African Trypanosomiasis

African Trypanosomiasis – Treatment Options

Introduction
African trypanosomiasis, also known as sleeping sickness, is a parasitic disease caused by Trypanosoma brucei gambiense (West and Central Africa) or Trypanosoma brucei rhodesiense (East Africa). It is transmitted by the bite of the tsetse fly. The disease progresses in two stages:

1. Hemolymphatic stage (early): Parasites circulate in blood and lymph, causing fever, headaches, joint pain, pruritus, and lymphadenopathy.

2. Meningoencephalitic stage (late): Parasites invade the central nervous system (CNS), leading to confusion, sensory disturbances, poor coordination, sleep cycle disruption, coma, and death if untreated.

Treatment depends on the infecting subspecies and the stage of the disease.

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1. Early-Stage (Hemolymphatic) Disease

• Trypanosoma brucei gambiense (West/Central Africa):

  • Pentamidine

    • Administered IM or IV.

    • Effective in early-stage disease; not active against CNS infection.

    • Well tolerated, but may cause hypoglycemia, hypotension, or nephrotoxicity.

• Trypanosoma brucei rhodesiense (East Africa):

  • Suramin

    • Given IV after a test dose to avoid hypersensitivity reactions.

    • Effective against early-stage rhodesiense disease.

    • Side effects: renal toxicity, allergic reactions, peripheral neuropathy.

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2. Late-Stage (CNS Involvement)

• Trypanosoma brucei gambiense:

  • Eflornithine (IV infusion, 14 days)

    • Effective against CNS stage.

    • Often combined with nifurtimox (oral) for improved outcomes (NECT regimen: nifurtimox-eflornithine combination therapy).

    • Side effects: bone marrow suppression, seizures, gastrointestinal upset.

  • Melarsoprol (IV):

    • Arsenic derivative, historically main therapy.

    • Now less favored due to high toxicity (encephalopathic reactions, seizures, death).

    • Still used in some regions with limited access to eflornithine.

• Trypanosoma brucei rhodesiense:

  • Melarsoprol remains the only effective treatment for late-stage CNS disease.

  • Given in IV cycles; strict monitoring is required due to risk of fatal encephalopathy.

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3. Supportive and Preventive Care

• Symptomatic management: Fluids, electrolytes, antipyretics, anticonvulsants if seizures occur.

• Monitoring: Cerebrospinal fluid (CSF) exams performed after treatment to confirm parasite clearance and detect relapse.

• Vector control: Tsetse fly eradication programs, insecticide spraying, and traps.

• Screening programs: Essential for early detection in endemic areas, particularly for T.b. gambiense.