitic stage (Stage II)
B efore ad m inistrating trypanocid es, th e priority is to im prov e th e patient‟s g eneral
cond ition (reh yd ration, treatm ent of m alaria, intestinal w orm s, m alnutrition, bacterial
infections). I t is noneth eless recom m end ed not to postpone th e trypanocid al treatm ent
for m ore th an 1 0 d ays.
nGifaumrtibmieonxsPe OHAT
F irst ch oice: nifurtim ox-eflornith ine com bination th erapy (N E C T )
+
C h ild ren and ad ults: 1 5 m g / kg / d ay in 3 d iv id ed d oses for 1 0 d ays
eflornithine I V infusion ov er 2 h ours
C h ild ren and ad ults: 4 0 0 m g / kg / d ay in 2 d iv id ed infusions (ev ery 1 2 h ours) for 7 d ays
140
– D iag nostic confirm ation: presence of trypanosom es in lym ph nod e aspirates or in blood
using concentration tech niques: capillary tube centrifug ation tech nique ( W oo test) ,
quantitativ e buffy coat (Q B C ), m ini-anion exch ang e centrifug ation tech nique (m A E C ).
– Stag e d eterm ination: d etection of trypanosom es (after centrifug ation) and w h ite cell
count in th e cerebrospinal fluid (lum bar puncture):
• H aem olym ph atic stag e: no trypanosom es A N D ≤ 5 w h i3te cells/ m m
• M ening oenceph alitic stag e: ev id ence of trypanosom es O R > 5 w h ite3cells/ m m
Treatment (except in pregnant women)
– D ue to th e toxicity of trypanocid es, d etection of th e parasite is essential before
initiating treatm ent. I n th e absence of parasitolog ical confirm ation, treatm ent m ay
nev erth eless be justified in certain cases: v ery strong clinical suspicion, patients in
life- th reatening cond ition, strong serolog ical suspicion ( C A T T 1 :1 6 positiv e) in a
population w h ere th e d isease is h ig h ly prev alent (> 2 % ).
– Sev eral treatm ent reg im ens exist. C h eck national recom m end ations and local
resistance lev els.
– T reatm ent m ust be ad m inistered und er close m ed ical superv ision. P atients receiv ing
pentam id ine can be treated as outpatients but th ose receiv ing suram in, eflornith ine
(w ith or w ith out nifurtim ox) or m elarsoprol sh ould be h ospitalised .
– A fter treatm ent, patients sh ould be ch ecked ev ery 6 m onth s (clinical exam ination,
lum bar
puncture and exam ination for trypanosom es) ov er 2 4 m onth s, to look for relapse.
Haemolymphatic stage (Stage I)
Gambiense HAT
pentamidine isetionate d eep IM
C h ild ren and ad ults: 4 m g / kg once d aily for 7 to 1 0 d ays
P atients sh ould receiv e a source of g lucose (m eal, sw eet tea) one h our before injection
( risk of h ypog lycaem ia) ; th ey sh ould rem ain supine d uring ad m inistration and one
h our after injection (risk of h ypotension).
Rhodesiense HAT
suramin slow I V
C h ild ren and ad ults: D 1 : test d ose of 4 to 5 m g / kg
D 3 , D 1 0 , D 1 7 , D 2 4 , D 3 1 : 2 0 m g / kg w ith out exceed ing 1
g / injection
Suram in m ay cause anaph ylactic reactions, a test d ose is recom m end ed prior to starting
treatm ent. I n th e ev ent of an anaph ylactic reaction after th e test d ose, th e patients m ust
not be g iv en suram in ag ain.
Meningoencephalitic stage (Stage II)
B efore ad m inistrating trypanocid es, th e priority is to im prov e th e patient‟s g eneral
cond ition (reh yd ration, treatm ent of m alaria, intestinal w orm s, m alnutrition, bacterial
infections). I t is noneth eless recom m end ed not to postpone th e trypanocid al treatm ent
for m ore th an 1 0 d ays.
nGifaumrtibmieonxsPe OHAT
F irst ch oice: nifurtim ox-eflornith ine com bination th erapy (N E C T )
+
C h ild ren and ad ults: 1 5 m g / kg / d ay in 3 d iv id ed d oses for 1 0 d ays
eflornithine I V infusion ov er 2 h ours
C h ild ren and ad ults: 4 0 0 m g / kg / d ay in 2 d iv id ed infusions (ev ery 1 2 h ours) for 7 d ays
140
