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6. Parasitic diseases
T h e cath eter m ust be h and led w ith g reat attention to av oid local or g eneral bacterial
infections: th oroug h ly d isinfect th e insertion site, ensure secure cath eter fixation,
protect th e insertion site w ith a sterile d ressing , system atically ch ang e th e cath eter
ev ery 4 8 h ours or earlier in case of sig ns of ph lebitis.
Second ch oice: eflornithine I V infusion ov er 2 h ours
C h ild ren und er 1 2 years: 6 0 0 m g / kg / d ay in 4 d iv id ed infusions ( ev ery 6 h ours) for
1 4 d ays
A d ults: 4 0 0 m g / kg / d ay in 4 d iv id ed infusions (ev ery 6 h ours) for 1 4 d ays
In th e ev ent of a relapse after N E C T or eflornith ine:
melarsoprol slow I V
C h ild ren and ad ults: 2 .2 m g / kg once d aily for 1 0 d ays
Prednisolone P O (1 m g / kg once d aily) is frequently com bined th roug h out th e d uration
of treatm ent.
M elarsoprol is h ig h ly toxic: reactiv e enceph alopath y (com a, or recurrent or prolong ed
seizures) in 5 to 1 0 % of treated patients, fatal in around 5 0 % of cases; periph eral
neuropath y, inv asiv e d iarrh oea, sev ere skin rash , ph lebitis, etc.
Rhodesiense HAT
melarsoprol slow I V
C h ild ren and ad ults: 2 .2 m g / kg once d aily for 1 0 d ays
Prednisolone P O (1 m g / kg once d aily) is frequently com bined th roug h out th e d uration
of treatm ent.
6
Treatment in pregnant women
A ll trypanocid es are potentially toxic for th e m oth er and th e foetus (risk of m iscarriag e,
m alform ation, etc.). H ow ev er, d ue to th e life-th reatening risk for th e m oth er and th e
risk of m oth er-to-ch ild transm ission, treatm ent m ust be initiated as follow s:
H aem olym ph atic stag e:
pentamidine for g am biense H A T as of th e second trim ester and suramin for rh od esiense
H A T.
M ening oenceph alitic stag e:
T reatm ent d epend s on th e m oth er's cond ition: NECT or eflornithine
– I f in im m ed iately life- th reatening cond ition: treatm ent w ith
cannot be d eferred until after d eliv ery.
– I f not im m ed iately life-th reatening cond ition: pentamidine for g am biense H A T and
suramin for rh od esiense H A T . T reatm ent w ith N E C T or eflornith ine is to be
ad m inistered after d eliv ery.
Prevention and control
– I nd iv id ual protection ag ainst tsetse fly bites: long sleev es and trousers, repellents,
keeping aw ay from risk areas (e.g . near riv ers). T.b. gambiense) ,
– D isease control: m ass screening and treatm ent of patients (
trypanocid e treatm ent of cattle (T.b. rhodesiense), v ector control using tsetse fly traps
or insecticid es.
141
T h e cath eter m ust be h and led w ith g reat attention to av oid local or g eneral bacterial
infections: th oroug h ly d isinfect th e insertion site, ensure secure cath eter fixation,
protect th e insertion site w ith a sterile d ressing , system atically ch ang e th e cath eter
ev ery 4 8 h ours or earlier in case of sig ns of ph lebitis.
Second ch oice: eflornithine I V infusion ov er 2 h ours
C h ild ren und er 1 2 years: 6 0 0 m g / kg / d ay in 4 d iv id ed infusions ( ev ery 6 h ours) for
1 4 d ays
A d ults: 4 0 0 m g / kg / d ay in 4 d iv id ed infusions (ev ery 6 h ours) for 1 4 d ays
In th e ev ent of a relapse after N E C T or eflornith ine:
melarsoprol slow I V
C h ild ren and ad ults: 2 .2 m g / kg once d aily for 1 0 d ays
Prednisolone P O (1 m g / kg once d aily) is frequently com bined th roug h out th e d uration
of treatm ent.
M elarsoprol is h ig h ly toxic: reactiv e enceph alopath y (com a, or recurrent or prolong ed
seizures) in 5 to 1 0 % of treated patients, fatal in around 5 0 % of cases; periph eral
neuropath y, inv asiv e d iarrh oea, sev ere skin rash , ph lebitis, etc.
Rhodesiense HAT
melarsoprol slow I V
C h ild ren and ad ults: 2 .2 m g / kg once d aily for 1 0 d ays
Prednisolone P O (1 m g / kg once d aily) is frequently com bined th roug h out th e d uration
of treatm ent.
6
Treatment in pregnant women
A ll trypanocid es are potentially toxic for th e m oth er and th e foetus (risk of m iscarriag e,
m alform ation, etc.). H ow ev er, d ue to th e life-th reatening risk for th e m oth er and th e
risk of m oth er-to-ch ild transm ission, treatm ent m ust be initiated as follow s:
H aem olym ph atic stag e:
pentamidine for g am biense H A T as of th e second trim ester and suramin for rh od esiense
H A T.
M ening oenceph alitic stag e:
T reatm ent d epend s on th e m oth er's cond ition: NECT or eflornithine
– I f in im m ed iately life- th reatening cond ition: treatm ent w ith
cannot be d eferred until after d eliv ery.
– I f not im m ed iately life-th reatening cond ition: pentamidine for g am biense H A T and
suramin for rh od esiense H A T . T reatm ent w ith N E C T or eflornith ine is to be
ad m inistered after d eliv ery.
Prevention and control
– I nd iv id ual protection ag ainst tsetse fly bites: long sleev es and trousers, repellents,
keeping aw ay from risk areas (e.g . near riv ers). T.b. gambiense) ,
– D isease control: m ass screening and treatm ent of patients (
trypanocid e treatm ent of cattle (T.b. rhodesiense), v ector control using tsetse fly traps
or insecticid es.
141
