Trypanosoma brucei gambiense infection

Bisser S et al Equivalence trial of melarsoprol and nifurtimox monotherapy and combination therapy for the treatment of second-stage Trypanosoma brucei gambiense sleeping sickness. J Infect Dis 2007 195 322. [PMID 17205469]... 

Priotto G et al Nifurtimox-eflornithine combination therapy for second-stage Trypanosoma brucei gambiense sleeping sickness A randomized clinical trial in Congo. Clin Infect Dis 2007 45 1435. [PMID 17990225]... 

In a randomized trial in 500 patients infected with Trypanosoma brucei gambiense treated with 10 daily consecutive doses of melarsoprol 2.2 mg/kg, the adverse effects were encephalopathic syndrome 5.6%, death from encephalopathy 2.4%, polyneuropathy less than 1%, severe bullous dermatitis 1.2%, severe maculopapu-lar rash 3.2%, severe pruritus 3.2% (5). Milder reactions were fever, headache, and diarrhea. 

Suramin is the drug of choice for the early hemolymphatic stage of both Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense infections before nervous system invasion occurs [17 ]. The dose is 15-20 mg/kg/week, given intravenously, up to a maximum single dose of 1 g. Suramin, which is excreted by the kidneys, binds to plasma proteins and can persist in the circulation in low concentrations for as long as 3 months. A single course for an adult is usually 5 g, never to exceed 7 g. The primary adverse reactions are fever, rash, conjunctivitis, renal insufficiency, abdominal pain, paresthesia, and muscle pain. 

Baltz T, Baltz D, Giroud C, Crockett J. Cultivation in a semi-defined medium of animal infective forms of Trypanosoma brucei T. equiperdum, I evansi, T. rhodesiense and T. gambiense. EMBO J 1985 4 1273-1277. 

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