Trypanosoma brucei-rhodesiense

Introduction

Etiologic agent of east African trypanosomiasis.

Epidemiology

• East Africa
• transmitted by the bite of the tsetse fly (genus Glossina)

Clinical manifestations

• rapidly progressive acute febrile illness with lymphadenopathy
• fevers, headache myalgias, night sweats
• hypotension, sepsis-like presentation
• patients die before central nervous system involvement is prominent

Management

• suramin (stage I, normal CSF)
  • 100-200 mg IV test dose to detect hypersensitivity
  • adults: 1 g IV on days 1,3,7,14 & 21
  • children: 20 mg/kg/day (max 1 g) IV on days 1,3,7,14 & 21
  • slow IV infusion of freshly prepared 10% aqueous solution
• melarsoprol (stage II, abnormal CSF)
  • stage II or stage I who fail suramin &/or pentamidine
  • because of toxicity, never the 1st agent for treatment of stage I
  • three courses of treatment each 3 days in duration
    • 2-3.6 mg/kg/day IV divided TID
    • 3.6 mg/kg/day IV divided TID (1 week later)
    • 3.6 mg/kg/day IV divided TID (10-21 days later)
  • caution, highly toxic
• tryparsamide plus suramin
  • tryparsamide
    • 30 mg/kg/day (max 2 g) IV every 5th day for 12 doses
  • suramin
    • 10 mg/kg/day IV every 5th day for 12 doses
• pentamidine
  • alternative agent for stage I
  • 4 mg/kg/day IV or IM for 10 days
• no vaccine available
• lethal if not treated

More general terms

• Trypanosoma brucei (African trypanosomiasis)

Additional terms

• fly/gnat-borne infection